GP partner and environmental sustainability consultant Dr Matt Sawyer shares some key things practices can be doing to create a more environmentally and financially sustainable future.
Improving environmental sustainability is being promoted across society, from individuals, businesses to whole nations. It covers topics including climate change, greenhouse gas emissions (GHGs), impact on plants and animals and wider wildlife, water use, plastic waste and many others. How healthcare is delivered affects the living natural world around us.
GHGs from the activities of mankind are well recognised to be driving climate change. They include carbon dioxide, methane, nitrous oxide and fluorinated gases. GHGs are often rolled into a single figure – the carbon dioxide equivalent or CO2e – for convenience and to compare different activities.
Legislation in the UK (Climate Change Act (2008)) sets a goal of net zero carbon emissions by 2050, with a Climate Change Committee reporting on progress.
Importantly for GP practices, an NHS England report published in 2020, ‘Delivering a “Net Zero” National Health Service’ declared the NHS as the first health service in the world with Net Zero ambitions.
So, what steps can GP practices take to improve their sustainability and meet that net zero ambition?
- 1. Measure your carbon footprint
Start by measuring your impact on the planet. Practices can use this carbon footprint calculator to measure their own nonclinical emissions. The results will provide a baseline for implementing a practice decarbonisation plan.
2. Set up a staff ‘green team’ to change behaviour
This team could turn off unused equipment when the surgery is closed. Leaving a single machine on standby overnight can cost about £10-20 per year, so if the practice has 20 computers, printers and a photocopier, the potential savings can quickly add up.
3. Install energy efficient technology
Investing in technology can reduce energy use and save both money and emissions.
Heating of space and water is both expensive and carbon intensive. Decarbonising this is vital to achieve ambitions of net zero. The Government has committed to phasing out installation of natural gas boilers in all newbuilds over the next few years and switching to much more efficient air (or ground) source heat pumps. If run from renewable electricity sources these can also be carbon neutral.
Heat pumps are relatively expensive to install. The Government’s Non-domestic Renewable Heat Incentive programme is now closed. If the practice is part of NHS Estates, then there is Salix funding available for public sector decarbonisation. Additionally, for energy reduction projects, there are different projects in different parts of the country. There are other funding sources for different aspects of environmental sustainability. Zero Carbon Business provides a comprehensive list.
4. Purchase an electric vehicle for home visits
Studies have shown that electric vehicles should produce lower emissions than fossil fuel vehicles over their lifetime, if charged from renewable energy sources. Promotion of e-bikes to staff can make cycling a more viable option for many people especially in hilly locations. They are the most energy efficient mode of transport – even better than walking!
Practices can currently benefit from reduced tax and National Insurance contributions on electric cars. The workplace charging scheme also provides financial support to install electric car charging stations on premises.
5. Cut down on waste
Reducing waste starts with examining what is bought in the first place. Practices that adopt the ‘waste hierarchy’ approach – aiming to first reduce, then reuse, recycle, recover or lastly dispose of waste – and put in place proper waste segregation will reduce overall waste disposal costs, largely through buying wisely in the first place. For example, using reusable masks, changing hand towels to electric dryers, and avoiding single-use disposable medical equipment all reduces waste.
Reducing paper use is an easy way to make savings. Switching to recycled paper will more than half your CO2e burden but cost the same as using virgin paper.
Paper-free options have increased in practices during Covid-19 with electronic prescribing, emailing of sick notes and more digital sharing of information. Practices should aim to make this standard practice where possible.
6. Change prescribing habits
Cutting down or changing how we prescribe can reduce our carbon impact without costing the practice anything, while leading to savings for the local health system.
Respiratory treatments in particular contribute to the NHS carbon footprint. The network, Greener Practice, has launched a High quality and Low Carbon Asthma Care toolkit with step-by-step projects and sustainable QI work. Organisations including NICE and the Primary Care Respiratory Society, and websites such as greeninhaler.org, offer advice on how to support patients to choose the most environmentally friendly inhaler possible.
Dr Matt Sawyer is a part-time GP partner in the North East of England. He runs the consultancy SEE Sustainability, running an online carbon literacy course for NHS staff, works with a variety of partners to help general practice reach the net zero ambition.