In their new strategy, under “Prioritising people and communities” the CQC list environmental sustainability as one of the metrics that they will mark services on. In the coming months, it is expected that CQC inspections will look to practices and PCNs to increasingly evidence their Corporate Social Responsibilities (CSR) and green credentials. Common to both is the concept of sustainability. But amidst all the other pressures that GP practices are under and many other competing priorities, why is the ‘green’ agenda so important?

CSR activities can be linked closely to green initiatives. When we help create healthy, pleasant spaces in communities for people to play sport in or relax in, we also help the environment. Where we help to promote these local spaces, whether through social prescribing or other information campaigns, we help to maintain their positive impact on the environment, and on our patients’ health.

GP carbon footprint

The impact a GP surgery can have on the environment comes not just from the resources used on the premises such as supplies made of paper or plastic, but also the cost of running equipment and transporting supplies, food, drink and people from one place to another. There is also the cost of heating and water usage. The following pie chart from the BMA shows the different sources of carbon emissions:

Masking the problem

Masks have been a literal life-saver recently, but they also have a rather more unseen environmental cost. Along with other Personal Protective Equipment (PPE) like gloves and gowns, masks can find their way into streams and rivers, can choke animals, spread pathogens and clog our sewage systems. If they contain plastic then they may also be very hard to recycle, and risk taking many decades to degrade. Reusable masks are clearly one way to reduce the problem, but using heat and bleach to sterilise masks is not without cost.

Manufacturing masks creates carbon; N95 masks release 50 g CO2-eq per single mask, excluding transportation (Klemeš et al., 2020a). Cloth mask production contributes about 60 g CO2-eq greenhouse gas emission per mask, which might seem small, but is huge when you imagine the sheer number of masks produced every day around the world.

Using and disposing of these masks creates waste, largely unrecyclable; a UK study found that if each person uses one disposable surgical mask every day for a year, together they will create 124,000 tons of unrecyclable plastic waste (Ayse et al., 2020).

Greener is leaner

There are many benefits to being an environmentally friendly practice with an eye on your carbon footprint. Not only can you help save the planet, and your patient’s health, but you can also ‘lean’ your practice’s finances and save money too. Consider these benefits:

• Immediate health benefits: choosing not to use a car immediately puts less pollutants into the atmosphere and has a direct effect on chronic diseases like asthma. Eating healthily today helps prevent chronic disease right now. And we all know the benefit of walking or resting in a green space—even more important throughout the pandemic.

• Future health protection: the less we impact on our environment and put harmful things into it, the more we guard against a future where our children and their children suffer from extreme weather, new and virulent diseases, food poverty and poor water quality.

• Reduces health inequality:a less obvious (but equally important) benefit to greener lives is how it helps the poorest in society. If we invest more in reliable, cleaner forms of domestic energy, the poorest in society are no longer disadvantaged and the current debate many have to grapple with at the moment—heating or eating—is consigned to the past.

• Saves money and reduces workload: if our communities are greener and our patients are healthier, they travel less to seek healthcare, and use fewer medicines and resources, thus reducing costs and workload.

So what are some tangible things you can do in your practice to be greener? The BMJ recently listed the following 6 steps towards a greener GP practice:

1. Prudent Prescribing: you might be surprised to hear that two thirds of general practice’s carbon footprint actually comes from prescribing. That’s why it’s important to try and avoid unnecessary prescriptions, and be mindful that certain specific medicines have higher environmental impact than others; metred dose inhalers contain greenhouse gases, whereas dry powder inhalers don’t.

2. Responsible Referrals: choosing when and where to refer a patient is good medical practice but it also has a positive environmental benefit. Rapid diagnostic centres (RDCs) aim to improve outcomes for patients by delivering faster diagnosis and treatment, while also significantly increasing efficiency, and reducing carbon emissions. Analysis suggests that these RDCs could help avoid some GP consultations.

3. Connecting communities: Enabling access to help and activities within a community is another way of increasing health, connecting people, and has the bi-product of creating environmentally friendly spaces such as parks.

4. Identifying inequalities: climate change affects poor people more than the wealthy—we need to start addressing the inequality here, for example by insulating cold homes and helping with energy bills, with more help to be energy-efficient. Warmer, safer homes can reduce the need for GP appointments associated with things like respiratory illnesses.

5. Empowering patients: If patient feel empowered to choose different ways of accessing their care, such as online appointments, then we can also cut down travel and carbon emissions, (though clearly e-consultations are not suitable for everyone and decisions must be taken on a patient-by-patient basis).

6. Respected role-models: we need to use the respected and trusted profile that GPs and practice staff have in society, so that patients see their medical professionals embracing the green agenda and being mindful of their carbon footprint, and they are inspired to do likewise in their own lives. Be seen to be green and your patients—and your local environment—will thank you.

There are many other things that primary care in general can do to be more environmentally sustainable. These include implementing carbon literacy training modules, increased use of social prescribing for management plans, return schemes for re-usable medical equipment, more remote working for staff to reduce travel emissions, and better insulation and standard of premises to make them all carbon neutral by 2030. Finally, consider supporting the Green Impact programme - a really easy way for your practice to move towards environmentally sustainable practice is to use the Green Impact for Health Audit created by the RCGP and NUS.

Pharmaceutical companies, too, should assess the total environmental impact of all their medicines and display that clearly. Medication recycling schemes should be used to reduce waste and make it easier for patients to dispose of them safely.

Want to know more?

You can check your personal carbon footprint at the following link using the WWF’s calculator. Small businesses can try this carbon footprint calculator, or visit the Energy Saving Trust. To find out more about The Green Practice Network, email greenerpractice@gmail.com. And don’t forget Earth Day, on April 22^nd this year!