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The push for sustainability has reached all areas of business and community pharmacies are no exception

Tackling climate change is a major issue for us all, and over the years community pharmacists have shown they are more than ready to review the impact of their own services on the environment.

But with medicines accounting for a quarter of the NHS’s carbon footprint, it’s clear that the actions of individual pharmacies can only go so far. Change is needed throughout the supply chain, so what can pharmacies and wholesalers do to make a difference?

Reports from 2024 revealed that medicines are polluting our environment in more ways than simply greenhouse gases from discarded inhalers. Pharmaceuticals are polluting our rivers and national parks, too. Rob Collins, director of policy and science at the Rivers Trust, suggests that change starts with the public, who can play their part in reducing pollution by returning old or expired medication rather than flushing it. “Few people are aware of medicine take back schemes whereby any unopened, unused and out-of-date medicines, can be taken to the local pharmacy, rather than flushed down the toilet and into the sewer system,” he says.

Highlighting a small action like this is just one small action that pharmacies can take to remind customers that they can make a difference, and small steps like this are often all it takes to nudge people out of complacency. A simple, inexpensive reminder can be incredibly effective, as proven by a recent pilot scheme which asked pharmacy users to return their expired and used inhalers for disposal at a pharmacy. 

Five Edinburgh pharmacies took part in the pilot scheme in the first half of 2024 that resulted in a 300 per cent increase in the number of inhalers disposed of at local pharmacies. Pharmacy staff added eye-catching reminder stickers to dispensing bags when the inhalers were handed out, asking customers to return them to the pharmacy when they were empty, or if they had expired. This resulted in 80 inhalers being returned over the course of the scheme. 

The project was funded by NHS Lothian Charity as part of its climate challenge grant initiative, and Katie Johnston, NHS Lothian’s respiratory care lead pharmacist, said that many people who use inhalers don’t consider their environmental impact, and schemes like this prove that community pharmacies can play an essential part in helping to reduce the environmental impact of medicines.

Minna Eii, advanced pharmacist practitioner at South Tyneside and Sunderland NHS Foundation Trust, recommends that pharmacy teams use the Royal Pharmaceutical Society (RPS) Greener Pharmacy Toolkit, which is aimed at community pharmacies, and which will be launched early in 2025. 

“It has three levels of action for pharmacies to work towards; bronze, silver and gold accreditation through self-assessment,” she explains. The toolkit includes carbon calculators for measuring and lowering footprints, focusing on medicines supply, use, and disposal. 

“This initiative will support teams in aligning with NHS net zero goals, tackling overprescribing and antimicrobial resistance while reducing health inequalities and air pollution.” suggests Elen Jones, RPS director for Wales and director lead for sustainability at RPS. Jones also encourages  pharmacists to sign up to the RPS Climate Change Charter, saying: “It’s a great first start. The charter involves five core commitments that help individuals and teams start to make their practice more sustainable, and the suggested actions can be tailored to their own timescales, circumstances and ambitions.”

Sustainability toolkit

The toolkit is designed to help all pharmacy staff –not just pharmacists – to: 

• Raise awareness and enhance understanding of the environmental impacts of healthcare, medicines and pharmacy practice
• Reduce the environmental impacts of healthcare, medicines (via waste reduction) and pharmacy practice to meet the NHS’s commitment to net zero
• Explain the co-benefits of taking sustainable actions in pharmacy, including improving patient care, increasing efficiency, and unlocking cost savings
• Certify the sustainability credentials of pharmacy settings to demonstrate their efforts in reducing environmental impact
• Benchmark the current carbon hotspots of the pharmacy setting and estimate the potential carbon savings based on the outcomes of the implemented actions.

“The project has been commissioned by NHS England and we have major stakeholders’ involvement in building this guide including Community Pharmacy England, big pharmacy chains such as Superdrug and integrated care boards’ sustainability leads working towards greener NHS metrics,” explains Eii.

“We anticipate a mass uptake of this from community pharmacy as a team building exercise and who will find out how, through this toolkit, what they currently do already aligns with the sustainability agenda.”

Eii also points out that the Sustainability in Pharmacy Education (SPE) group as part of Pharmacy Declares is currently working on a pharmacy curriculum to embed sustainability in undergraduate, postgraduate pharmacist and pharmacy technician education, and they plan to have the curriculum endorsed by Pharmacy Schools Council UK.

