When we talk about sustainability we tend to think first about recycling, but some pharmacists believe that pharmacies should be focusing more of their efforts on clinical services if they want to save the planet. 

Since NHS England and NHS Improvement (NHSE&I) published an ambitious new strategy in 2020 – in which it pledged to become the world’s first health service to agree on net-zero emissions – several green initiatives have been piloted in pharmacies.  

Pharmacy has seen a range of initiatives centred around recycling. Recycling has well-documented benefits for the planet and has been shown to reduce carbon emissions. But can this alone achieve enough?  

Tracy Lyons, medicines optimisation pharmacist and pharmacy sustainability lead at Poole Hospital, is the founder of Pharmacy Declares, a group of climate-conscious pharmacy professionals. She explains that recycling facilities differ ‘hugely’ across the country making it hard for companies to launch national schemes.  

When it comes to recycling in pharmacies it gets more complex due to the added difficulty of removing medical waste from the packaging, she tells The Pharmacist.  

Green clinical services  

‘Sustainability goes far beyond recycling’ she argues. ‘Pharmacists can help stop the need for recycling down the road by helping patients better understand the medicines they are on and the impact they have on the environment’.  

Recently, researchers found traces of commonly used drugs, such as antibiotics, in rivers globally. 

In response, leading pharmacy figures called on pharmacy teams to further educate their patients on pharmaceutical pollution and encourage them to always return unused medicines to pharmacies so they can be disposed of correctly.  

Optimising medicine usage is in itself a ‘green activity,’ Ms Lyons says. She uses the example of counselling patients on appropriate inhaler disposal and use which will lower the need for further asthma inhalers. 

‘If we can focus on preventing the waste in the first place it negates the need for the recycling process down the road’, she says.  

Minna Eii, vice-chair of sustainability at the Guild of Healthcare Pharmacists and co-founder of Pharmacy Declares, adds that community pharmacies are ‘so well placed’ to offer services that stop patients from needing to access further healthcare services, which in turn helps the environment.  

‘Instead of visiting the doctor far away, a patient can visit their local pharmacy and get seen by a pharmacist through the community pharmacy consultation service. That reduces their carbon footprint from travelling.'  

She also refers to the Discharge Medicines Service as another green service. 

‘If we can reduce polypharmacy that will also help the environment in a big way,' she says.  

This month, a study found that switching an asthma patient from a metered-dose inhaler to a dry powder inhaler significantly reduces their carbon footprint without loss of asthma control. 

‘A lot of things we do in community pharmacy we don’t realise are green activities, such as blood pressure monitoring and the weight management scheme.  

‘Rather than keeping someone on blood pressure tablets long term, why don’t we tackle their weight issues and promote a healthy lifestyle? This will reduce the number of medicines we are giving out to patients and reduce their chances of longer-term health issues which again would require more medication,’ she suggests. 

Last month, NHSE recruited community pharmacy teams to refer adults living with obesity, and other conditions, to the twelve-week online NHS weight management programme. 

She adds: ‘The most sustainable thing we can do in community pharmacy is to provide services that prevent the need for further healthcare.’  

Should we forget about recycling for now? 

The pharmacists agreed that recycling and waste management are only small parts of being sustainable. However, both said it is still a great way for people to get involved in sustainability and to help pharmacies ‘get into a greener mindset’.  

‘Recycling is the thin end of the green wedge and is something everyone can get into, and everyone can understand. It’s popular, and demand for recycling is high,’ she says.  

In July, independent community pharmacies were removed from a free blister pack recycling programme after participating pharmacies became overwhelmed with the number of packs needing to be recycled. 

The scheme, run by TerraCycle – which specialises in recycling hard-to-recycle materials – was launched initially in September 2020 to enable households to recycle their used medicine blister packs from any manufacturer through a network of independent pharmacies. 

A spokesperson for TerraCycle told The Pharmacist, there was an ‘encouragingly high uptake’ for the scheme. However, the resources set up at the beginning of the project were unable to accommodate the large quantities of recycling being received. 

Ms Lyons believes – perhaps controversially – that we should ‘forget’ about recycling ‘for now’ and instead focus on steps earlier on in the process to reduce the need for products and medicines in the first place.  

‘Even if you manage to run a recycling scheme that can cope with large volumes of waste you are still going to be producing large amounts of waste and as we know, materials like plastic can only be recycled a certain number of times.’ Ms Lyons says.  

‘I think you can have a far greater green impact by just stopping the need for recycling in the first place’, she reiterates. 

Put your patients first 

Ajay Rehan, pharmacy director at K-Chem pharmacy in Northumberland, who has himself introduced some greener practices, says he agrees that a larger emphasis should be placed on clinical services instead of recycling to reduce pharmacies carbon footprint.  

‘Deprescribing services will definitely hurt contractors' pockets, but you have to think about the health of the patient and environment. The overall benefit seems to outweigh the financial impact in my opinion’. 

‘It’s not about being greedy; it is not about taking what you can, it is about the holistic approach and getting the balance right. Patient care is paramount but at the same time we can also take care of the environment while also being successful in our right in a clinical and business sense’. 

Mr Rehan told The Pharmacist he had bought an electric van which he uses to deliver all his medicines, which he says has reduced their fuel costs by over two-thirds.  

He has also created his own recycling schemes within his pharmacy. ‘We get a monumental amount of cardboard coming through the pharmacy. So, we always let customers who are moving house to come in and reuse some of our delivery boxes’. 

Similarly, Mr Rehan said he was allowing patients to reuse the bubble wrap he receives products in.  

‘We have a post office within the pharmacy, so instead of patients buying bubble wrap to fill their packages we encourage them to use ours’, he explains. 

‘I don’t think pharmacies need to do anything revolutionary to help the environment’, he says. ‘Just be conscious of what you are throwing away, what you could do with it instead, and put your patients first.’