diff --git a/cli/src/pixl_cli/main.py b/cli/src/pixl_cli/main.py
index ec758c2d2..492cfe1b7 100644
--- a/cli/src/pixl_cli/main.py
+++ b/cli/src/pixl_cli/main.py
@@ -23,9 +23,8 @@
 import click
 import requests
 from core.exports import ParquetExport
-from core.logging import configure_logging
 from core.patient_queue.producer import PixlProducer
-from core.tracing import configure_tracing
+from core.telemetry import configure_logging, configure_tracing, telemetry_is_enabled
 from decouple import RepositoryEnv, UndefinedValueError
 from loguru import logger
 from opentelemetry.instrumentation.pika import PikaInstrumentor
@@ -53,7 +52,7 @@
 os.environ["NO_PROXY"] = os.environ["no_proxy"] = "localhost"
 
 
-def _configure_telemetry_env_vars() -> None:
+def _configure_telemetry(logging_level: str) -> None:
     """
     Set the OTel environment variables needed by the CLI.
 
@@ -62,24 +61,25 @@ def _configure_telemetry_env_vars() -> None:
 
     Load the config and set the relevant environment variables.
     """
-    endpoint = config("OTEL_EXPORTER_OTLP_ENDPOINT", default="")
-    if not endpoint:
+    if not telemetry_is_enabled():
         return
 
-    os.environ["OTEL_EXPORTER_OTLP_ENDPOINT"] = endpoint
+    os.environ["OTEL_SDK_DISABLED"] = "false"
+    os.environ["OTEL_EXPORTER_OTLP_ENDPOINT"] = config("OTEL_EXPORTER_OTLP_ENDPOINT")
     os.environ["OTEL_SERVICE_NAME"] = "pixl-cli"
     os.environ["OTEL_RESOURCE_ATTRIBUTES"] = "service.namespace=pixl"
 
+    configure_logging(level=logging_level)
+    configure_tracing()
+    PikaInstrumentor().instrument()
+
 
 @click.group()
 @click.option("--debug/--no-debug", default=False)
 def cli(*, debug: bool) -> None:
     """PIXL command line interface"""
     logging_level = "DEBUG" if debug else "INFO"
-    _configure_telemetry_env_vars()
-    configure_logging(level=logging_level)
-    configure_tracing()
-    PikaInstrumentor().instrument()
+    _configure_telemetry(logging_level=logging_level)
 
 
 cli.add_command(dc)
diff --git a/cli/tests/conftest.py b/cli/tests/conftest.py
index 4ff9ffb8d..582583c16 100644
--- a/cli/tests/conftest.py
+++ b/cli/tests/conftest.py
@@ -42,6 +42,7 @@
             os.environ[key] = value
 
 # Set the remaining environment variables
+os.environ["OTEL_SDK_DISABLED"] = "true"
 os.environ["PROJECT_CONFIGS_DIR"] = str(Path(__file__).parents[2] / "projects/configs")
 
 os.environ["EXPORT_AZ_CLIENT_ID"] = "export client id"
diff --git a/docs/setup/developer.md b/docs/setup/developer.md
index 14a5c606f..7917c71cd 100644
--- a/docs/setup/developer.md
+++ b/docs/setup/developer.md
@@ -139,18 +139,17 @@ PIXL can export structured logs to an
 PIXL exports telemetry via the OpenTelemetry Protocol (OTLP) and works with any
 OTel-compatible observability backend.
 
-To enable observability, set `OTEL_EXPORTER_OTLP_ENDPOINT` in the `.env` file to
-the gRPC endpoint of an OTel collector, e.g. `localhost:4317` (4317 is the
-standard OTLP gRPC port).
+To enable observability, set `OTEL_SDK_DISABLED` to `false` and define an `OTEL_EXPORTER_OTLP_ENDPOINT`
+in the `.env`. The endpoint be for the gRPC endpoint of an OTel collector, e.g.
+`localhost:4317` (4317 is the standard OTLP gRPC port).
 
 After starting the PIXL services, logs should start to appear in your
 collector's UI.
 
 ### Disabling OTel
 
-Leave `OTEL_EXPORTER_OTLP_ENDPOINT` empty (or unset) to disable all telemetry. No
-other configuration is needed — the services detect the absence of the endpoint
-and skip OTel initialisation.
+Set `OTEL_SDK_DISABLED` to `true` to disable all telemetry. No other configuration is
+needed.
 
