The NHS aims to be the world’s first net zero national health service. Download a copy of ‘Delivering a ‘Net Zero’ National Health Service’.
This aspiration is in recognition that the climate crisis is a health crisis https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health and that tackling climate change offers health co-benefits https://www.bmj.com/content/375/bmj.n2707.full.
Primary care, being responsible for 23% of the carbon footprint of the NHS, clearly has a role to play in delivering this important ambition https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30271-0/fulltext.
GM Primary Care Sustainability Group
A multidisciplinary group is working on developing and delivering on primary care sustainability in Greater Manchester. Seven initial workstreams were identified after workshops run with the support of the GP Excellence programme where the carbon footprint of primary care was considered.
- Inhaler prescribing
- Communications and engagement
- Staff and patient travel
- Primary care estate
- Social prescribing
- General prescribing (non inhaler)
Developing the GM Green Plan
Given the pivotal role that Integrated Care Systems (ICSs) play, each system will also need to develop its own Green Plan, based on the strategies of its member organisations. The GM Green Plan is now being developed, which will include plans for primary care.
How to produce a Green Plan: A three-year strategy towards net zero explains how NHS organisations should construct their Green Plans.
If you have any ideas, thoughts, comments or inspiration about how to move Primary Care in Greater Manchester closer to Carbon Zero, we would love to hear from you GM.firstname.lastname@example.org.
Inhaler prescribing workstream
The large impact of inhaler prescribing has prompted focusing on this area for early action. Working with Greater Manchester Medicines Management Group (GMMMG), community pharmacy, primary and secondary care staff a greener inhaler strategy is being developed.
An updated COPD guideline has been developed and is available https://gmmmg.nhs.uk/wp-content/uploads/2021/11/COPD-Treatment-Guideline-Nov-2021-V7.1.pdf.
Download the Greener Practice guideline How to reduce the carbon footprint of inhaler prescribing? A guide for healthcare professionals.
Data on inhaler prescribing as per PCN IIF targets in now presented on the Greater Manchester Tableau Dashboard. You can see how CCGs compare, you can then drill down to practice level on the two IIF targets. You can then highlight a PCN from the list of CCG practices and if you hover over practice you can see the trend.
There is also data about SABA prescribing so you can see what type of inhalers a practice is prescribing e.g. lots of generic SABA (which often ends up being dispensed as Ventolin).
Low carbon inhaler tableau data https://www.gmtableau.nhs.uk/t/GMHSCPPublic/views/LowCarbonInhalers/HomePage
To request a new Tableau account visit
Greener inhaler prescribing
Watch the quick and fun educational videos on greener inhaler prescribing, produced by Dr Mike Poplawski a GP in Salford through support from Salford CCG Innovation & Research Fund.
Climate crisis explained
Green inhaler prescribing
How to do an asthma medication review
Further local resources are being developed and will be shared here. There are some excellent national guidance and resources available from Greener Practice that have been approved by NHS England and NHS improvement inhaler working group https://www.greenerpractice.co.uk/high-quality-and-low-carbon-asthma-care
Improving inhaler technique through Community Pharmacy
The ‘Improving Inhaler Technique through Community Pharmacy’ service is a GM-commissioned service which targets all patients receiving inhaled medication for asthma or COPD.
The pharmacist or pharmacy technician will target patients with prescriptions for inhalers and provide an initial inhaler review, including an assessment of current technique and demonstration of correct technique as appropriate, CAT or ACT score and use of the In-Check device. They will assess the patients’ disease control and provide health promotion information (e.g., stop smoking advice).
Improved patient outcomes through:
- Assessment of inhaler technique
- Improved patient understanding and hence adherence with inhaler therapy
- Optimum use of inhaler therapy
- A reduction in adverse events associated with inhaler treatment
- Ensuring that patients who smoke are offered appropriate advice with regard to stop smoking
Reduction in waste of inhaler therapies through:
- Improved inhaler technique and improved use of therapies, leading to a reduction in wasted doses
- A possible reduction in prescribed inhalers for poorly controlled conditions
- Patients being encouraged to order only the prescription items that they need
GM Greener Practice Group
The Greater Manchester Greener Practice Group is for workers in primary care dedicated to providing healthcare in a more sustainable and environmentally friendly way.
We are a friendly group meeting every 8 weeks on zoom and have an active WhatsApp group. If you are interested in joining please contact: GM.email@example.com.
Greener Practice Network
Engaging General Practice in actions for the health of patients and planetGreener Practice Network
Greener Practice is a primary care climate and sustainability network which recognises that the climate and ecological crisis is the leading public health issue of our generation. Read more about the network
Access recordings and learning resources from the ‘Green Prescribing for Sustainable Healthcare: from policy to practice’ event.
The Environmentally Sustainable Healthcare elearning programme designed to equip healthcare workers with the knowledge and skills they need to deliver healthcare that is financially, socially, and environmentally sustainable.
Sustainability in Quality Improvement
The Sustainable Quality Improvement (SusQI) Framework is a practical tool to drive incremental change towards a more ethical, sustainable health system.
In SusQI, the health outcomes of a service are measured against its environmental, social and economic costs and impacts to determine its “sustainable value”.
SusQI embeds the CSH principles of sustainable clinical practice: prevention, patient empowerment and self-care, lean clinical pathways and low carbon alternatives.
Including sustainability and resource stewardship in QI allows health professionals to respond to ethical challenges such as climate change and social inequalities. It also benefits the QI process itself: inspiring new energy for change, highlighting wastes and opportunities otherwise overlooked, and directing projects systematically towards the highest value improvements.
Find out more at https://www.susqi.org.