Vasumathy Sivarajasingam is a GP in West London and an Honorary Clinical Research Fellow at Imperial College London. She is also the North West London Primary Care Clinical Lead (Ealing Borough) for Green Agenda, Adult Mental Health, and Patient Engagement. She is on Twitter: @vasu27765631
The positive shift towards an understanding of the impact of climate change on health across nations is promising. Many of us are already taking steps in our personal and professional lives to improve our health now and in the future whilst reducing our carbon footprint.
Primary care teams, in particular, see many of the resulting health impacts (including health inequalities) in their consulting rooms. They can play considerable part in the problem of the climate crisis and can in many ways be the solution to this major public health threat, identifying health opportunities a long the way – actions taken to reduce climate crisis have substantial and immediate health benefits. Eating locally produced food can be cheaper, fresher, healthier and tastier; active travel reducing air pollution and increasing fitness level; spending time outdoors in nature and green spaces improving physical and mental health. Reassuringly, GP practices are increasingly focussing on how to make their practices more sustainable. This is of course a battle against time amid the soaring workload and plummeting workforce, which adds to the feeling of demoralisation.
The focus was mainly on inhaler changes, green travel, efficient appointment timings, recycling and medicine usage whilst celebrating achievements and learning from each other.
Here, I showcase how we support GP practices in Ealing to work towards becoming a ‘greener practice’ and sustainable healthcare.
To reduce carbon emissions across GP practices in Ealing and in line with the NHSE’s ambition of becoming the world’s first health service to achieve carbon-neutral by 2040,1 the Ealing Borough Primary Care Team adopted a leadership position and implemented the Green Initiative as part of the local primary care specifications (formally known as ‘The Ealing standard’), for the first time in April 2022. These specifications are designed to provide a quality framework for primary care. The aim was to inspire as many practices as possible to start making changes, in reducing their environmental impact and improving the health and well-being of their patient population.
The focus was mainly on inhaler changes, green travel, efficient appointment timings, recycling and medicine usage whilst celebrating achievements and learning from each other. We supported GP practices by sharing simple, bite-size practical tips and guidance on how to achieve these objectives via the weekly newsletters. Emails were sent reminding practices of their targets and to continue working towards our goals. Additionally, the tips and achievements were uploaded to the ‘local groups’ section (subsection ‘Ealing’)2 on the national GreenerPractice website,3 to share our learnings with the wider UK’s primary care sustainability network.
A total of 64 GP practices across Ealing Borough achieved the Green Initiative targets in 2022/23 … we recognise the benefits of a concerted effort.
A total of 64 GP practices across Ealing Borough achieved the Green Initiative targets in 2022/23. The activities included: switching over 50% of metered dose inhalers (MDIs) to dry powder inhalers (DPIs), switching 50% of patients from low-dose to high-dose MDIs (e.g. 100mcg to 200mcg) and switching current MDIs to lower carbon inhalers (50%); taking time to encourage patients to reduce car use travelling to practice, encouraging staff to use alternative forms of transport or car share; providing staff training around efficient appointment timings and encouraging patients to reduce the number of appointments they attend in person and to be efficient with booking review appointments; increasing paper recycling, reducing the amount of printing/encouraging double-sided printing; discussing lifestyle intervention before starting medication, reviewing repeat prescriptions for patients taking seven or more medications and assessing their need and if it could be reduced, using social prescribers to reduce medication usage, bulk text messaging to patients reminding about safe disposal of inhalers etc.
The Borough Sustainability Primary Care Team soon realised the importance of collaborative work with our communities, patients, partners and staff to take steps in tackling climate change. General practice plays a key role in driving behavioural changes within the organisation and with patients. This led us to develop the 10-point green plan for GP practices and their patients in December 2022, in partnership with North West London ICS Sustainability Team. We believe this would demonstrate to both the staff and patient population that their practice takes their health and future seriously. The proposal utilises the principles of sustainable healthcare and includes a working plan that facilitates the reduction in GP practices’ carbon emissions (clinical and non-clinical) while providing high-quality person-centred sustainable patient care. Throughout this plan, the significance of raising awareness amongst staff and the patient population is emphasized, as we recognise the benefits of a concerted effort.
For the second year, we incorporated the ideas from the 10-point green plan into the local primary care specification, Green Initiative (2023-24). Our goal is for the primary care team to reduce their environmental impact and embed sustainability into their daily work without imposing a considerable amount of additional work. Celebrating achievements, however small it seems is promoted as it motivates staff and keeps the momentum.
We believe these activities would improve holistic patient care and staff well-being, contributing to a happy, healthy and productive workforce which would fulfil the recommendations of the new GP contract. While improving staff morale and practice efficiency, it would also reduce GP workload and practice expenses (through improved population health and reduced prescribing) and health inequalities. This is fundamental in promoting sustainable healthcare given the uncertainties of future general practice.
https://www.england.nhs.uk/greenernhs/publication/delivering-a-net-zero-national-health-service/ [accessed 25/4/23]
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Mortimer F, The sustainable physician, Clinical Medicine 2010, Vol 10, No 2: 110–11 [accessed 25/4/23]