Mareeni Raymond is a GP Partner at The Heron Practice in Hackney, London, with a passion for holistic, community-focused care. She was employed by NHS North East London ICB as a Clinical Lead for Net Zero.
In response to the NHS commitment to reach net zero by 2040, how can primary care align clinical practice with environmental sustainability?
In 2024, City and Hackney Integrated Care Board (ICB) Primary Care Team and the City & Hackney Integrated Primary Care Community Interest Company (CIC) took a practical approach by embedding the RCGP Green Impact for Health (GiFH) Toolkit1 into the Local Enhanced Service (LES), under the medicines management domain.2 By the end of the year, 29 practices had engaged with the toolkit, the majority achieving formal recognition.
I was employed by North East London integrated commissioning board as a clinical lead for Net Zero.* Part of my role was to gather evidence of how the practices adopted the GiFH toolkit in the City and Hackney area. Participating practices were required provide reflections on their experience of using the toolkit and their plans for the practice to make further carbon reductions in the following year. These requirements were added to the Clinical Commissioning Engagement (CCE) tracker which is a spreadsheet available to all practices engaging in the Local Enhanced Service. The spreadsheet details the requirements for each domain that need completion before end of year payment. What follows is a commentary on the excellent uptake of the toolkit and reflections we received . Further details about the initiative are available from City and Hackney Confederation and NHS North East London2,3 and nationally.4,5 I hope that practices, commissioners and policymakers in the UK and beyond will see that greener practice is achievable and that good practice can be shared.
Prior to the LES integration, only one practice in the area had engaged with the toolkit. Adoption at scale resulted in measurable operational changes. Practices reported initiatives such as moving to digital documentation, reducing paper waste, switching to rechargeable batteries, and eliminating single-use plastics.
A number of practices made improvements to infrastructure, installing motion sensor lighting, LED bulbs, or solar panels.
“All previous documentation that was available in paper form has been moved online and is no longer printed,” noted one practice. Another stated: “Recycling bags are now available throughout the practice, and we have eliminated the use of plastic cutlery.”
A number of practices made improvements to infrastructure, installing motion sensor lighting, LED bulbs, or solar panels. “Air source heat pumps reduce our reliance on gas and lower our carbon footprint,” reported one team. Another added: “The entire garden has been designed with the use of eco products to attract bees and wildlife.”
Sustainable Prescribing
Sustainable prescribing was a prominent focus. Many practices reviewed inhaler use, replacing metered-dose inhalers (MDIs) with dry powder inhalers (DPIs) where clinically appropriate. “Our pharmacy team have taken the lead on environmentally friendly inhaler prescribing and swapped all prescriptions over where clinically applicable,” said one practice. Another reported: “The practice has changed its policy; first-line prescribing for any inhalers are DPI inhalers.”
These changes reflected not only environmental intent but clinical engagement with the carbon footprint of medicines, which remain the largest contributor to emissions in primary care.
Team Engagement and Motivation
The toolkit was seen by many as a helpful structure for engaging the wider team. Practices described the process as “insightful,” “productive,” and “empowering.” Several reported that involving administrative and clinical staff improved morale and fostered shared ownership.
“It has promoted collective responsibility across our team,” one practice noted. Another reflected: “Staff have benefited from learning about and increasing their knowledge on a range of green topics.”
For some, the toolkit led to changes in governance structures. “We have implemented a segment in all staff meetings to include monthly discussions on the Green Toolkit,” reported one team. Another stated: “Ensure climate action remains a standing agenda item at practice meetings.”
Barriers to Implementation
Despite strong engagement, several practices highlighted barriers. Infrastructure and building constraints were common. “Energy saving has been more difficult due to limitations in what we can achieve with the landlord,” one practice noted. Another added: “Some suggestions were unfortunately unfeasible, particularly regarding building management (as we are based in a Grade II listed building).”
Time was another recurring issue. “Completing the actions requires a significant investment of time and effort,” one team commented. Several practices identified a need to improve monitoring of environmental data. “We aim to get a clearer breakdown of gas, electricity, and water usage,” said one. Another planned to “monitor energy use outside of normal business hours to address avoidable consumption.”
Future Ambitions
Many practices expressed intentions to build on their progress. Plans included forming dedicated “green teams,” increasing staff carbon literacy, integrating sustainability into clinical training, and aiming for higher-level toolkit awards.
“We are in the process of forming a green team to work towards the silver award,” said one practice. Another committed to: “Ensuring that at least 50% of our staff complete carbon literacy training.”
The toolkit prompted action, improved awareness, and in many cases, fostered a collective sense of purpose.
Some are considering expanding telehealth, promoting active travel, and switching to eco-friendly suppliers. “We plan to focus on reducing transportation-related emissions by encouraging and supporting public transit options for staff,” reported one. Another summarised their direction as: “We are on a mission to improve on the many areas that we have already addressed and make our surgery a beacon of environmental sustainability.”
Reflections
This experience highlighted how structured, supported initiatives can generate cultural and operational shifts within general practice. The toolkit prompted action, improved awareness, and in many cases, fostered a collective sense of purpose. The involvement of Net Zero clinical leads, alongside strong commissioner engagement, was instrumental in the success of this initiative.
However, the model may not be easily replicable in areas where such support to include it in the LES or GP partners is lacking. Furthermore, the toolkit’s checklist approach, while useful, may not capture the depth or consistency of change, particularly where audit is absent.
Nonetheless, the shift in culture reported by many practices—from isolated awareness to integrated action—is notable. For the NHS to meet its environmental commitments, further work is needed to understand and address the barriers to participation. Funding, time, and local leadership remain essential.
Deputy Editor’s note – see also these related articles from BJGP Life:
- https://bjgplife.com/going-greener-the-story-of-our-success/
- https://bjgplife.com/how-to-be-a-triple-bottom-line-tbl-general-practice-working-for-profit-the-people-and-the-planet/
- https://bjgplife.com/gp-carbon-calculator-making-it-easier-to-support-the-nhs-net-zero-ambitions/
- https://bjgplife.com/book-review-environmentally-sustainable-primary-care-good-for-the-planet-good-for-practices-good-for-patients/
- https://bjgplife.com/environmentally-friendly-inhalers-issues-for-the-general-practice-consultation/
* Authors note: With particular thanks to Amaia Portelli, Russell Barnes-Heath, Howard Yoo Hyun Chae, and Rebecca Waters for their support of this initiative.
References
- https://toolkit.sos-uk.org/greenimpact/giforhealth/login [accessed 19/6/25]
- https://primarycare.northeastlondon.icb.nhs.uk/home/green-primary-care/ [accessed 19/6/25]
- https://northeastlondon.icb.nhs.uk/publication/green-plan/ [accessed 19/6/25]
- https://greenimpact.nus.org.uk/green-impact-for-health/ [accessed 19/6/25]
- https://s40639.pcdn.co/wp-content/uploads/2024-Summary-of-Primary-Care-Net-Zero-and-Climate-Emergency-Work-by-Integrated-Care-Boards-in-England.pdf [accessed 19/6/25]
Featured Photo by Aniket Bhattacharya on Unsplash
