Tips for greener general practice

Taking the initiative to tackle climate change can help improve people’s health both now and in the future – and can benefit practices. Dr Aarti Bansal explains where to start if your practice wants to go green 

This is an edited version of an article first published by Medeconomics

The climate crisis is a health crisis. Climate change affects the fundamental determinants of health through its impact on food availability, water and air quality as well as causing excess deaths through heat, extreme weather and increases in vector-borne disease.

Acting on climate change not only reduces the risks of future impacts, it also improves health now.  For example, reducing fossil fuel use reduces air pollution, which benefits our health now as well as mitigating climate change.

An environmentally sustainable diet, low in animal products and high in vegetables, enables a growing population to be fed, encourages re-wilding of the land and is also a healthy diet. This is why the 2015 Lancet Commission on Health and Climate Change called action on climate change the ‘greatest opportunity for public health in the 21st century’.

First steps for practices

Many GP practices are interested in becoming more green and sustainable. You will be able to achieve a great deal more if the whole practice team is motivated and understands how action on climate change is essential to our health and wellbeing.

On the Greener Practice website, there are some excellent, two-minute videos which explain the link between climate change and health, and the multiple co-benefits on health of taking action now. You could provide a link to the Greener Practice website on your own practice site to make your commitment to sustainability visible, while also educating your patients of the link between climate action and health.

The Centre for Sustainable Healthcare also has a primary care network with useful resources for practices and a forum for people to ask questions. Terms used to describe healthcare that acts on the climate crisis which you could search for include ‘sustainable healthcare’ and ‘planetary health’.

Here are my ten top tips to get you started.

Take part in the Green Impact Audit for Health

The Green Impact Audit for Health toolkit has been developed by GPs and advises practices on actions that can be taken towards environmentally sustainable clinical practice. Actions are wide-ranging, from reducing waste to increasing social prescribing. It’s easy to get started and practices get a ‘working towards accreditation’ certificate for taking even one action, and can progress to gain bronze, silver and gold awards. Anyone can ’test drive’ the site before registering using the login [email protected] and password testtoolkit.

Nominate a climate champion

This person can then report progress and challenges at every practice meeting, where action on planetary health should be a standing item on the agenda.

Promote active travel

Walking or cycling to work reduces air pollution (which the Royal College of Physicians estimates is responsible for 40,000 premature UK deaths every year) and has huge benefits on physical and mental health. Practices can enable active travel by, for example, installing cycle racks to help staff and patients travel by bike and obtaining an e-bike to enable staff to travel to home visits quickly. By demonstrating active travel we act as exemplars for our patients. For those staff and patients worried about their safety on a bike, practices can consider signposting to cycle proficiency training, which may be available free through your council.

Consider switching to green inhalers during annual reviews

The propellants in metered-dose inhalers (MDIs) are greenhouse gases 1,000 times more powerful than carbon dioxide. MDI inhalers contribute to 4% of the NHS carbon footprint. Dry powder inhalers (DPI) have a dramatically lower carbon footprint and research shows that, for many patients, they can be just as effective at a similar cost. In the UK, 80% of all patients are on MDIs compared with Sweden where only 10% are on MDIs. NICE has produced a decision aid for practice nurses and patients to consider together whether swapping to a DPI is the best option. There is also an excellent, patient-facing website called Green Inhaler, which is written by a respiratory consultant, which you can link to from your practice website.

Refer patients in fuel poverty

A 2019 government report estimates that 10.9% of the UK population are living in fuel poverty, which is linked to cardiovascular and respiratory disease. Supporting patients in fuel poverty to insulate their homes reduces energy bills and improves health. Your community support worker may identify local charities that support patients in this situation.

Signpost to green prescribing

There is increasing evidence of the benefits of both social prescribing and time spent in nature on mental and physical wellbeing. Green prescribing aims to combine these benefits by signposting patients to social activities involving time spent in nature, such as gardening and guided walks.

Switch to renewable energy

Consider using a comparison site to guide a switch to a 100% renewable tariff. 

Do a sustainable quality improvement project

Quality improvement is part of GPs appraisal process and expected of practices. If you are a teaching or training practice, quality improvement projects may be part of the training requirement of GP registrars and medical students. Consider doing a QI project on environmental sustainability – you could choose one of the areas above. The Centre for Sustainable Healthcare has some useful downloadable resources and offers training. 

Work at primary care network (PCN) level

This may be the best place for pooling resources and energy and for supporting a green mindset across many practices. Money invested at this level can be used more strategically to develop projects on all the actions listed here. PCNs can support initiatives such as pocket gardening (creating small garden areas), e-bike schemes for chronic disease patients, recycling, discounts for a block renewable energy contract, etc. 

Advocate for climate action

We are trusted professionals with a responsibility to improve and protect our patients’ health. We can support the case for urgent climate action by communicating the health impacts of climate change, the need for climate adaptation and advocating for health to be at the centre of policymaking on climate change at local, regional and national levels.

These are just a few suggestions and there are many other actions that can be taken from a personal to national level. The important thing is to take a first step, and enjoy the journey. You’ll find many people who willing to join you in your efforts.

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