Jones suggests that there are many ways that pharmacies can work to reduce their environmental impact – and that they don’t have to be onerous. “Pharmacies can reduce their impact through a variety of means. Things like promoting safe medicine disposal, reducing waste through accurate repeat prescriptions, and supporting patients in the effective use of their prescribed inhalers all make a difference,” she maintains.

While it is possible to make meaningful changes at pharmacy level, it is also clear that there are broader changes needed across the medicines supply chain. “NHS pharmaceutical procurement contributes to around 20 per cent of its carbon footprint,” says Jones.

“To reduce emissions, we can focus on efficient medicines use, low carbon alternatives such as inhaler choice, and work with suppliers committed to environmental responsibility. Pharmacies can also prioritise sustainability when selecting suppliers and products.

“In the coming years, a circular economy approach to medicines could further improve sustainability.

"This would involve repurposing components instead of discarding them, especially for products like inhalers and anaesthetics. For inhalers, this could mean recycling gases, metals and plastics.”

Pharmacy teams are already contributing to the NHS’s sustainability goals through initiatives like inhaler recycling schemes, reducing paper use and promoting greener healthcare choices to patients, but clearly there’s still more to be done across the board.

“Sustainability in pharmacy also means addressing health inequalities and reducing overprescribing,” Jones comments. “By embedding greener practices, pharmacies can improve patient care and benefit the planet.

“While the public recognises the climate challenge, the link between climate change and healthcare isn’t widely understood. We’d encourage pharmacy teams to explain this link to patients and include them in sustainable treatment choices as this will lead to better, more sustainable care and empower patients to be a part of their own healthcare.”

A more sustainable supply chain

Alliance Healthcare, one of the largest pharmaceutical wholesalers in Europe, is taking sustainability seriously with an approach that spans multiple areas of operations, from fleet management to energy efficiency. 

“We’re continually exploring options to create a more efficient and sustainable supply chain,” says James Epps, environmental, social and governance (ESG) manager at Alliance Healthcare UK,” and we know that our responsibility extends beyond delivering healthcare products to pharmacies and hospitals.

"It’s about ensuring a healthier future for our communities and our planet. Our commitment to sustainability is central to everything we do, from reducing our carbon footprint to promoting operational efficiency.”

In 2023 Alliance Healthcare introduced an electric support vehicle to prepare for the EV transition, and there are plans to roll out electric delivery vans starting this year. This is part of a larger commitment from the wholesaler to decarbonise its fleet where possible, while also exploring alternative fuels and hydrogen technologies.

“To support this commitment, we’ve established a minimum mileage threshold for company car users. Currently, 44% of our company cars are fully electric, while 92% are either electric or hybrid.”

Alongside this, Alliance says that it’s also rethinking ways of optimising routes, reducing idle times, and engaging with its logistics partners to maximise efficiency. There are also plans to upgrade more facilities with LED lighting and introduce renewable technologies.

“By 2023, we had fitted LED lighting in four service centres, adding an additional site in 2024,” says Epps. “All our service centres and offices are powered by renewable electricity, and we’re investing in onsite solar panels, including at our Preston service centre.

"Achieving a recycling rate of up to 60 per cent is just the beginning. We’re also working to reduce single-use plastics and support manufacturer recycling initiatives to divert waste from landfills.”

The wholesaler has shown strong support for the NHS’s sustainability goals and environmental stewardship through its participation in the Re-Hale inhaler recycling scheme. By leveraging its existing logistics network, it enabled pharmacies to collect unwanted and used inhalers that would otherwise end up in landfill. 

“By incorporating these collections into our regular delivery routes, we have minimised additional CO2 emissions, aligning with both NHS and our environmental, social, and governance (ESG) values. This approach ensures the recycling scheme operates efficiently without increasing the carbon footprint,” Epps explains.

“Sustainability is a team effort. In 2024 we launched our Decarbonisation Steering Group, bringing together leaders from across our UK business to shape our environmental strategy.”

For Alliance Healthcare, sustainability is about more than environmental impact. “It’s about operational efficiency, regulatory compliance, and fulfilling our responsibility to the communities we serve.”