As the largest employer in the UK, the NHS has a sizeable carbon footprint and produces up to 600,000 tonnes of waste a year – more than 1% of all domestic UK waste.
With this, however, comes the responsibility to reduce that footprint and pave the way to becoming more efficient, more sustainable, and ultimately, more environmentally friendly.
NHS England has vowed to cut more than 100 million plastic straws, cups and cutlery items a year, and while this is a step in the right direction, we need to do far more than this, and with greater urgency throughout our health system – including in clinical practice.
The BMA’s Sustainability and environmentally friendly general practice report lays this out at a community level, with a specific emphasis on general practice, and is part of a wider campaign to deliver carbon neutrality by 2030.
It argues that reducing the carbon footprint of practices will not only help to mitigate climate change, but that it can also potentially improve patient health, reduce workload, and ultimately, save not just money, but lives.
Many GP surgeries have started doing their bit by cutting office waste, installing eco-friendly lights, and even cycling to carry out home visits, but there must be a widespread shift in how we work if we’re serious about making the NHS greener.
According to the report, between 65% and 90% of the carbon footprint in general practice is associated with pharmaceutical prescribing – things like labelling items, switching from metered dose inhalers, reducing unnecessary prescribing, and the incorrect disposal of used medications.
Combined, these have a huge impact on the environment, but, as our report shows, there are ways to combat it. Some of this involves creating a consistent methodology to properly assess the impact of these things on the climate, but other changes can be made more swiftly, and many practices are already taking steps to do so.
For example, patients being offered dry powder inhalers, which have a reduced impact on practices’ and ultimately patients’ carbon footprints, and clinicians can do this using integrated online tools to help patients make decisions around limiting or stopping certain medications.
In the consultation room, how we use medical equipment and instruments is another area in need of a rethink.
Sterilising and reusing medical equipment was once commonplace in medicine, but with the rise of single-use plastics came the beginning of our current ‘throwaway culture’, with syringes, gloves, and aprons, to name but a few, all discarded after one use.
Of course, for safety reasons, there are some single-use items we can’t do without in the NHS, like IV drips, but many are unnecessary and ultimately contribute towards our growing climate crisis, ending up in landfill because they can’t be recycled or aren’t biodegradable.
Sterilising items or switching plastic instruments to metal or glass, however, could drastically cut how much waste the NHS produces and have a significant impact on the amount of carbon emissions generated by our health system.
Exclude all medical treatments though, and next the biggest impact on the environment in primary care is patient and staff travel.
If COVID-19 has taught us anything, it’s that there are alternative ways of working, and both clinicians and patients are gradually becoming more familiar with telephone and video consultations, which, where clinically appropriate, can not only help the environment, but are also more convenient for many patients and can support flexible working for practitioners.
It could also free up the time spent travelling to and from a home visit, which in some areas of the country can be considerable.
As communities become more comfortable with the use of remote consultations, many will want to continue this beyond the lockdown, including clinicians and practice staff who, as we’ve seen, do not always have to travel into work to carry out consultations.
It’s clear that this is only the start and there is a lot of work to do in making general practice – and the wider NHS - truly environmentally friendly, but the COVID-19 pandemic has shown us what we’re capable of.
Fundamentally this needs backing by government and so we, the NHS, and the government must now stay committed to reforming these elements of primary care, not only for the sake of our patients, but also the planet.
Dr Richard Vautrey is the BMA's GP committee chair and a GP in Leeds