The purpose of this paper is to determine how best to reduce, reuse and dispose of household waste medicines in the National Health Service (NHS) (UK). Through a combination of literature review and empirical work, this research investigates the existing household waste medicines reverse logistics (RL) system and makes recommendations for improvement by benchmarking it against household waste batteries RL. The viability and feasibility of these recommendations are evaluated through in-depth interviews with healthcare professionals and end user surveys. The batteries RL system appears to be a more structured and effective system with more active engagement from actors/stakeholders in instigating RL practices and for this very reason is an excellent comparator for waste medicines RL practices. Appropriate best practices are recommended to be incorporated into the waste medicines RL system, including recapturing product value, revised processing approaches, system cooperation and enforcement, drivers and motivations and system design and facilitation. This study offers academics and professionals an improved insight into the current household waste medicines RL system and provides a step towards reducing an existing gap in this under-researched area. A limitation is that only a small sample of healthcare professionals were involved in subjectively evaluating the feasibility of the recommendations, so the applicability of the recommendations needs to be tested in a wider context and the cost effectiveness of implementing the recommendations needs to be analysed. Reducing, reusing and properly disposing of waste medicines contribute to economic sustainability, environmental protection and personal and community safety. The information retrieved from analysing returned medicines can be used to inform prescribing practice so as to reduce unnecessary medicine waste and meet the medicine optimisation agenda. This paper advocates learning from best practices in batteries RL to improve the waste medicines RL design and execution and supports the current NHS agenda on medicine waste reduction (DoH, 2012). The recommendations made in the paper not only aim to reduce medicine waste but also to use medicines effectively, placing the emphasis on improving health outcomes.

This research aims to design a green Pharmaceutical Supply Chain (PSC ) that reduces preventable pharmaceutical waste and effectively disposes of inevitable pharmaceutical waste. The main output of this study is the formulation of an integrated green PSC model involving all critical stakeholders, leading to improved environmental, economic and safety performance in medication management and delivery. The research is based on literature and on secondary resources. To green the PSC, every producer of waste is duty bound to facilitate the safe handling and disposal of waste. A Cross boundary Green PSC (XGPSC) approach is proposed to identify participants’ contribution to the PSC. Peripheral influences are also recognised from professional and regulatory bodies. This study focuses solely on community PSC in the UK where patients receive medication from local community pharmacies and thus may be limited. The proposed XGPSC approach also needs to be tested and validated in practice. It may also be difficult to transfer some of the environmental practices proposed in this research into practice. The environmental practices and actions proposed provide invaluable insight into various PSC activities, including purchasing, product design, prescription patterns and processes, medication use review, and customer relationship management. The proposed environmental actions encourage firm commitment from everyone to reduce, recycle or effectively dispose of pharmaceutical waste, with patients becoming stewards of medication rather than only consumers. A cross boundary approach is developed to green the PSC, and it encourages total involvement and collaboration from all participants in PSC.

Purpose: The aim of this research therefore is to explore the causes of drug shortages within the pharmaceutical supply chain and assess the adopted mitigation strategies. Research Approach: The study is carried out from an inductive perspective where we seek to understand the phenomenon by a detailed review of extant literature followed by a series of semi-structured interviews with first tier consumers within a case study framework. The respondents were chosen using purposive sampling as those best to comment on the phenomenon under scrutiny. Data was analysed using thematic analysis, where a dual focus was adopted; 1) the preliminary focus was on the identification of system themes (where the system was impacted and the responds e.g. complexity, disruptions and product alternatives) and 2) the secondary focus was the impact on the patient as system recipient and product user (where themes such as stress, anxiety, and adverse drug reactions emerged). Findings and Originality: The analysis show that drug shortages within the pharmaceutical supply chain in the UK occur as a result of stringent regulatory frameworks, faults in the manufacturing processes, lack of Active Pharmaceutical Ingredients, monopolistic wholesaler markets; lack of information dissemination, offshore trading and price manipulations for profit. The impact on the consumers is reported to be extensive and can endure long after the disruptive event occurs. The findings indicate that existing recovery strategies are however cumbersome, add complexity to the supply chain and in extreme cases facilitate the infiltration of counterfeits. The study is innovative as it explores disruptive events and associated recovery strategies which have not been adequately addressed in supply chain management studies to date. Research Impact: This research contributes to existing literature by extending discussions on supply chain disruptions within a dynamic supply chain whilst focusing on product service supply chain recovery strategies and mechanisms. Practical Impact: This study provides Operations/Supply Chain Managers and Pharmaceutical companies and professionals with strategies that can be adopted can adopt in reducing and recovering in a more resilient manner to disruptive events. This thus presents the bedrock for resilient practice and systems design and development, thus reducing system vulnerability and ultimately leading to improved product availability and patient care.

