Podcast transcript
Good morning. I’m Neil Cartwright. I am net zero programme manager for Greener NHS in the North East and Yorkshire region. I work for NHS England.
Joining me today. I’ve got the lovely Dr Aarti Bansal. Aarti is a GP and clinical net zero leader over in Humber and North Yorkshire ICB and co-founder of greener practice, Dr Emma Castle is GP Partner at Page Hall Medical Centre in Sheffield and clinical sustainability lead for Foundry PCN, Dr Rumina Önaç, hope I’ve got that pronunciation right Rumina, GP and sustainable healthcare advisor, and co-chair of the York and North Yorkshire greener practice group Dr Jo Stutchbury, GP and co-chair of the North East England greener practice group and finally Dr Matt Sawyer, a former GP Matt(?) within North East and North Cumbria Integrated Care Board or ICB that has literally written the book around environmentally sustainable primary care. Welcome everybody.
So let’s kick off – from your experience, what do we mean by greener general practice?
Who am I going to pick on – who is going to go first? Aarti Bansal?!
Aarti Bansal
Hi, Neil. So yes, so for me, I suppose there’s a fundamental understanding at the heart of greener practice which is that human health and planetary health are inextricably linked. So firstly, we have to understand that the planet gives us our life support systems, and we need these life support systems for human health and flourishing. And the climate crisis is the most significant determinant of human health. But also that the actions that we can take to mitigate the climate crisis actually are our greatest opportunity to improve human health and reduce health inequalities. So there’s that kind of understanding. And then I suppose, greener general practice is really about acting in a way, practicing in a way, that recognises that connection between human and planetary health. And effectively it’s doing the things that lead to better individual and population health by working in a way that is preventing ill health but also making healthcare more efficient. Yeah, so I’ll, I’ll start with that.
Neil Cartwright
Fabulous, Aarti You’re a co-founder of greener practice. Could you just give us a bit of a sense of where the organisation came from and what the motivation is around this?
Aarti Bansal
Yeah, so the organisation came from – it was actually a question that was posed to me.
by a colleague of mine who knew that I was thinking about how we could act on the climate crisis as sort of an individual in Sheffield and he said, ‘what can we do to help our professional community take action on the climate crisis?’
And I realised that we were doing a lot – when I say we, I say people were doing a lot and a larger level of people understood the connection between health and the climate crisis and they were advocating for change at a sort of a political level and there was action happening generally to educate people on the climate crisis. But there wasn’t really anything that was happening in our professional community to say in primary care, what do we need to know and what action can we actually take in our professional spheres to make a difference? So that’s really where it came from. It came from that question of how can we help the professional community and enable them to take action towards environmentally sustainable healthcare?
Neil Cartwright
And not just picking on you Aarti, please colleagues chip in, but in in terms of when greener practice started and that trajectory where the organisation has grown to, can you just give us a sense of where you are now as an organisation?
Aarti Bansal
Yeah. So when we started it was just a small group of people in Sheffield coming together to think about that question and we very much were sort of just trying to connect with other people who were interested in the area to see what were we interested in and how could we support each other to take action. We wanted to sort of create a hub space for anyone in, in general practice to be able to at a glance, in one spot, to connect with any resources that were out there that were helpful and to be able to understand what they could do. So we started off giving ourselves a name and Anna and you know, a website really early on. But then we also started to work with larger organisations like the RCGP and the BMA to sort of understand how could we influence these larger organisations to also take action.
So initially we asked the RCGP to declare a climate emergency and take action so you know we supported that work. But then we also were able to connect with other people across the country who were interested. And so our little group in Sheffield was the, I guess, the starting group, but we now have groups across the UK from the Highlands of Scotland to, you know, Northern Ireland and Cornwall and the Channel Islands. We’ve got people who are coming together similarly to connect to say, what can we actually do?
