“Environmentally Sustainable Primary Care” is a new book which has many contributing authors from Greener Practice and is available for pre-order from today.

There are three quizzes to introduce you to some of the contents of the book. Here is the first one (If you want a longer challenge there are some more week one questions here). You might enjoy trying either of them out on yourself or colleagues!

Please email contact@greenerpractice.com if you have identified ways to improve the clarity of the questions. You’re welcome to use these questions in your own not for profit work but please acknowledge the source!

1. If somebody moves from being a meat eater to being plant based, which one of the following is the reduction in their dietary carbon footprint?

• A 20%
• B 25%
• C 33%
• D 50%

Answer

The biggest gap is between meat eating and being vegetarian, the additional gain from moving to being vegan is smaller Chapter 1 p3

2. True or false. Planning perfect climate actions is more important than getting on and starting something.

Answer

False  

It is better to get started with something than wait for the perfect approach
Most of us will get this right when asked the question … but in our lives it is easy not to do anything because we feel that we are not doing the right thing or not doing enough. There is good evidence that getting started is empowering and links people to community and helps them find how to undertake effective actions.
Chapter 1 p4

3. In 2019, primary care was responsible for what proportion of the NHS carbon footprint?

• A 5-6%
• B 12-15%
• C 20-23%
• D 31-33%

Answer

C 23% of the total of the NHS footprint
The allocation of some services used by primary care like lab testing is normally made to secondary care… and of course what is or should be primary care and what is provided by other providers has some soft edges
Chapter 1 p11

4. In the UK, what proportion of the carbon footprint of primary care is due to medication?

A 15%

B 30%

C 45%

D 60%

Answer

D 60%

60% of the footprint of primary care is medication. The vast majority of the footprint from medication is due to the creation of the drug rather than transport of packaging which accounts for something like 5-10% each. Special drugs or ones which are less commonly produced or rarely produced in this form are more expensive, liquid preps being a good example.

Chapter 1 p11

5. Looking at the provision of dental services, which of the following is or are true?

• A Provision is better in areas of greater deprivation. 
• B Greater private provision is associated with better services for the population as the
• benefits trickle down the system.
• C The poorer the population, the harder dental services are to access.
• D provision of services is worse in more areas where there is little public provision.

Answer

C and D are True
The Inverse care law applies to dentistry. Tudor Hart’s inverse care law says that the people who need healthcare the most are the least likely to receive it and that this effect is greater the more privatised the system of provision is. There is no evidence that trickle down benefits those who are less well off, indeed the evidence suggests the opposite.

6. The biggest carbon footprint in UK dentistry comes from which one of the following?

• A The creation of amalgam and resins for filling 
• B Maintaining the premises and keeping the premises at an appropriate temperature 
• C The travel of patients and staff
• D The use of Single Use Plastics and other plastics in dental practices

Answer

C 
Patients and staff travelling accounts of about 2/3 of the carbon footprint of dentistry in UK
Chapter 2 p16

7. Which one of the following is the greatest carbon footprint related to an eye test?

• A Travel
• B Energy use in the optometrist premises
• C Procurement (including spectacles and lenses etc)
• D Waste and water use by the practice

Answer

A  
Significantly greater than all the other footprints is the footprint of travel  by patients and
staff; so the best way to reduce the footprint is avoiding unnecessary reviews.

Chapter 4 p47

8. Most prescribers think they only prescribe what is necessary but what proportion % of prescriptions do studies suggest are not necessary?

•  A 2%
• B 7%
• C 10%
• D 15%

Answer

C
It is estimated that 10% of prescriptions are unnecessary. (This work did not include the impact of successful lifestyle changes on prescribing.) Overprescribing is a serious problem internationally with complex cultural (both in relation to the culture of Doctors and health workers and in relation to cultural expectations in different countries) and systemic causes.
Chapter 5 p55

9. True or false. Prescribing medications for 28 days is best for those who are on a stable medication mix and who are understood to have good concordance.

Answer

False 
56 day prescribing is advised for patients whose medication is stable and where there is a
positive history of adherence.

Chapter 5 p58

10. For a child’s prescription which one of more of the following is or are true:

• A Liquid medication is more likely to be acceptable and so is environmentally better
• B It is never appropriate to crush the medication as this normally alters the properties of
  the drug
• C Orodispersible formulations are best
• D Using KidzMed approaches is better financially, for the environment and for the
  patient.

Answer

Answer D
Liquid medication almost always has a higher carbon footprint than solid formulation alternatives. Crushing tablets can be a good approach but this depends on the tablet (pharmacists can advise). Orodispersible formulations can be useful but may also have disadvantages. KidzMed project approaches are great for many children.

Chapter 5 p 62