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Clinical

group@greenerpractice.co.uk
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Introduction

Clinical covers clinical aspects of sustainable care including investigations and treatments.

Approximately 60% of the carbon emissions of primary care arise from our clinical work. The clinical actions that reduce our carbon footprint align with our existing health priorities and evidence-based, person-centred practice.

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Medicines

Prescribing contributes the largest carbon footprint of all our activities in General Practice.

  • Medicines wastage: The Royal Pharmaceutical Society estimates that between 30-50% of medications taken for long term conditions are not taken as intended. This is a potential risk to patients and places a huge carbon and financial burden (£300m/year) on the NHS. 
  • Overprescribing: About 10% of medicines are thought to be overprescribed: where people are given medicines they don’t need or want, or where harm outweighs benefits.  
  • Polypharmacy: About 1 in 5 people in the UK take 5 or more medicines every day and 40% feel burdened by their treatment. Taking multiple medications (polypharmacy) is particularly common in elderly people and increases the risk of adverse effects.  

Are there solutions?

  • Deprescribing & Medicines optimisation: Deprescribing is about reducing the burden of medications that are no longer beneficial. Medicines optimisation is about ensuring the right choice of medicine at the right time. A well-structured medication review can pay dividends. Here are some resources to get started, for more please visit our resource library.
  • Inhaler prescribing: Inhalers contribute 4% of the entire NHS carbon footprint so they need to be a key area of focus in primary care – Please see our High Quality Low Carbon Asthma Toolkit for more information.  

Over-diagnosis & over-testing

Excessive investigation increases health care cost, carbon footprint and is either not beneficial for patients or can even lead to harm. Organisations such as the BMJ (Too Much Medicine Initiative) and the RCGP (Overdiagnosis group) have looked at tackling this issue, and joined together to produce the Better Medicine report.  

Person Centred Medicine

Partnering with patients and supporting a focus on what matters to them can deliver health gains through patient empowerment and reduced harm and waste from unnecessary investigations, referrals and treatment. The ‘What matters to you?’ question has been incorporated widely across the NHS, and further useful resources can be found from the movements Choosing Wisely (originating from the the American Board of Internal Medicine) and Realistic Medicine (originating from NHS Scotland). 

Promoting Healthy Living

Enabling healthcare professionals to deliver lifestyle interventions has potential to benefit both people and planet. Healthy sustainable eating, physical activity, sleep, stress optimisation, connectivity to nature and social prescribing are all examples of low carbon health interventions with positive health impacts. For information and accreditation on Lifestyle Medicine in the UK, see the British Association of Lifestyle Medicine 

  • Diet: Whilst a population based approach to good public health messaging is likely to be much more meaningful and effective than individual patient interventions, clinicians can still support the principles of the The Planetary Health Diet .
  • Activity: A good way to promote physical activity amongst patients is to model it amongst the staff. The RCGP have launched the Active Practice Charter with simple 5 point measures to take and achieve the free accreditation. You can also become a Park Run Practice. Moving Medicine promotes and supports short conversations with patients on how activity supports a range of different health issues from amputations to dementia. 

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