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Avoid waste, save money — recycling matters in hospital pharmacy practice

In this article, logistics experts Liz Breen and Ying Xie explain how effective recycling of pharmaceutical products could save money for hospital trusts and for the NHS as a whole

By Liz Breen and Ying Xie

In this article, logistics experts Liz Breen and Ying Xie explain how effective recycling of pharmaceutical products could save money for hospital trusts and for the NHS as a whole

The logistics of managing returned unused, unsold or damaged goods back into the supply chain and the associated activities of handling, consolidation and disposal of such products is becoming of increasing interest in reducing costs and maximising efficiencies.1 Within hospital pharmacy as part of the larger NHS, there is a strong emphasis on contributing to efficiency targets through reductions in waste and drug spending, as well as better practices.2

NHS Supply Chain asserts that it is committed to a sustainable future by meeting the objectives of improving energy efficiencies, reducing emissions and pollutions, increasing recycling and reducing use of natural resources. The operations strategy within NHS Supply Chain is the specific decisions and actions that play a key role in achieving these objectives.

We examined reverse logistics practice within the NHS pharmaceuticals supply chain and, more specifically, hospital pharmacy, and the operations strategy which drives such practices. To do this we approached a regional hospital pharmacy operational group in the north-west of England and it agreed to be involved in an online survey. The group consisted of 32 members and 46 per cent responded to our survey.

Why do we recycle?

Recycling as an activity is part of the wider remit of reverse logistics within the pharmaceuticals supply chain. According to supply chain management theory and practice, reverse logistics is defined as “the process of planning, implementing and controlling the efficient, cost-effective flow of raw materials, in process inventory, finished goods and related information from the point of consumption to the point of origin for the purpose of recapturing or creating value or for proper disposal”.3 The main activities in a reverse logistics system are reducing the use of resources, reusing materials, recycling products, refurbishing, repair, remanufacturing and disposing of waste.4

The three main drivers that motivate companies to adopt reverse logistics are identified as economic, corporate citizenship and legislation.5 Economic drivers indicate that reverse logistics activities such as reducing waste, reusing materials, remanufacturing, recycling and product refurbishing have the potential to minimise economic cost and improve profitability. Corporate citizenship could also be interpreted as corporate social responsibility, and it defines a business’s engagement in issues from an ethical perspective that tries to bring greater good to society.

From a supply chain management perspective, it means that companies that seek sustainable development, efficiently and effectively handle reverse logistics of materials from an environmental and social point of view. Legislation refers to the laws and policies imposed by any jurisdiction which dictate the legal obligations of a company to take back returned products. Environmental management must be built into all the operational functions, including product design, waste minimisation programmes, pollution prevention strategy, waste audit process, green technologies and recycling systems. 

Current recycling strategy

In order to gain a better insight into the strategy supporting the practice of pharmaceutical recycling and the overarching reverse logistics system, participants were asked why they recycled pharmaceutical stock and from a predefined list asked to choose their top five reasons for doing so (Table 1). All the listed criteria were ranked using a Likert scale of 1 (most popular) to 5 (least popular). The reason that most underpinned recycling activity was “it’s the right thing to do”. All eight responses for this reason ranked it either first or second priority. Not all respondents chose five reasons in their responses so the findings may not in this case present the full picture as represented by the respondent sample. All, however, did provided at least three reasons.

Participants were also asked to share their views as to why pharmaceutical recycling is needed within their organisation and the NHS. The reduction of waste and saving money were common responses from this open-ended question. One respondent stated that it is too expensive to throw away all returns so therefore the recycling activity, we can presume, is warranted. A different view was provided by two other respondents, who focused on the waste incurred in not getting processes and systems underpinning stock movement and management correct in the first instance.

Current recycling practice and resources

The initial question to all participants was to determine the presence of a pharmaceutical recycling system in their organisation. All the responses indicated that one was in place with most stating that it had been running for five years or more. Only one respondent had a less mature system, which had been operational for one to three years. One respondent did, however, add that due to the implementation of best practice waste levels were low. One assumes from this statement that there may have been less necessity for recycling activity in this location. 

When defining “pharmaceutical recycling” and offered a range of pre-determined definitions, 60 per cent of participants stated that it was the practice of returning pharmaceutical stock from wards and other locations for reuse. Other respondents focused on the return of stock for reuse and final disposal so combining a number of reverse logistic elements. One respondent specifically commented on the return of packaging for recycling as opposed to the pharmaceutical product.

From the findings it was evident that there was a disparity between how resources were used to support the recycling of pharmaceutical products. Thirteen of the respondents had a range of different grades of staff involved in this system, with only two respondents having one individual grade involved (Table 2).

Participants were also asked how many staff were involved in this activity as opposed to the grade of staff involved. Most respondents (60 per cent) had five or more staff involved in this, 26 per cent used two to five staff, and two respondents stated that their systems had an allocation of one to two staff members.

