PharmaBag: A Sustainable Packaging System to Reduce Pharmaceutical Waste and Support a Net-Zero NHS

Research Question: Can a sustainable, temperature-monitored and tamper-evident over-packaging system (PharmaBag) enable the safe return and future reuse of unused oral anti-cancer medications (OACMs), thereby reducing waste and contributing to NHS net zero goals? Background: A large volume of NHS medication is wasted each year due to unavoidable factors such as treatment changes, toxicity, or patient death. UK regulations prohibit the reuse of medicines once dispensed, even if unopened and in-date, because storage conditions cannot be verified. This has serious environmental consequences: the manufacture and distribution of medicines produce more carbon emissions than the motor industry, and improper disposal can pollute ecosystems. It also places financial and resource strain on the NHS. In 2009, medicine waste was estimated to cost over £300 million annually, and it continues to contribute to medication shortages. OACMs are a particular concern, with approximately one-third discontinued early. A prior study demonstrated that over-packing systems with temperature sensors can enable the return and reuse of OACMs, but high-cost, resource-intensive materials limited scalability. Aims and Objectives: We aim to develop the PharmaBag, a sustainable, low-cost prescription over-packing system with integrated sensors to identify returned OACMs potentially suitable for reuse. Our primary objective is to evaluate the environmental impact of this system. Secondary objectives include validating the PharmaBag, modelling cost savings, and assessing usability. These will be achieved across four work-packages (WPs). Methods and Timelines: We will first conduct a clinical audit of all OACMs prescribed at The Clatterbridge Cancer Centre (CCC), extracting anonymised prescribing data to understand waste patterns (WP1). In parallel, a 7-month product development programme (WP2) will deliver a sustainable, tamper-evident, temperature-monitored PharmaBag, which will be tested and validated. From month 8, a prospective single-group Quality Improvement study (WP3) will assess returned OACMs for suitability for reuse (e.g., packaging integrity, expiry, and storage). 1,000 patients will be recruited to receive standard OACMs within the PharmaBag, with primary outcomes being the quantity and proportion suitable for reuse. From month 20, WP4 will model the environmental and economic impacts of the PharmaBag through life cycle and cost-benefit analysis. Knowledge Mobilisation, Dissemination and Impact: We will mobilise knowledge through co-production with pharmacy teams, patients, and NHS planners, ensuring real-world relevance and early buy-in. Supported by Cheshire and Merseyside’s Integrated Care Board (CM ICB) and Cancer Alliance (CMCA), findings will inform procurement, policy, and regulatory dialogue. Impact will be measured through waste reduction, emissions savings, NHS cost models, stakeholder engagement, and uptake into NHS workflows, with tailored dissemination to each audience. Research Inclusion: Inclusion will be ensured by delivering the intervention across all CCC sites, reaching patients from rural, underserved, and socioeconomically deprived areas. Barriers will be addressed by embedding the study in pharmacy workflow, reducing travel, cost and time burdens. PPI is integrated throughout the project and will guide the design and evaluation to ensure accessibility. Outcomes will be analysed for variation across sites, demographics, and experiences.