Medicines management is only one part of NHS (UK) procurement and management, but essentially a very expensive part. In December 2012 the Department of Health issued an action plan to improve the use of medicines and reduce waste. There is an onus therefore on the NHS to ensure that they are as efficient in the medicines management as possible in all aspects of the supply chain in order to ensure sustainability (economically and operationally). To do this consideration must be given to medicines optimization, from procurement, through to storage, dispensing, compliance and finally waste prevention and reduction and waste retrieval. As part of the larger National Health Service (UK), hospital pharmacy places strong emphasis on contributing to the efficiency targets through reductions in waste and drug spending, and best practice. The purpose of this study is to examine medicines reverse logistics practice within the NHS hospital pharmacies, and the operational strategy which drives such practices. The overarching aim is to explore through qualitative analysis the variance and commonality in strategy and practice in what is a standard logistical activity. The outputs offer transparency of medicines RL as practiced by NHS professionals and contribute to ongoing discussions within the Department of Health (NHS UK) on best practice governing waste medicines recycling processes. A qualitative approach was adopted in undertaking this research study, utilizing a purposive study sample. The survey examined practice in 45 hospitals as individual cases across all stages in the medicines reverse logistics system. The findings indicated there is some commonality in the strategy employed in conducting medicines recycling, and all 3 drivers are prevalent in undertaking recycling and encouraging a more sustainable approach, i.e., economic, corporate citizenship, and legislation. However, the means by which the same objective was achieved differed, such as resource utilisation, training etc.

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.

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.

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.

Introduction: This paper demonstrates the practical application of process mapping principles as a model for evaluating NHS improvement. The NHS improvement in question was the merger of three crisis resolution teams within an NHS trust in 2012. The aims were to improve overall operational efficiency and enhance multidisciplinary working to meet operational targets. This paper examined changes following the merger to capture the effects of service improvement and the reality of the patient journey. Methods: A pooled cross-sectional approach, using six years of aggregated hospital data, was taken. To achieve operational efficiency, a process map of referrals, readmissions, length of stay and waiting times for crisis resolution team assessments was examined. Prevalence of clinical referral rates and disease classification before and after the merger were compared. Conclusion: Between 1 April 2009 and 30 March 2015, length of stay and readmissions for patients to crisis resolution team rates reduced. Operational sustainability and capacity was enhanced through the redistribution of clinical human resources. Multidisciplinary skill mix (e.g. through improved team composition) also improved.

The effective disposal of medication and more specifically accidental exposure to fentanyl via transdermal patches has recently been highlighted in two key documents [1, 2]. Whilst the volume of unused medicines cost the NHS over £300 million every year [1], the volume of transdermal patch waste is unknown. There is a need for greater pharmacy intervention in the effective disposal of medicines to resolve issues such as hospital (re)-admissions, stockpiling leading to patient self–prescribing/dosing, and land and water pollution. The aim of this study was to examine transdermal patch disposal systems and practice amongst private sector care providers in the UK. This was part of a larger study focusing on transdermal patch application.

The role of the pharmacist as we know it has altered substantially over recent years. No longer is the expectation that they are a dispenser of pills and potions and nothing else (Richardson and Pollock, 2010). Skills/competencies mapping and associated performance have been examined from a supply chain perspective e.g. Kauppi et al., 2013; Sohal, 2013; but there is limited evidence of such exploration within the pharmacy profession and healthcare operations management. The aim of this study is to explore the critical management skills needed by pharmacists to effectively perform their role within the National Health Service (UK).

The concept of corporate and social responsibility (CSR) has gained increasing momentum and importance in business operations today and companies have globally responded to this philosophy. To what end though? Product Stewardship (PS) and the corporate, social and environmental responsibilities associated within this term are a key part of a business’s CSR agenda. In the extant literature, it is a challenge to clearly identify the boundaries of responsibility for PS - who sets these boundaries for governance and what are the actions taken under the guise of PS. This paper aims to start the process of demystification in responding to the title of this work, stimulate further musings and outline a future research agenda.

The lack of separation between urgent and non-urgent medical goods encourages sub-optimal vehicle fleet operations owing to the time critical nature of urgent items. An unattended electronic locker bank, to which individual urgent items can be delivered thereby separating urgent and non-urgent supply, was proposed for the Great Ormond Street Hospital in London, UK. This concept was quantified using ‘basic’ and ‘intuitive’ hill climbing optimisation models; and qualitatively using staff interviews and expert reviews. Results indicated that a locker bank with a fixed height (1.7 m) and depth (0.8 m) required a length of 4 m (basic model) and 3.63 m (intuitive model), to accommodate 100% of urgent consignments for a typical week. Staff interviews indicated the wider benefits such as staff personal deliveries.