The National Health Service (NHS) Five Year Forward View in 2014 issued a grave warning that if healthcare demand in the UK continued to grow as its current rate, and efficiency or funding changes were not instigated there could be a mismatch between the service (in terms of resource provision) and patients of up to £30 billion a year by 2020/21. The report asserted that in order to “sustain a comprehensive high-quality NHS; action will be needed on all three fronts – demand, efficiency and funding” (2014:5). Based on this escalating issue, and with a focus on the expanded and value-added role of Community Pharmacists, this study chooses to focus on this service operation in light of the pressures as highlighted above by examining what Sustainability means and how it is applied in Community Pharmacy as a service provider in the NHS (UK).

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The National Health Service (UK) is wholly accountable and heavily scrutinised for its strategy, activity, performance and spending (Appleby, 2016; NHS Confederation, 2016; Parliament UK, 2010), and much research has been undertaken as to its effectiveness at managing its operations and its competency in doing so (Gov.Uk, 2016; National Audit Office, 1999)). The impact of not performing adequately combined with threats such as funding cuts (King’s Fund, 2016), government intervention and private sector competition; has led to uncertainty and disillusion with the sustainability of the service (Hunter, 2016). Based on current economic concerns, this paper chooses to focus on the area of Medical Equipment Loans Services where products are released to patients to aid therapeutic rehabilitation and physical mobility. The aim of this study is to examine the process of product retrieval in a multi-case study analysis and consider how value-added technologies can be used to improve retrieval success rates.

The concept of waste and how it can be reduced, recycled, refurbished or reused in its current form has been widely discussed in industry. The importance of waste reduction from an environmental and economic perspective has also heightened in both industry and within the research arena. Thus said, stringent steps have been taken to facilitate the collection of and capture residual value in waste items. This article explores this premise in relation to medicines waste as part of the wider medicines optimisation agenda.

This commentary considers changes to education in UK mental health nursing.

Purpose: The aim of this research is to evaluate if the Complex Adaptive Systems theory can be used to explain resilience strategies within the pharmaceutical supply chain Research Approach: An in depth review of literature surrounding resilience in the pharmaceutical supply chain. In order to pursue this study agenda, data was collected from Scopus, the largest peer review journal as well as EBSCOhost. The PRISMA guideline was adopted in the systematic review process where 34 peer reviewed papers in the field of CAS, supply chain and supply chain resilience were identified with respect to methodologies employed, location of the study and approaches. Findings and Originality: The systematic review of literature shows that there are inherent similarities between the concept of resilience and the CAS theory. The CAS theory explains that PSC’s are dynamic, have emergent behaviours complex, adaptive, interconnected as well as possess schemas that regulate their operations. Hence if resilience strategies are to be employed to mitigate disruptive events they need to be harnessed in a manner to fit this particular supply chain. This work is innovative as it provides a new insight into the contemporary discourse on resilience strategy creation and deployment, examining the use of this theory in the PSC, and thus provides original contribution. Research Impact: This study contributes to the existing literature base, by providing theoretical underpinnings in the area of resilience and the pharmaceutical supply chain. This furthers the CAS agenda, SCR agenda and also presents an innovative output which warrants more detailed analysis and feasibility testing. Practical Impact: Complexity principles are multi-scaled and multi-domain and as such the suggestions put forward in this theoretical framework can be adopted in various supply chain networks as well as disruptive events. It provides new insights with regards to structures for managers seeking to design and improve resilience supply chains, a key element of which is the adoption of a holistic analysis by SC managers when developing resilience strategies. This is critical if disruptions are to be identified and mitigated before their impact is felt.