 ### Adding context to logs
 
diff --git a/hasher/src/hasher/main.py b/hasher/src/hasher/main.py
index d8069f592..c2c87a8bf 100644
--- a/hasher/src/hasher/main.py
+++ b/hasher/src/hasher/main.py
@@ -15,7 +15,7 @@
 
 from __future__ import annotations
 
-from core.logging import configure_logging
+from core.telemetry import configure_logging
 from decouple import config  # type: ignore [import-untyped]
 from fastapi import FastAPI
 from fastapi.middleware.cors import CORSMiddleware
diff --git a/hasher/tests/conftest.py b/hasher/tests/conftest.py
index e57f9d988..f644891b9 100644
--- a/hasher/tests/conftest.py
+++ b/hasher/tests/conftest.py
@@ -20,6 +20,7 @@
 os.environ["LOG_LEVEL"] = "DEBUG"
 os.environ["AZURE_KEY_VAULT_SECRET_NAME"] = "test-key"
 os.environ["LOCAL_SALT_VALUE"] = "pixl_salt"
+os.environ["OTEL_SDK_DISABLED"] = "true"
 
 
 class MockKeyVault:
diff --git a/orthanc/orthanc-anon/plugin/pixl.py b/orthanc/orthanc-anon/plugin/pixl.py
index f8a835906..8d1c5b041 100644
--- a/orthanc/orthanc-anon/plugin/pixl.py
+++ b/orthanc/orthanc-anon/plugin/pixl.py
@@ -35,9 +35,8 @@
 import pydicom
 import requests
 from core.exceptions import PixlDiscardError, PixlSkipInstanceError
-from core.logging import configure_logging
 from core.project_config.pixl_config_model import load_project_config
-from core.tracing import configure_tracing
+from core.telemetry import configure_logging, configure_tracing
 from decouple import config
 from loguru import logger
 from opentelemetry import trace
diff --git a/orthanc/orthanc-raw/plugin/pixl.py b/orthanc/orthanc-raw/plugin/pixl.py
index 101b1b6a8..552801867 100644
--- a/orthanc/orthanc-raw/plugin/pixl.py
+++ b/orthanc/orthanc-raw/plugin/pixl.py
@@ -23,8 +23,7 @@
 import os
 from typing import TYPE_CHECKING
 
-from core.logging import configure_logging
-from core.tracing import configure_tracing
+from core.telemetry import configure_logging, configure_tracing
 from decouple import config
 from loguru import logger
 from opentelemetry import trace
diff --git a/pixl_core/src/core/logging.py b/pixl_core/src/core/logging.py
index af003968b..3fc52f1fb 100644
--- a/pixl_core/src/core/logging.py
+++ b/pixl_core/src/core/logging.py
@@ -12,7 +12,7 @@
 #  See the License for the specific language governing permissions and
 #  limitations under the License.
 """
-Configure loguru to emit structured logs to an OpenTelemetry collector via OTLP.
+Provides a loguru sink that forwards records to an OpenTelemetry collector via OTLP.
 
 Note, only loguru records are exported. Logs from third-party libraries are not
 forwarded to the OTel collector.
@@ -21,12 +21,9 @@
 from __future__ import annotations
 
 import atexit
-import os
-import sys
 from typing import TYPE_CHECKING
 
-from loguru import logger
-from opentelemetry._logs import SeverityNumber, set_logger_provider
+from opentelemetry._logs import SeverityNumber, get_logger_provider, set_logger_provider
 from opentelemetry.exporter.otlp.proto.grpc._log_exporter import OTLPLogExporter
 from opentelemetry.sdk._logs import LoggerProvider
 from opentelemetry.sdk._logs.export import BatchLogRecordProcessor
@@ -35,7 +32,7 @@
 if TYPE_CHECKING:
     from loguru import Message
 
-__all__ = ["configure_logging"]
+__all__ = ["OTelSink"]
 
 # Map loguru level names to OTel severity
 LOGURU_TO_OTEL: dict[str, SeverityNumber] = {
@@ -53,15 +50,26 @@ class OTelSink:
     """Send loguru records to an OTel logs exporter via OTLP."""
 
     def __init__(self) -> None:
+        """Initialise the OTel sink."""
         self.provider = self._build_provider()
 
     def _build_provider(self) -> LoggerProvider:
         """
-        Create a LoggerProvider for exporting logs via OTLP.
+        Return LoggerProvider for exporting logs via OTLP.
+
+        Re-use an existing provider if one has already been created. Otherwise, create
+        a new provider and set it as the global provider.
 
