A net-zero health plan starts with pharmacy

Climate change has been described by the World Health Organization as “the single biggest health threat facing humanity”^​1​. More than 200 health journals, including The Pharmaceutical Journal, have united in an urgent plea for governments to take emergency action in tackling the potential catastrophic harm to health^​2​. 

However, while the Department for Health and Social Care’s ‘Ten-year health plan for England’ briefly references a resolution to “prioritise existing net-zero targets”, it scarcely acknowledges the impact that meeting these targets would have, nor does it highlight how ill-equipped the NHS is to address future challenges^​3​. 

The three big shifts outlined in the plan (moving from treatment to prevention, hospital to community and analogue to digital) bear some hallmarks of environmental sustainability. But truly pivoting healthcare around sustainability has huge potential that can only be fully realised when its staff understand what sustainable healthcare means beyond “waste and recycling” — and when this is embedded into strategic planning at every level^​4​.

Sustainability

Awareness and integration of environmental sustainability principles remain limited across many NHS organisations and several interrelated factors contribute to this. Despite statutory obligations under the Climate Change Act 2008 and the Health and Care Act 2022, enforcement is limited and sustainability metrics are inconsistently applied across organisations. This undermines motivation and consistency at a strategic leadership level. 

When contractual obligations are lacking, sustainability initiatives often lack board-level engagement and are led by individuals without sufficient authority or visibility, resulting in fragmented efforts and minimal integration into core organisational strategies^​5​. The structural overhaul of the NHS in recent years has introduced greater complexity and fragmented governance, hindering coordinated efforts to embed environmental considerations in early planning and weakening providers’ ability to deliver.

Our primary focus should be on strengthening contractual obligations, incentives and accountability mechanisms when developing any new strategies and service frameworks. To drive meaningful change, environmental sustainability should be mandated and embedded in national policy, commissioning frameworks and regulatory standards. Reliance on passionate pharmacy professionals to lead sustainability efforts is insufficient and inequitable. A top-down approach is needed with clear targets and adequate resources to ensure pharmacy teams are empowered to act. 

Many pharmacy professionals report a lack of knowledge, confidence or support to implement sustainable practices effectively, while those keenly advocating for change receive limited resources amid competing priorities. If environmental sustainability is not embedded as part of the overhaul of education and training curricula to future proof the NHS workforce, it will remain peripheral to clinical priorities, leaving the status quo intact. This would be a huge missed opportunity.

One setting with huge potential to support this sustainability shift is community pharmacy — which lies at the heart of the proposed neighbourhood health services^​3​. Community pharmacies are highly trusted and accessible local care settings that play a pivotal role in promoting public health, sustainable prescribing, medicines optimisation and patient education. More than 80% of England’s population live within a 20-minute walk of their nearest community pharmacy, meaning that they are ideally placed to reduce unnecessary medicines use, support low-carbon alternatives (e.g. dry powder inhalers) and facilitate medicines returns or recycling^​6​. The Royal Pharmaceutical Society has developed the Greener Pharmacy Toolkit for hospital and community pharmacies to improve staff knowledge of the sustainability mandate^​7​. Since the toolkit was launched in April 2025, dozens of pharmacies have attained bronze level accreditation aligning with their key strategic pillar to support environmental goals^​8​.

There is further huge potential for community pharmacy to significantly reduce the carbon footprint of healthcare by seeing patients closer to home. More provision of clinical services — such as Pharmacy First, contraception service and hypertension case finding — as well as the management of minor ailments and long-term conditions, such as obesity and high blood pressure, will mean more patients can access care locally. 

Hospital to community

Pharmacy colleagues in other settings are also set to support the shift from ‘hospital to community’. More than 600,000 people across the UK are currently receiving healthcare via an NHS-contracted clinical homecare provider, which reduces emissions from patient travel and hospital dispensing while enabling remote monitoring and personalised care^​9​. Other co-benefits include efficient switching of medicines with significant financial benefits, consolidated delivery routes and temperature-controlled logistics, which can reduce medicines wastage and improve medicines adherence. Virtual ward rollouts supported by pharmacy colleagues have a significantly lower carbon footprint than traditional inpatient bed days^​10​.

The ten-year plan has also stressed the importance of a technological shift, highlighting five transformative technologies, including the use of data, AI, genomics, wearables and robotics^​3​. From a sustainability perspective, a genomic approach will ease the chronic disease burden while cutting pharmaceutical waste and reducing the healthcare sector’s carbon footprint.

Work is already underway with the establishment of the NHS genomic medicine service and the focus on accelerating genomic medicine in the NHS strategy, which outlines a five-year plan to embed genomics across all levels of care^​11​. The ‘Pharmacy genomics workforce education and training strategic framework’ sets out a national strategy to equip pharmacists and pharmacy technicians with the skills needed for more precise, predictive and personalised diagnosis, treatment and prevention. By analysing an individual’s genetic profile, they can identify inherited risks, tailor therapies to genetic profiles and reduce adverse drug reactions. However, the success of the reshaped innovation strategy depends on public awareness, strong pharmacy leadership, and rapid IT integration, especially full interoperability with the Single Patient Record.

The NHS faces significant budgetary limitations, workforce shortages and rising service demands, which deprioritise long-term environmental sustainability investments^​12​. Projects with delayed financial returns are often sidelined in favour of immediate service delivery needs. For example, several inhaler recycling schemes launched nationwide have not been upscaled or have been folded altogether because they lacked sustained funding and dedicated resources^​13​. With an existing funding gap from the government for transforming community pharmacies, the population in underserved neighbourhoods living with chronic diseases will continue to face geographical inequalities.

In several NHS hospitals, clinical and non-clinical teams have coordinated efforts outside their substantive roles to drive sustainability by cutting anaesthetic gas waste, generating around £5m in annual savings^​14​. Embedding sustainability into strategic planning ensures a low-carbon care model that will reduce waste, improve resource efficiency and unlock long-term savings while delivering high-quality care. 

Role of pharmacy

Pharmacy services are a cornerstone of the NHS ten-year plan, contributing to improved access, medicines optimisation and population health. Pharmacy professionals are increasingly delivering clinical care, supporting prevention and managing long-term conditions. Their role in genomics, digital prescribing and medicines safety further demonstrates the sector’s strategic importance in delivering personalised, efficient and equitable healthcare. 

However, to fully realise the potential of pharmacy services, their integration must be supported by system-wide enablers, including environmental sustainability, to ensure long-term resilience and alignment with NHS net-zero goals.

From reducing medicine waste and emissions associated with supply chains, to supporting low carbon models — such as homecare medicines delivery and virtual consultations — pharmacy services can actively contribute to greener healthcare. Embedding sustainability into procurement, logistics and prescribing practices not only supports climate targets but also enhances service efficiency and patient experience.

As the NHS evolves, pharmacy must be empowered to lead on sustainability, ensuring that innovation and clinical excellence go hand in hand with environmental stewardship.