Integrated care boards (ICBs) in North East and Yorkshire are working to make diabetes care greener by supporting patients to switch to reusable insulin pens.
The Issue
In North East & Yorkshire, the number of people living with diabetes continues to increase, with many using a disposable pen to deliver insulin. Compared to reusable pens, disposable insulin pens are less environmentally friendly and generate far more clinical waste, costing integrated care boards (ICBs) a significant amount in disposal efforts.
Baseline data for 2022 showed that across the region, 79% of prescriptions were for disposable pens when reusable cartridge pens may have been suitable instead. For every one person that chooses a cartridge pen over a disposable pen, there will be a saving of approximately 4.83KCo2e over a year’s treatment.
The solution
A Diabetes Environmental & Sustainability Impacts Working Group was formed to look at how best to move people using a disposable pen onto a reusable cartridge pen. The group has engaged with all four ICBs in North East & Yorkshire to support this change, and all four ICBs have committed to delivering reusable pens wherever possible for new insulin starts too.
Humber & North Yorkshire ICB and Sheffield and Doncaster places from South Yorkshire ICB have added this in some form to their primary care Prescribing Incentive Scheme to encourage this change. The aim of this scheme is to improve the quality, safety and environmental sustainability of prescribing in the NHS. In Humber & North Yorkshire, ICB primary care providers are financially rewarded to increase prescribing of insulin cartridges over disposable pens with the overall aim of reducing the carbon footprint.
Educational materials have been produced for ICBs, healthcare professionals, and medical students, including a switch checklist that identifies which reusable pens are suitable for patients to switch to. Two universities in the region have also engaged with the group to use these resources in their training materials, so medical students understand the environmental impact when choosing a suitable insulin pen.
The impact
All four ICBs in North East & Yorkshire have seen a decrease in the prescription of disposable insulin pens since the project started. Humber North Yorkshire ICB has seen the largest decrease of 16.2% since this was included within their Prescribing Incentive Scheme with a financial component.
Sheffield Teaching Hospital continues to see a downward trajectory in the prescribing of disposable pens, with the equivalent weight of 6 baby elephants saved in plastic between November 2021 and 2023.
What’s next
The group will now collaborate with and support the other ICBs in the North East & Yorkshire Region to include these changes in their own Prescribing Incentive Scheme. In addition, the group has started to look at reducing the environmental impact of other items used by those living with diabetes such as blood glucose meters and continuous glucose monitoring systems.
There are also opportunities to work with other regions to encourage wider-scale change, which the group will be prioritising as a next step. Stakeholders can share the educational material produced by the group with their systems, secondary care, and primary care. This includes a video aimed at health care professionals explaining the benefits: Diabetes goes GREEN.
- Contributors: North East & Yorkshire Diabetes Environmental & Sustainability Impacts Working Group
- Institution: NHS England – North East & Yorkshire regional team.
"This initiative has set an excellent precedent for integrating environmental sustainability into routine clinical practice. By prioritising reusable insulin pens, the region is not only reducing carbon emissions and clinical waste but also demonstrating how sustainable prescribing can align with high-quality patient care.
“It highlights the power of collaboration across integrated care boards, local providers, and educational institutions, with the potential for this approach to be applied across other parts of the health and care system. As we face increasing pressures from climate change, projects like this showcase the NHS’s leadership in delivering greener healthcare solutions.”
Dr Mark Harber, the Royal College of Physicians' special adviser on healthcare sustainability and climate change