         The provider is flushed on exit so we can include logs from short-lived processes,
         i.e. the CLI.
         """
+        # If we have auto-instrumented the service, there's no way to tell the OTel SDK not to
+        # create the provider. So we have to reuse it here to avoid warnings in the logs.
+        # The provider created by the OTel SDK is equivalent to the one we create below.
+        existing_provider = get_logger_provider()
+        if isinstance(existing_provider, LoggerProvider):
+            return existing_provider
+
         exporter = OTLPLogExporter()
         processor = BatchLogRecordProcessor(exporter)
         provider = LoggerProvider(resource=Resource.create())
@@ -95,18 +103,3 @@ def __call__(self, message: Message) -> None:
             attributes=attributes,
             exception=exception.value if exception else None,
         )
-
-
-def configure_logging(level: str) -> None:
-    """
-    Configure loguru for a PIXL service.
-
-    Always logs to stderr, which will be viewable in the Docker logs. When
-    OTEL_EXPORTER_OTLP_ENDPOINT is set, also send logs to the OTel collector.
-    """
-    logger.remove()
-    logger.add(sys.stderr, level=level.upper())
-
-    if os.environ.get("OTEL_EXPORTER_OTLP_ENDPOINT"):
-        sink = OTelSink()
-        logger.add(sink, level=level.upper())
diff --git a/pixl_core/src/core/telemetry.py b/pixl_core/src/core/telemetry.py
new file mode 100644
index 000000000..17157e913
--- /dev/null
+++ b/pixl_core/src/core/telemetry.py
@@ -0,0 +1,100 @@
+#  Copyright (c) University College London Hospitals NHS Foundation Trust
+#
+#  Licensed under the Apache License, Version 2.0 (the "License");
+#  you may not use this file except in compliance with the License.
+#  You may obtain a copy of the License at
+#
+#     http://www.apache.org/licenses/LICENSE-2.0
+#
+#  Unless required by applicable law or agreed to in writing, software
+#  distributed under the License is distributed on an "AS IS" BASIS,
+#  WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied.
+#  See the License for the specific language governing permissions and
+#  limitations under the License.
+"""Configure OpenTelemetry for PIXL services."""
+
+from __future__ import annotations
+
+import atexit
+import os
+import sys
+
+from decouple import config
+from loguru import logger
+from opentelemetry import trace
+from opentelemetry.exporter.otlp.proto.grpc.trace_exporter import OTLPSpanExporter
+from opentelemetry.sdk.resources import Resource
+from opentelemetry.sdk.trace import TracerProvider
+from opentelemetry.sdk.trace.export import BatchSpanProcessor
+
+from core.logging import OTelSink
+
+__all__ = [
+    "configure_logging",
+    "configure_tracing",
+    "telemetry_is_enabled",
+]
+
+
+def telemetry_is_enabled() -> bool:
+    """
+    Check whether telemetry should be enabled.
+
+    It should be disabled if OTEL_SDK_DISABLED is true or if OTEL_EXPORTER_OTLP_ENDPOINT is not set.
+    """
+    disabled = config("OTEL_SDK_DISABLED", cast=bool)
+    if disabled:
+        logger.warning("OTEL_SDK_DISABLED is set, skipping OTel configuration")
+        return False
+
+    endpoint = config("OTEL_EXPORTER_OTLP_ENDPOINT")
+    if not endpoint:
+        logger.warning(
+            "OTEL_EXPORTER_OTLP_ENDPOINT is not set. Telemetry will not be sent to the collector."
+        )
+        # Disable the SDK to avoid errors from the OTel SDK
+        os.environ["OTEL_SDK_DISABLED"] = "true"
+        return False
+
+    return True
+
+
+def configure_logging(level: str) -> None:
+    """
