View from the ground, by Dr Vasumathy Sivarajasingam
The climate emergency is one of the biggest public health threats that we have ever faced. In the time since the COVID-19 pandemic began, we have moved 1 year closer to the 2030 deadline to halve, and the 2050 deadline to reach, net-zero carbon emissions.1 The NHS is currently responsible for more than 5% of the UK’s carbon emissions;2 however, it aims to become the world’s first carbon-neutral national health system by 2040.3
At the front line of patient management, general practice is ideally placed to introduce changes to become more environmentally sustainable.4 In July 2020, I introduced the ‘Hillview Going Greener’ initiative, which aims to raise awareness of the importance of carbon footprint reduction, and to implement measures to help tackle climate change. Through regular discussions with staff, we hope to identify ways to reduce our carbon footprint at Hillview, and have introduced ‘climate champions’ to help facilitate dialogue and take any practical ideas forward.
Initially, we introduced recycling of non-clinical waste at the practice. Clinicians are responsible for shredding any waste paper that contains confidential information. All other recyclable items are disposed of in recycling bins placed throughout the building. As a practice, we also recycle printer and toner cartridges, print only when necessary, and photocopy double-sided, with two pages per side. In addition, we encourage staff to switch off lights, computers, equipment, and air conditioning when not in use, and to limit dishwasher use.
Our next step was to look at the carbon footprint of the most commonly used inhalers. Using NICE’s decision aid tool,5 we discussed different inhaler types and the feasibility of using inhalers with a low carbon footprint. We aim to review our inhaler prescribing habits without compromising clinical care; our clinical pharmacist updated our medication review guide accordingly, and it now includes inhalers with a low carbon footprint. We continue to educate patients about appropriate inhaler use to prevent wastage, particularly the use of inhalers that do not have a dose counter. We are also considering switching to stronger inhalers with fewer doses to further reduce carbon emissions and wastage and to improve compliance.
To educate patients on how to safely dispose of their unused medications—including inhalers, used or unused—we displayed posters in waiting rooms and posted information on Twitter and the surgery website. We also emailed local schools, pharmacists, and community paediatric asthma nurses to explain the relationship between inappropriate inhaler disposal and carbon footprint, and to encourage patients and carers to return inhalers to the pharmacy for safe disposal.
Only 16% of patients take new medicines as prescribed by healthcare professionals,6 so our discussions have also centred around alternatives to medicine and promoting a healthy lifestyle. We have published information on our surgery website about self-care and lifestyle measures, a positive strategy for reducing waste and the costs of overprescribing and medical interventions. We also refer patients to a social prescriber whenever appropriate, and aim to invest in green social prescribing.
To reduce the environmental impact of travel, the practice introduced a ‘total triage’ model during the pandemic, which improved patient access and reduced travel to the surgery, with remote consultations available via video, telephone, and online. The majority of administrative tasks—including requests for prescriptions, test results, and fit notes—are handled via email. We aim to continue with this model post-COVID to deliver better patient care and to reduce travel to the practice.
The option to work from home, as appropriate and depending on the needs of the practice, is valued by our staff, and we plan to continue staff, practice, and partner meetings via Zoom whenever possible in future. Reducing travel is an important part of reducing carbon footprint; consequently, we introduced the Government-supported ‘cycle to work’ scheme, which has added benefits for staff wellbeing.
This initiative has brought the whole practice together as ‘one Hillview team’. With the support of our patient participation group, we hope to continue reducing the carbon footprint of Hillview Surgery, in addition to improving patient care and wellbeing, reducing GP workload, and improving finances.
Our belief is: ‘If it’s good for the planet, it’s good for you too!’
Dr Vasumathy Sivarajasingam
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- United Nations website. Key findings. www.un.org/en/climatechange/science/key-findings#:~:text=Global%20net%20human%2Dcaused%20emissions,removing%20CO2%20from%20the%20air (accessed 30 April 2021).
- Bawden A. The NHS produces 5.4% of the UK’s greenhouse gases. How can hospitals cut their emissions? www.theguardian.com/society/2019/sep/18/hospitals-planet-health-anaesthetic-gases-electric-ambulances-dialysis-nhs-carbon-footprint (accessed 30 April 2021).
- NHS England and NHS Improvement. Delivering a ‘net zero’ National Health Service. London: NHSE&I, 2020. Available at: www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf
- Green Impact for Health. Welcome to Green Impact for Health. www.greenimpact.org.uk/GIforHealth (accessed 30 April 2021).
- NICE. Patient decision aid: inhalers for asthma. NICE, 2020. Available at: www.nice.org.uk/guidance/ng80/resources/inhalers-for-asthma-patient-decision-aid-pdf-6727144573
- Royal Pharmaceutical Society. Medicines optimisation: helping patients to make the most of medicines. London: RPS, 2013. Available at: www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Policy/helping-patients-make-the-most-of-their-medicines.pdf