Non-clinical

Introduction

Non-clinical covers the carbon and environmental impacts of all the elements of our workplaces and jobs which are not directly clinical. For example, energy, patient and staff travel and procurement of other goods.

Carbon Footprinting

A carbon footprint measures the total greenhouse gas emissions caused directly and indirectly by a person, organisation, event or product – in this case the carbon emissions associated with the running of a practice and providing healthcare to our patients. Understanding this means that hotspots and priorities can be identified and progress measured.

SEE Sustainability is an organisation specialising in non-clinical decarbonisation and sustainability. It provides a free and easy-to-use online non-clinical carbon footprint calculator for General Practices in the UK as well as a host of other resources.  

Other Aspects of Planetary Health

The carbon footprint is just one element of the climate and ecological crisis. Planetary health encompasses other dimensions such as freshwater quality and supply,  air quality, biodiversity, ocean health and so on. Fortunately many of the actions  that reduce our carbon footprint also improve other aspects of planetary health, but in our drive towards carbon reduction it is important to be mindful of other planetary boundaries, and to do our best to improve these. You can find out more in our ‘Why’ section and Clinical Special Interest Group.

Energy

A typical non-clinical carbon footprint breakdown is shown below. As you can see energy use is the largest single component. Reducing energy wastage and, if possible, switching to a greener energy provider that utilises and invests in renewable energy are therefore very impactful things to do.

Travel

Travel by staff and patients contributes the second biggest carbon impact in primary care overall, and the benefits of reducing fossil fuel travel go well beyond just reducing our carbon.

There are a few considerations: 

1. Reducing Travel – In recent years there has been more development around home working for staff and offering remote consultations (where appropriate) for patients. With regards to remote consulting, The Nuffield Trust has produced an article outlining the issues, and the principles involved in finding the right balance of face-to-face and alternatives. There is also huge scope for reducing patient travel by streamlining services between primary and secondary care, to reduce unnecessary hospital visits; and other systems such as electronic prescribing.  
2. Active Travel – this can offer co-benefits for both staff and patients, but there are barriers. Consider installing secure bicycle storage and review availability of changing rooms/showers. Signing up to schemes such as the bike2work scheme is an easy way to encourage bicycle commuting. There is no cost to the employer, but unfortunately partners cannot take advantage of these schemes. To make it easier to sign up, we have created simplified guides for employers and employees available through our resource library. Your practice could also consider buying a bicycle or ebike for staff to use for visits. It’s worth considering contacting your local authority to see if funding or subsidised schemes exist or considering corporate sponsorship e.g. by a local ethical business.  
3. Electric vehicle (EV) offers for NHS staff- Fleet Solutions offer a salary release scheme on EVs for NHS staff. Whilst active travel is even better than using a vehicle at all, an EV can reduce your carbon footprint if your current vehicle has come to the end of its life. 

Buildings

Insulating your building reduces energy bills and carbon emissions. Low carbon energy generation, such as solar panels and air source heat pumps are also worth considering: 

• Retrofitting Insulation and Double Glazing. Please see this government guide to retrofitting internal wall insulation which may help if you are considering contracting a firm to do this. 

• Solar panels for practices. You will need to check with your mortgage provider if you own the premises, and if the premises are rented, you will need to arrange this via the owners of the building. There are community interest companies in several cities and regions which are keen to put solar panels on public buildings including GP surgeries through deals which will reduce your bills and generate electricity. Community Energy England or the Energy Saving Trust may be able to link you up. 

• Air Source Heat Pumps. Air source heat pumps are another option for providing renewable energy to your building. ‘Which’ have guides for more information on this.

Procurement

By making ethical and green choices about our procurement, we can have a significant effect on the ethics and sustainable practices of the whole supply chain.  

• Reusable equipment – Choosing reusable over single-use equipment is generally less environentally harmful. For example:
  • Reusable bins for sharps collection
  • Reusable type IIR face mask
  • Reusable diabetic pens for patients (information available in our resources library) 

• Wider scale procurement decisions – At a systems level, impacts can be even larger. For example, ‘single-use’ steel surgical instruments pose a particular problem. Local organisations like an Integrated Care System (ICS) could consider whether they can work with the providers of reusable surgical instruments to support a reusable instruments service for GPs.

Waste

Reduce

• Plastics – Care Without Carbon has a toolkit on how to reduce plastic waste along with many other excellent resources. A specific example is The Great Ormond Street “Gloves Off “ Campaign, which was very successful in reducing unnecessary glove use with many translatable resources 
• Medication – large amounts are requested uneccesarily which poses a safety issue, as well as an environmental and financial cost. See our clinical SIG for more information on schemes to address this. 

Reuse

• Alternatives – Is there a product alternative with lower impact? For example, Vagifem  has multiple applicators in the pack, whereas for the same cost Vagirux has a reusable applicator. Milex ring pessaries are reusable for up to 5 years providing they are checked at recommended intervals.  

• Medication boxes – We are keen to explore ways of overcoming the perceived infection control concerns with reusable monitored dosage systems. If you are aware of any innovations that could help us return to reusable packaging, please contact us – contact@greenerpractice.com 

Repair

• Calibrate-UK provide a wide range of repairs of medical equipment. If you want to keep down the costs of buying medical equipment, and help the environment at the same time.

• Seal Medical sells some reconditioned medical equipment at reduced cost. 

Recycling

• Blister pack recycling – These can be recycled with Terracycle, though unfortunately there is a cost currently. Some pharmacies (such as Superdrug and Boots) also accept blister packs for recycling, though they can only accept small personal amounts. 
• General recycling – Depending on the local arrangements with your council, many small businesses have to pay for doorstep recycling services. However it is now a legal requirement for workplaces to ensure safe disposal of recyclable waste including all food waste, and are obliged to provide workplace recycling of recyclable plastic, glass, paper, cardboard and metal. You might wish to consider paying for cardboard and paper recycling, as much cardboard waste is generated by goods deliveries in primary care. You could consider setting up recycling bins and taking turns to take non-contaminated plastic, aluminium and glass recycling home. All food waste must be separated. A compost bin in the practice garden could be used for apple cores and banana skins! Recycling providers (such as local authorities) are sometimes able to give group discount so some LMCs/federations have negotiated discounts for practices.

Donating

• Medical equipment and medication – Charities such as Mediaid can take unused equipment and re-use it in under-resourced countries. PharmAid is a charitable initiative that redistributes medicines information resources (such as BNFs) to pharmacists that need them. 
• Office equipment – Warp It is an organisation that facilitates donating or receiving second hand office equipment. This is a subscription based service (free for charities), so check if your local organisation is a member or would sign up to reduce financial and environmental costs to your organisation as a whole.

Waste Disposal

Though it is not very exciting, correct disposal is important! Disposing of waste in the wrong stream can mean things like hand towels go through clinical-grade incineration which is expensive and polluting. Making sure everyone knows what to dispose of where, and having clearly marked and convenient ‘default’ standard rubbish bins will help. There are a range resources available relevant to this in our resource library.