+    Configure loguru for a PIXL service.
+
+    Always logs to stderr, which will be viewable in the Docker logs. When
+    OTEL_SDK_DISABLED is false and OTEL_EXPORTER_OTLP_ENDPOINT is set, also
+    sends logs to the OTel collector.
+    """
+    logger.remove()
+    logger.add(sys.stderr, level=level.upper())
+
+    if not telemetry_is_enabled():
+        return
+
+    sink = OTelSink()
+    logger.add(sink, level=level.upper())
+
+
+def configure_tracing() -> None:
+    """
+    Set up an OTLP span exporter when OTEL_SDK_DISABLED is false
+    and OTEL_EXPORTER_OTLP_ENDPOINT is set in the environment.
+    """
+    if not telemetry_is_enabled():
+        return
+
+    # If we have auto-instrumented the service, there's no way to tell the OTel SDK not to
+    # create the provider. So we have to reuse it here to avoid warnings in the logs.
+    # The provider created by the OTel SDK is equivalent to the one we create below.
+    existing_provider = trace.get_tracer_provider()
+    if isinstance(existing_provider, TracerProvider):
+        return
+
+    exporter = OTLPSpanExporter()
+    processor = BatchSpanProcessor(exporter)
+    provider = TracerProvider(resource=Resource.create())
+    provider.add_span_processor(processor)
+    trace.set_tracer_provider(provider)
+    atexit.register(provider.shutdown)
diff --git a/pixl_core/src/core/tracing.py b/pixl_core/src/core/tracing.py
deleted file mode 100644
index f091000f8..000000000
--- a/pixl_core/src/core/tracing.py
+++ /dev/null
@@ -1,44 +0,0 @@
-#  Copyright (c) University College London Hospitals NHS Foundation Trust
-#
-#  Licensed under the Apache License, Version 2.0 (the "License");
-#  you may not use this file except in compliance with the License.
-#  You may obtain a copy of the License at
-#
-#     http://www.apache.org/licenses/LICENSE-2.0
-#
-#  Unless required by applicable law or agreed to in writing, software
-#  distributed under the License is distributed on an "AS IS" BASIS,
-#  WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied.
-#  See the License for the specific language governing permissions and
-#  limitations under the License.
-"""Configure OpenTelemetry tracing for services not wrapped by opentelemetry-instrument."""
-
-from __future__ import annotations
-
-import atexit
-import os
-
-from opentelemetry import trace
-from opentelemetry.exporter.otlp.proto.grpc.trace_exporter import OTLPSpanExporter
-from opentelemetry.sdk.resources import Resource
-from opentelemetry.sdk.trace import TracerProvider
-from opentelemetry.sdk.trace.export import BatchSpanProcessor
-
-__all__ = ["configure_tracing"]
-
-
-def configure_tracing() -> None:
-    """
-    Set up an OTLP span exporter when OTEL_EXPORTER_OTLP_ENDPOINT is set.
-
-    When the endpoint is not set, tracing and spans are no-ops.
-    """
-    if not os.environ.get("OTEL_EXPORTER_OTLP_ENDPOINT"):
-        return
-
-    exporter = OTLPSpanExporter()
-    processor = BatchSpanProcessor(exporter)
-    provider = TracerProvider(resource=Resource.create())
-    provider.add_span_processor(processor)
-    trace.set_tracer_provider(provider)
-    atexit.register(provider.shutdown)
diff --git a/pixl_core/tests/conftest.py b/pixl_core/tests/conftest.py
index ca1e5df0e..324ce88e5 100644
--- a/pixl_core/tests/conftest.py
+++ b/pixl_core/tests/conftest.py
@@ -69,7 +69,7 @@
 os.environ["XNAT_PORT"] = "8080"
 os.environ["XNAT_DESTINATION"] = "/archive"
 os.environ["XNAT_OVERWRITE"] = "none"
-os.environ["OTEL_EXPORTER_OTLP_ENDPOINT"] = "http://localhost:4317"
+os.environ["OTEL_SDK_DISABLED"] = "true"
 
