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The benefits of this project
Benefits for Your Patients
- Enjoy seeing reduced waste at the surgery
- No change to their experience of care
Benefits for Your Practice
- Can save the practice money after 18 months of use
- Reduced need for storage space for single-use equipment
- Clinicians prefer using the reusable equipment as they are less likely to break, and they are easier to use
- Reduced waste in the surgery saving space and money
Benefits for The Planet
- Reduction in potential green house gases of 38-50%
- Reduced waste, ozone depletion, ecotoxicity, resource depletion and improvements in air quality
- Increased efficiency of pathology couriers by transporting more per journey, with reduced mileage needed from delivery vehicles delivering single-use equipment
- Helping to reduce slavery, as >1/5 NHS suppliers providing items, including surgical instruments, are at high risk of contributing to modern slavery (https://www.theguardian.com/society/2023/dec/27/at-least-20-of-nhs-suppliers-at-high-risk-of-modern-slavery-use-review-says)
Opportunity for improvement
- Single-use disposable equipment made of plastic or metal is not a good use of the world’s natural resources. Currently, the NHS contributes to 4.6% of all UK emissions, 10% of this is from NHS equipment and 4% from business travel.
- There are many varieties of single-use of equipment used in primary care such as plastic vaginal speculums, disposable metal forceps and disposable metal scissors; switching these to reusable versions reduces net emissions and is safe and acceptable to patients. 3.25 million vaginal speculum examinations occur annually in the UK for cervical screening alone. Single use plastic speculums are used as standard in most healthcare settings in the UK with incineration as clinical waste after use.
- Two life cycle analyses have been published in the US comparing the environmental impact of reusable stainless steel speculums with single use acrylic versions. The studies showed a clear environmental benefit of reusable speculums over time even once all aspects of their manufacture, usage and sterilisation are taken into consideration.
- The greenhouse gas emissions (GHGE) from initial production of stainless-steel speculums are higher than for plastic, but after two to three uses the GHGE have equalised. The findings for speculums mirror those found in a systematic review of life cycle analyses comparing various single use and reusable medical instruments. Use of reusable products was associated with a reduction in potential GHGE of 38-50%.
- The move away from single use items is supported by patients and staff: 80% of patients supported the use of reusable sterilised medical equipment to reduce waste in healthcare or were indifferent to the change. A survey of clinicians in the UK reported that 83% said they would be happy to switch to metal speculums for reasons of sustainability.
- This project aims to help other GP practices to reduce their single-use medical equipment by switching to reusable equipment (see disclaimers).
- You might like to create a SMART goal for this project e.g., to reduce the practice’s ordering of single-use equipment by at least 75% within 6 months.
How to carry out this project
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Set up a team meeting
Meet with your clinical team (doctors and nurses) to explain the problems with single-use plastic and metal equipment. Once they are on board with the idea of moving away from this to reusable equipment, move to step 2 .
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Contact the Head of Decontamination in your local hospital
Ask if they would agree to sterilising your equipment and find out the costs involved (it may be cheaper to sterilise a tray of your equipment rather than individual items).
Also, ask them about the expected turnaround time and which company they would recommend buying your equipment from.
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Contact the Head of your Pathology Transport Service
Ask if they would consider transporting your equipment with the samples they already transport for your practice, and return them when cleaned.
Also, check if they are happy to take the items to the decontamination department, or whether the decontamination department is happy to collect them from pathology.
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Calculate
Calculate the numbers and costs of all the single-use items purchased by your practice in the last 4 months.
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Fact finding
Speak to the nursing team about how many of each item the practice uses every 1-2 weeks (depending on the sterilisation turnaround time).
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Request quotes
Contact the recommended companies to ask for a quote for the items your practice uses in 1-2 weeks.
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Calculate
Work out how long it will take to break even by adding up the costs of the sterilisable equipment and the costs to sterilise them, and comparing these to the costs of single-use equipment, which you will need to keep purchasing.
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Purchase
Buy your new equipment – you may be able to access a grant to help with this initial purchase (see top tip below).
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Sterilise
Take the new equipment to the hospital so they can be sterilised and placed in a bag with an individual bar code tag, which will stay with the item.
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Monitoring form
Develop a system to sign and date when the items have gone in and out of the practice so you can trace where they are (using a table with the individual bar codes is one idea – see example sheet).
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Launch the project
You could start with just the nursing team using the equipment initially before moving on to the doctors.
It can be helpful to have some single-use equipment in the practice in case this is needed one day (eg. clear plastic speculums can be useful to check for vaginal wall pathology).
More items can be bought if needed once you have become used to the change.
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Ask for feedback
Ask patients and staff for their feedback with the change. You could send this AccuRx Questionnaire after they have used a metal speculum and review their responses through their AccuRx replies.
You can add the SNOMED code “session feedback questionnaire” so your responses can be searched. To do this search for all patients with SNOMED code 961331000000105 “session feedback questionnaire”.
Resource: Patient feedback on speculums
We have introduced a new type of speculum and would appreciate your feedback. Did you feel the speculum used was: “Better than those previously used?” “Not really different from those previously used?” “You did not like the new speculum?” Thank you very much for your replies. If this was your first speculum examination, you do not need to answer”
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Review
Review the results, summarise learning, share with practice team and decide if any changes are needed to improve the process.
Decide when to re-audit again to ensure the change has lasted e.g. 2-3 months and use the Project Monitoring form to keep track.
Many practices run audits at regular intervals – speak to your practice team about including this project in those audits.
Top tip
It may be cheaper to use a private company that will collect, sterilise and return your equipment, but check whether they will be using electric vehicles.
Look for funding grants that may be available to help small business transition to more climate friendly options. Mile Oak Medical Centre was helped by a £2,164.25 grant for the initial purchase of equipment by the Brighton and Hove City Council’s Shared Prosperity Fund.
Use reputable companies that other departments such as the GU clinic, gynae and surgical clinics use to buy their equipment. Mile Oak Medical Centre initially went for the cheapest offers online, buying from 6 different companies. Unfortunately, all had to be returned as they were poor quality, unsuitable for sterilisation and not as advertised.
How to scale this project up or down
| Please note - Use of this project requires NetworkPLUS membership. If you would like to share this project with others, please invite them to purchase their own membership—access must not be shared with non-members. |
You could upscale this project by working with your local ICB (England), Health Board (Scotland & Wales) or SPPG Pharmacy Advisor (Northern Ireland) to ensure once daily or alternate day dosing is the default pick in local formularies. You could even share it internationally.
You could take it to your Primary Care Network or Cluster to implement across all practices in your area.
Case study
We were spending £2,859.69 per year on 12 different types of disposable equipment (plastic vaginal speculums and metal forceps and scissors).
We worked out that we could switch the 3,436 of annual disposable items being ordered with 12 different types of metallic forceps, scissors and speculums of reusable, sterilisable equipment. We would need to buy between 2 and 20 of each item depending on how many are used per week (91 separate items in total).
In Brighton, there is a charge of £2.69 to have each item sterilised at our local hospital (they all need this initially). This includes purchasing specialist individual bar-coded bags for each item, so the equipment finds its way back to the practice and transporting the equipment from the pathology reception to and from the decontamination area. However, our pathology couriers have agreed to transport our equipment from our practice to the hospital and back for free.
All our staff and patients have been positive about the change. We have saved £662.54 in the second year, with £1,439.37 savings annually going forward as we will not need to replace the items.
Dr Abigail Fry, Mile Oak Medical Centre, Brighton
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Tell us a little about your project and enter your data in order to generate a certificate showing the probable cost savings and other benefits. This project may help with CQC evidence submission (see disclaimers).
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