Primary Care Networks (PCNs) across Gloucestershire are working to reduce their environmental impact. PCNs are made up of groups of GP practices working in partnership with community, mental health, social care, pharmacy, hospital and voluntary services in their local area.

Wendy Tyler-Batt, Clinical Pharmacist and Sustainability lead for TWNS PCN (Tewkesbury, West Cheltenham, Newent & Staunton) explains how through a variety of initiatives, from prescribing inhalers containing less greenhouse gas propellant, looking at lifestyle changes before prescribing medication, to reducing paper and electricity use, Gloucestershire’s health community is leading the way in greener health and care.  

In October 2020, the NHS became the world’s first health service to commit to putting no more greenhouse gases into the atmosphere than it was removing by 2040-45. This is described as ‘carbon net zero’. This was in response to the profound and growing threat to our health and the health of the planet as a result of climate change; the climate crisis is a health crisis.

There are many greenhouse gases which are being produced in excess and cover the earth like a blanket causing temperature rises with consequent droughts, melting of the ice caps, floods and adverse weather.

Both the Greener NHS and our own organisation’s ‘green plan’ have influenced and encouraged more sustainable healthcare. We talk about these in terms of 4 principles:

  1. Preventing ill health
  2. Helping people look after themselves to stay healthy
  3. Trying to have more efficient systems
  4. Looking at products and services which have lower carbon emissions, commonly referred to as the ‘carbon footprint’.

The carbon footprint of GP surgeries

Medicines are a major consideration for principle 4 as they are about a quarter of the NHS carbon footprint and mostly (75%) prescribed in GP surgeries; and a significant proportion is from the metered dose (aerosol) inhalers.

Wendy said: “We are changing our practice in inhaler prescribing to start off with dry powder rather than an aerosol inhaler where this is also the best option for the patient; and research has shown that most people can use, and get better control of their condition, using a dry powder inhaler.

“Gloucestershire GP practices have been highly successful in reducing inhaler greenhouse gases and we are at the top of the table in England for reducing the carbon emissions for salbutamol  (blue) inhalers. This is something to be celebrated particularly with our patients.

“There is no reason to believe that Gloucestershire will not continue to be a trailblazer in carbon footprint reduction with better health for patients.

“It is also important that people know to take their empty and unwanted inhalers (as well as all medication) back to the community pharmacy for safe disposal to minimise environmental pollution and escape of remaining greenhouse gas propellants. There is no inhaler recycling scheme currently.

“I use the resources on the  Greener Practice website to support my practice.

“There are other things we can do to be healthier and reduce waste and environmental impact:

  • Only order medication that you need,
  • Check your prescription bag before you leave the pharmacy; if you return an item before you leave the pharmacy, the medicine can be reused
  • Let your pharmacy team know if you have stopped taking a medication.”

Wendy is an advocate of ‘health creation’:

“Putting patients at the centre of discussions so that they can make informed choices about keeping healthy and taking control of their own lives, including alternatives to medication, is empowering for them and positive for the environment. It is often the case that the best therapy is also the one with the lowest carbon footprint; a win win for people and the planet,” she said.

NHS Gloucestershire has also supported primary care for the last 2 years in a sustainability initiative to take a mix of clinical and non-clinical actions to raise awareness of and help reduce their carbon footprints. 97% of GP practices participated and 60% also enrolled in the Green Impact for Health award accreditation scheme, which lists more than 100 actions to improve environmental sustainability. These include tips on how to consume less and waste less.

The toolkit contains 25 actions focusing on themes within sustainability such as food and drink, governance, learning, news and communications, prescribing, social prescribing, travel and exercise, waste and recycling, water and energy.

“The scheme helps GP practices in the UK improve their sustainability, reduce harmful impacts on planetary health, adapt to the risks of climate change and reduce practice expenses,” explained Wendy.

“So far five gold, three silver and four bronze awards have been given to Gloucestershire GP practices with more to follow.

“The aim of the scheme is not to have a few people trying to do everything perfectly, but instead to have most people doing something positive towards reducing climate change.”

Wendy is now busy planning the TWNS Health creation week from June 10 – 14 where there will be a focus on activities and information for both patients and staff across the 5 practices highlighting the many local resources and facilities available for healthier people and a healthier planet. Co-incidentally this is all also the national Great Big Green Week