All but one respondent stated that a training package was in place to support recycling. Out of the 93 per cent who respondent positively, the training package consisted of a mixture of instruction using: standard operating procedure and policy (39 per cent); on the job training with a mentor or more experienced member of staff (15 per cent); or a combination of both of these, supported by workshops (46 per cent).

External influences

Participants were asked how much of the pharmaceutical recycling activity is developed and steered by internal staff as opposed to company or NHS/external organisation guidance. Sixty-seven per cent of participants said that all activity was led by internal staff and 17 per cent said that it was closer to 50 per cent of activity. There was one outlier in this question, who stated that operational practice complied with national guidance as opposed to company or NHS guidance.

All participants were asked to identify one directive, policy or piece of legislation which steered or governed pharmaceutical recycling.  The responses provided ranged from “none” or “not sure if one exists” to regulations from the Department of the Environment, Food and Rural Affairs and internal procedures or requests from chief pharmacists. Participants followed this, with 60 per cent stating that assistance and guidance from external parties would not allow them to perform pharmaceutical recycling more effectively.

The 40 per cent who did believe that it offered some positive influence thought that that supportive guidance would come from the following associations (in order of popularity of response): (i) regional groups and regional pharmacy specialists, (ii) the Department of Health and the Commercial Medicines Unit, (iii) pharmaceutical manufacturers, (iv) the Medicines and Healthcare products Regulatory Agency, and (v) national groups and pharmaceutical wholesalers.

Discussion and conclusions

The findings and discussion indicate that there is some commonality in the strategy employed in conducting pharmaceutical recycling in that NHS pharmacies believe that it is the right thing to do and that, as well as generally reducing waste, it can lead to savings for both trusts and the NHS. These are all signs of an operations strategy which has an environmental awareness and incorporates good practice.

Survey respondents overwhelmingly stated that pharmaceutical recycling “is the right thing to do”. One could argue that in “doing the right thing” and recycling a product, savings would be made anyway and the product would not be wasted or cause harm to the environment.

The impetus and support for recycling activity seemed more in-house and home grown with no influence from external parties such as directives from the Department of Health. Only 40 per cent of the group surveyed thought that external parties could have an influence on their recycling activity, the most prevalent source of support being regional pharmacy groups and regional pharmacy specialists. Once again the emphasis on support seems to be more of a local nature than from national or government bodies. This is surprising because one would assume that best practice would be realised and disseminated from bodies such as the DoH and the Commercial Medicines Unit.

The NHS is publicly accountable for all funds spent so best practice in procurement, materials management and disposal is critical to success. The means by which the NHS ensures that it does this varies but relies on management and staff devising an operations strategy that encompasses sustainable thinking regarding the product, the service and the operation. The NHS is in an era where the term “efficiency”, the QIPP agenda, etc, are constant reminders of the pressure to perform in a manner that is appropriate and somewhat frugal but also where action is always meaningful and has a purpose.

Funds are needed to finance the NHS and funds in the pharmaceuticals supply chain can be reabsorbed into the system by best practice such as the effective recycling of stock, identification of issues relating to stock management and acknowledgement of the cost of wasted stock and disposal. The latter entity is not always known but should be one of the drivers of pharmaceutical recycling and should influence operations strategy, practice and resource allocation for reverse logistics system development.

Acknowledgements This study could not have taken place without the support of the members of the North West Region Pharmacy Operational Group. Many thanks for their participation in this research.


1 Cherrett T, Maynard S, Mcleod F, Hickford A. In: McKinnon A, Cullinane S, Browne M, Whiteing A. Green logistics: improving the environmental sustainability of logistics. London: Kogan Page; 2010.
2 FoI (Freedom of Information) request finds GPs facing new restrictions on prescribing high-cost drugs. Available at: (accessed 7 July 2011)
3 Rogers DS, Tibben-Lembke RS. Going backwards: reverse logistics trends and practices., Pittsburgh: Reverse Logistics Executive Council Press;1992.
4 van Hoek RI. From reversed logistics to green supply chains. Supply Chain Management, An International Journal 1999;4:129–35.
5 de Brito MP, Dekker R, Flapper SDP. Reverse logistics: a review of case studies. In: Fleischmann M, Flapper SD (editors). Reverse logistics, quantitative models for closed-loop supply chains. Berlin: Springer; 2004.

Liz Breen is senior lecturer in operations management at the University of Bradford School of Management. Ying Xie is principal lecturer at the University of Greenwich. Correspondence to


Owing to an error during the editing process, Table 2 misrepresents the actual situation.

Not all bands are pharmacist grades. Bands 1 to 3 are assistant technical officers. Bands 4 and upwards are student technicians or technicians. Band 5 includes preregistration trainees. Pharmacists usually begin their careers at grade 6.



Citation: The Pharmaceutical JournalURI: 11096772

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