 
 @pytest.fixture(scope="package")
@@ -248,6 +248,7 @@ def otel_logger(
     log_exporter: InMemoryLogRecordExporter,
 ) -> Generator[None]:
     """Configure an OTelSink using the in-memory exporter."""
+    monkeypatch.setenv("OTEL_SDK_DISABLED", "false")
     processor = SimpleLogRecordProcessor(log_exporter)
     provider = LoggerProvider(resource=Resource.create({"service.name": "test"}))
     provider.add_log_record_processor(processor)
diff --git a/pixl_core/tests/test_logging.py b/pixl_core/tests/test_logging.py
index 5a0293e31..a8b7f76a7 100644
--- a/pixl_core/tests/test_logging.py
+++ b/pixl_core/tests/test_logging.py
@@ -20,17 +20,37 @@
 import pytest
 from loguru import logger
 from opentelemetry._logs import SeverityNumber
+from opentelemetry.sdk._logs import LoggerProvider
 
-from core.logging import configure_logging
+from core.logging import OTelSink
+from core.telemetry import configure_logging
 
 if TYPE_CHECKING:
     from opentelemetry.sdk._logs.export import InMemoryLogRecordExporter
 
 
-def test_configure_logging_creates_otel_sink() -> None:
-    """Test that configure_logging adds the OTel sink when the endpoint is set."""
+def test_build_provider_reuses_existing_provider(monkeypatch: pytest.MonkeyPatch) -> None:
+    """Test that OTelSink reuses a LoggerProvider already set by opentelemetry-instrument."""
+    existing = LoggerProvider()
+    monkeypatch.setattr("core.logging.get_logger_provider", lambda: existing)
+    sink = OTelSink()
+    assert sink.provider is existing
+
+
+def test_configure_logging_skips_otel_when_sdk_disabled() -> None:
+    """Test that configure_logging only adds stderr when OTEL_SDK_DISABLED is true."""
+    configure_logging(level="INFO")
+    assert len(logger._core.handlers) == 1  # stderr only
+    logger.remove()
+
+
+def test_configure_logging_creates_otel_sink(monkeypatch: pytest.MonkeyPatch) -> None:
+    """Test that configure_logging adds the OTel sink when telemetry is enabled."""
+    monkeypatch.setenv("OTEL_SDK_DISABLED", "false")
+    monkeypatch.setenv("OTEL_EXPORTER_OTLP_ENDPOINT", "http://localhost:4317")
     configure_logging(level="INFO")
     assert len(logger._core.handlers) == 2  # stderr and OTel sink
+    logger.remove()
 
 
 @pytest.mark.usefixtures("otel_logger")
diff --git a/pixl_export/src/pixl_export/main.py b/pixl_export/src/pixl_export/main.py
index 39742f850..fc7b8554b 100644
--- a/pixl_export/src/pixl_export/main.py
+++ b/pixl_export/src/pixl_export/main.py
@@ -23,8 +23,8 @@
 from typing import Annotated
 
 from core.exports import ParquetExport
-from core.logging import configure_logging
 from core.rest_api.router import router
+from core.telemetry import configure_logging
 from core.uploader import get_uploader
 from decouple import config  # type: ignore [import-untyped]
 from fastapi import Body, FastAPI, HTTPException
diff --git a/pixl_export/tests/conftest.py b/pixl_export/tests/conftest.py
index fe0c9efe6..180c9ad96 100644
--- a/pixl_export/tests/conftest.py
+++ b/pixl_export/tests/conftest.py
@@ -36,6 +36,7 @@
 os.environ["ORTHANC_ANON_USERNAME"] = "orthanc_anon_username"
 os.environ["ORTHANC_ANON_PASSWORD"] = "orthanc_anon_password"
 os.environ["ORTHANC_ANON_URL"] = "http://orthanc-anon:8042"
+os.environ["OTEL_SDK_DISABLED"] = "true"
 
 TEST_DIR = Path(__file__).parent
 
diff --git a/pixl_imaging/src/pixl_imaging/main.py b/pixl_imaging/src/pixl_imaging/main.py
index 751aa4492..f664a03eb 100644
--- a/pixl_imaging/src/pixl_imaging/main.py
+++ b/pixl_imaging/src/pixl_imaging/main.py
@@ -18,9 +18,9 @@
 import asyncio
 import importlib.metadata
 
-from core.logging import configure_logging
 from core.patient_queue.subscriber import PixlConsumer
 from core.rest_api.router import router, state
+from core.telemetry import configure_logging
 from decouple import config
 from fastapi import FastAPI
 from fastapi.responses import JSONResponse
diff --git a/pixl_imaging/tests/conftest.py b/pixl_imaging/tests/conftest.py
index ed1c38071..6e745821a 100644
--- a/pixl_imaging/tests/conftest.py
+++ b/pixl_imaging/tests/conftest.py
@@ -42,6 +42,7 @@
 os.environ["ORTHANC_PACS_URL"] = "http://localhost:8045"
 os.environ["ORTHANC_PACS_USERNAME"] = "orthanc"
 os.environ["ORTHANC_PACS_PASSWORD"] = "orthanc"
+os.environ["OTEL_SDK_DISABLED"] = "true"
 os.environ["PRIMARY_DICOM_SOURCE_MODALITY"] = "UCPRIMARYQR"
 os.environ["PRIMARY_DICOM_SOURCE_AE_TITLE"] = "PRIMARYQR"
 os.environ["SECONDARY_DICOM_SOURCE_MODALITY"] = "UCSECONDARYQR"
diff --git a/test/conftest.py b/test/conftest.py
index 9d6f3c29e..b238a0018 100644
--- a/test/conftest.py
+++ b/test/conftest.py
@@ -30,6 +30,7 @@
 os.environ["PIXL_DB_USER"] = "pixl_db_username"
 os.environ["PIXL_DB_PASSWORD"] = "pixl_db_password"
 os.environ["PIXL_DB_NAME"] = "pixl"
+os.environ["OTEL_SDK_DISABLED"] = "false"
 os.environ["OTEL_EXPORTER_OTLP_ENDPOINT"] = "http://localhost:4317"
 os.environ["OTEL_RESOURCE_ATTRIBUTES"] = "service.namespace=pixl"
 os.environ["OTEL_SERVICE_NAME"] = "pixl-cli"