Medicines – Green Plan

Medicines contribute around 25% of the NHS’s carbon footprint, driven by manufacturing, supply chains, anaesthetic gases, inhalers, and waste.

Sustainable medicines management is essential to achieving net zero and requires:

  • optimising prescribing
  • reducing overuse
  • switching to lower-carbon alternatives
  • improving storage and disposal

By embedding patient-centred, evidence-based prescribing into clinical pathways, and tackling high-impact areas such as anaesthetic gases and metered dose inhalers, we can reduce emissions while improving outcomes and reducing harm.

Our medicines objective is to:

Reduce the environmental impact of medicines by embedding sustainability into prescribing practice, optimising use, minimising waste, and promoting low-carbon alternatives to deliver safer, lower carbon, and more effective patient care.

Where we are

  • Removed desflurane and replaced with this sevoflurane from use ahead of the NHS target removal date
  • Strategies in place for removing piped nitrous; funding has been obtained to remove the remaining nitrous manifolds across the Trust
  • Adopted e-prescribing
  • Included design specifications for mobile Entonox destruction as part of development plans for our new Endoscopy department at BRI

Where we want to be

  • Review Entonox and anaesthetic gas usage and implement targeted strategies to reduce nitrous oxide (N2O), with defined goals and timelines for elimination
  • Whilst key milestones have been achieved with respect to N2O removal, the gas remains a constituent component within the use of Entonox, which typically consists of a 50/50 mix of N2O and oxygen. A focus on Entonox is therefore important in order to address emissions from N2O, which is a potent greenhouse gas
  • Review waste (ordering, use and storage) in medicines and implemented improvement strategies
  • Review disposal of pharmaceutical waste and implemented improvement strategies
  • Identify and implement appropriate switches from intravenous (IV) to oral medications, with a focus on antimicrobials
  • Support usage of lower carbon inhaler devices, through a system wide approach

Actions

We have identified the following actions to enable achievement of our medicines objective:
Action Trust lead Delivery date
Complete decommission of nitrous oxide infrastructure Estates and Facilities End of 2026
Identify opportunities to decommission Entonox Manifolds Clinical Lead End of 2027
Review medicines and pharmaceutical wastage, with a focus on returns to pharmacy and waste streams Pharmacy Lead End of 2028
Implement initiatives to increase the use of oral medication as an alternative IV, with a focus on antibiotics and pre-operative medicines Clinical Lead and Pharmacy Lead End of 2028
Support high-quality, lower-carbon respiratory care, including supporting patients to choose the most appropriate inhaler(s) in alignment with clinical guidelines, engaging with system wide approaches (as appropriate) Pharmacy Lead End of 2028

← Back to Our areas of focus