The mission to make the NHS greener

IF healthcare was a country it would be the fifth largest carbon emitter in the world.

It’s a startling fact that lays bare the important role of global health leaders in the fight against climate change.

In 2020, the NHS became the world’s first health service to commit to reaching carbon net zero – but reports show that it still accounts for 5.4 per cent of the UK’s greenhouse gas emissions.

Primary care is responsible for a significant proportion of the NHS’ carbon footprint (almost a quarter of total NHS emissions in England), with the main culprit being prescribing.

While the task ahead may seem daunting, there are a number of innovative approaches that practices can take.

Benefits of going green

Advocates for a “greener NHS” are quick to emphasise that tackling climate change can have a direct positive impact on our health, not to mention saving the NHS money.

The Greener NHS campaign in England refers to a “climate health emergency” and cites examples of climate change health consequences, including:

• Air pollution (whose causes are often the same as climate change) is linked to conditions like heart disease, stroke and lung cancer, contributing to around 36,000 deaths annually.
• The impact of extreme weather events (which are becoming more frequent due to climate change). Flooding is connected to the spread of infectious disease in the UK, while heatwaves are also believed to be a factor in hundreds of excess deaths.
• The prediction that rising temperatures and emissions could lead to an increase in physical and mental conditions such as asthma, Lyme Disease, encephalitis and anxiety disorders.

How to make a difference

A key player in the mission to make general practice more environmentally friendly is Greener Practice – a virtual network of people across the UK encouraging action on sustainability in primary care. Its website hosts a wide range of information and practical resources to help practices “decarbonise”.

The Royal College of GPs has a dedicated climate change and sustainability page. This includes a link to its Green Impact for Health toolkit which offers a starting point to help practices:

• improve their sustainability
• reduce their environmental impact
• improve staff morale, learning and efficiency
• reduce costs.

It also contains a link to the College’s Net Zero learning hub, which offers eLearning materials on sustainable healthcare.

Greener prescribing

Around two-thirds of the carbon footprint in general practice is associated with prescribing, with much advice focusing on encouraging practices to reduce unnecessary prescribing. Such “medicines optimisation” is not only beneficial for the environment, Greener Practice argues, but it is regarded by the likes of NICE and the Care Quality Commission as being an important part of good patient care.

Inhalers

One of the biggest contributors to prescribing emissions is inhalers, which contain potent greenhouse gases. The carbon footprint emitted by just one metered dose inhaler (28kg) is roughly the same as the gas emissions of driving 175 miles in a small car.

Practices are encouraged to consider – where appropriate – using alternative options such as dry powdered inhalers which have a far smaller carbon footprint (1kg).

The Greener Practice website features an article by GP Dr Vasu Siva about her West London practice’s efforts to go greener by reviewing inhaler prescribing while continuing to optimise clinical care. Options discussed by the clinical team include switching patients to lower carbon devices, assessing whether patients could be given higher dose inhalers (fewer doses meaning lower emissions), and educating patients about appropriate use of their inhalers.

Dr Siva said: “We still have a long way to go in achieving our target, but we have made a good start – and every little change we can make helps.”

Greener Practice has also published an asthma toolkit which includes a guide for reducing the carbon footprint of inhaler prescribing.

Promoting healthy living

Another key theme from Greener Practice is the importance of “low carbon health interventions” where clinical teams look for ways to carry out more social prescribing – encouraging patients (where appropriate) to exercise more, eat healthily, consider outdoor or community activities and helping them manage stress or sleep problems.

According to the National Academy for Social Prescribing, almost a fifth of GP appointment time is spent on non-medical problems such as loneliness, isolation, relationship issues, or stress. It says social prescribing can boost patient wellbeing while also helping to take pressure off the NHS by reducing the need for GP appointments and for medical prescriptions.

Non-clinical emissions

Practices are also encouraged to look for ways to go greener in non-clinical ways. The RCGP’s guide Decarbonising general practice (PDF) offers advice and suggestions on a variety of areas, including:

• making practice buildings more energy efficient
• encouraging staff to ditch the car for a greener commute
• providing clearly labelled recycling bins in main areas
• correctly segregating waste to ensure recyclable items are not thrown away with clinical waste
• reducing avoidable plastic waste.

Balancing demands

As the health service faces unprecedented pressures and many teams battle exhaustion and burnout, the mission to make the NHS greener seems tougher than ever. But there are GP teams going above and beyond to fight climate change.

Colton Mill Medical Centre in East Leeds has talked about its #GoingGreen campaign to make a number of simple changes to their usual routine. These include:

• replacing plastic water cups with reusable glass cups (saving around £80 per month)
• recycling used batteries and ink cartridges
• turning off electronic devices (rather than leaving on standby) and lighting when not in use
• ensuring recycling bins are easy to access in the practice.

The practice’s digital officer Amy Kot also highlighted plans to review other practice systems, including looking for ways to reduce the number of hard copy patient letters.

She said: “By introducing the #GoingGreen campaign, it gets everyone into a routine of making environmentally friendly decisions, which they will hopefully also introduce at home. We are all enthusiastic at the practice to make some changes and to do our part for the environment.”

The British Medical Association (BMA) has called on UK governments to provide NHS organisations with more support to help them achieve sustainability goals.

“Progress in decreasing carbon emissions within the NHS appears to be stalling,” the BMA said. “The pandemic has required the NHS to prioritise protecting the immediate health of the population and service delivery. However, climate change poses a major threat to health and doctors are already seeing the impact of air pollution and climate change on patients.”

It called on governments to increase awareness of sustainability strategies and targets, to work to improve staff engagement and to ensure relevant funding is made available to NHS organisations.

And with the right support and resources, there is hope health leaders could make great strides in their mission to make the NHS greener.