My Greener Practice Journey- discovering sustainable healthcare
I am a 53 year old GP and have worked in a practice with a high level of deprivation in Dundee for the last 21 years. I have always been fairly environmentally conscious in my home life but had never really thought too much about the impact of my work environment other than the obvious switching off lights etc. In March 2021 I finally got round to watching the David Attenborough “A Life on Our Planet” documentary and was both shocked and inspired. I started to consider what else I could improve at home. We already had solar PV, a biomass boiler and an electric car. We grew our own veg and ate fairly seasonal, veggie meals during the week (except when my carnivorous 18 year old son was at home when it was veggie twice a week!!). I signed up for ethical consumer and bought the book “How Bad are Bananas” by Mike Berners Lee. I started looking at household cleaning products and toiletries (I now make some of them which is easier than you’d think and much cheaper!). It was this that started me thinking about the emollients I prescribed at work.
First steps March ‘21
I began speaking to my wonderful partners about the documentary and things I was trying to change at home. We discussed switching to a green energy provider and greener business bank.
I also brought up the Green Agenda at our cluster meeting (we are in one of 4 clusters in Dundee and comprise 7 deprived practices) and discovered the Green Impact for Health award. We agreed we could work on this as a cluster quality improvement project.
Initially the practice pharmacist emailed around to ask if there was palm oil in the emollients we prescribed. This led to contact with the GP prescribing lead regarding emollients. He sent me a link to Grand Rounds on Climate Change and Health with Dr Nick Watts the Lead Author for the Lancet Commission Countdown and Munro Stewart the RCGP sustainability Lead for Tayside.
From a random thought about emollients the more I learnt the more horrified I became by the implications of climate change for health
Gathering Momentum
Having learnt about climate change and health I contacted the RCGP sustainability lead who came to speak at our next cluster meeting. I think we were all shocked but inspired by some of the information he imparted. We started having discussions about inhaler prescribing.
By May ’21 we had begun work on inhalers- starting with switching ventolin to salamol.
Things were changing in the practice too. We conducted more environmentally friendly tea and coffee taste tests. These were not necessarily met with overwhelming enthusiasm but we had a laugh and settled on 2 fairtrade options cafe direct and percol.
We also conducted a home visit mileage audit and were surprised to discover we drove more miles than we thought so decided to trial cycling to home visits. We undertook inner city cycle training with Cycling Scotland.
We found through auditing our doctors’ bags there were a lot of meds which went out of date. On this basis we changed to having 2 home visiting drug boxes in the treatment room and only take them out if we are likely to need. (We all have our own supply of benzyl penicillin)
Our practice took out a business ethical consumer subscription which allows up to 40 users access to the site.
We also set up a business account with our nearest ethical wholesaler (Green City Co-op) so we could source cost price ethical and fairtrade tea, coffee and cleaning supplies.
We contacted Zero Waste Scotland to conduct a site visit of our branch surgery which we own.
Finding connections
In June ’21 I attended an online Carbon Footprint course at Centre for Sustainable Healthcare.
There I met Katrina Davies who was a Greener Practice local group lead- she mentioned a variety of groups I may be interested in joining and offered to introduce me to Honey Smith who co-ordinated Greener Practice.
I also met up with good friend who is a GP in Fife and together we decided to start Greener Practice Tayside and Fife.
I contacted Honey who put me in touch with the Glasgow Greener Practice lead. They both provided really helpful information on setting up a group and Honey invited me along to the SY local meeting.
I let our local RCGP lead know I was intending to form the group and he was happy to be involved.
NHS Tayside IT set us up with our own greener practice email address.
We asked the LMC and primary care newsletter team to advertise the group in their newsletters and asked interested parties to email if they wanted more information. The RCGP sustainability lead also sent details to the secondary care sustainability group and the out of hours service shared information regarding the group formation with their GP list.
We had a really good response and now have 83 members. We have had 4 meetings since we started. The first meetings were generally in the format of speaker(s) then discussion. I am hoping to move to a “thinking environment” for subsequent meetings and have purchased Nancy Kline “Time to Think” to prepare for this.
Achievements
Following on from the Zero Waste Scotland visit we were successful in obtaining an Energy Saving Trust grant and loan and have upgraded our lighting and insulation and installed air source heat pumps at our branch surgery. We had old fashioned night storage heaters which were very costly to run so will hopefully see a cost saving over the next few years.
We were also lucky to be selected as a wee forest site and now have our own wee forest adjacent to our branch surgery.
We have achieved our Silver Green Impact for Health award.
We have completed our inhaler review project which we estimate will save 56 tonnes of CO2e/year.
We completed a polypharmacy review for all our over 75’s on 10 or more oral meds which led to significant reductions in medication burden.
Next Steps
We are applying for charity funding to set up a well-being hub based around our branch surgery and wee forest. We have already received council funding for some raised beds and are hoping to extend this to a small allotment with beds being allocated to local residents and/or health groups. This is very much still in the early stages of planning.
We hope to continue our inhaler work discussing good disease control and greener inhaler choices at annual review.
We are working towards our GiFH Gold Award.
Key message
Start conversations about climate and health at home, with family and friends and at work. You might be surprised where it can lead!!
Dr Alison MacTavish