And then in 2021, we realised that we needed some kind of legal status to be able to actually partner with organisations more. So we became a community interest company. So we went from sort of being quite an informal group to a sort of a more legal status. And that’s given us the opportunity to really partner with organisations like NHS England to produce really practical toolkits to help people actually take action, and very recently we were successful in winning one of the SPRI net zero grants, so that SPRI stands for, I think, Small Business Research innovation or something like that. It’s an arm of the NHS which gives out grants. And this particular competition was about looking at how can we make the NHS a more net zero organisation and we won in the category of clinical engagement and what we’re able, you know, we’ll be launching actually very soon, a new website which will actually house all the really practical, quality improvement actions that people can take, but a much better way for people to connect with each other than we even have even now. So we’re very sort of practical-focused in that sense that we’re trying to make it as easy as possible for general practice to take this action.
Neil Cartwright
Thank you for that, Aarti and greener practice expands through groups of GPs coming together in different localities. Rumina, are you able to speak to that from the perspective of York and North Yorkshire?
Rumina Onac
Yeah. So a lot of what you’ve just heard Aarti say really comes down to, you know, what we talked about, the 3Cs. So communication, collaboration and connections and you know, you’ve heard her talk about the importance of explaining to colleagues and patients what the climate crisis means and how it affects healthcare and vice versa. And so in order to be really effective and to support each other it’s so important that we connect, I mean just like we’re doing this morning and we find like-minded healthcare professionals locally that we can, you know, become friends with, share resources with, meet face-to -face, which is so powerful. And a lot of what we’re doing, you know, requires thoughts and energy. And we try and always share ideas with colleagues because we’re all busy. We’re all clinicians or, you know, working and we don’t want anybody to reinvent the wheel. So it’s so important that we collaborate with each other and one of the purposes of the local groups is to do just that. So you know, we’re all from Yorkshire and the North East here and, you know, we’ll have problems with our patients that are unique to this area. Something to do with the geography of the area, you know, the patient demographic, certainly where I work in York, we have a lot of problems with flooding every single year, you know, in in more rural locations, the problems will be slightly different. You know, even the temperatures are slightly different up and down the country. So there is a huge importance in collaborating locally.
And it it’s also a question of practicality. So you know, we’re mindful of the carbon footprint of travel, and if we do want to meet face to face with each other, obviously it’s a lot easier to do that if we’re not travelling long distances. And so for instance, in our local York and North Yorkshire group, myself and Matt and our other co-chair, Margaret Jackson, we try and meet face to face at least once a year. And it’s really great, it’s a really nice sociable thing to do. We also do some problem solving and you know, work out what we’re going to do for the rest of the year in terms of talks.
And so it it’s really useful being part of a local group and I think certainly, as Aarti said when she started out with founding greener practice, we’re all looking for a tribe, aren’t we, we’re all looking for people who share our ethos and want to work towards the same goals. And so that’s really, really important as well. And one of the things I enjoy doing is the communication side of things. So it’s really vital that we explain the message in patient- friendly terms and also I like to make sure everything that I put out has a quite lighthearted edge to it. It needs to be really engaging. I want people to be involved, so I rarely do lectures. I like to do workshops – that will be my preference – so that people feel that they can contribute and you know as we have here, a room full of really sort of diverse and experienced professionals and you’ll always get that when you’re doing an educational session, you know and you want to hear from everybody and hear what their experiences are. It’s the same with the PPG, we’ve got people who have life experience and ideas that they want to share to help drive our, you know, green plans forward. So yeah, so the importance of having a local group of like-minded people is the basis of these groups and you know, Jo, what’s your local group in the north east like?
Jo Stutchbury
Thanks. That was really good explanation Rumina. Yes, so we’ve got a group of maybe pending 5 to 10 sort of core people who are very engaged and interested, and we’ve got a much bigger mailing list of people who get – when we have a meeting, we summarise the meeting and share resources that we’ve talked about. So even though people – there are lots of people who don’t come regularly, I’m hoping that they are still able to gain some support and access materials and we’re saying we’ve tried to face to face meeting on the beach, last year it was. We’ll do the same this summer as well. So yeah, it’s just I think sometimes at work when you’re trying to make green changes – or any change – is difficult sometimes. I think having that network in the background supporting you is so valuable. So I found it a really inspiring group to be part of.
Neil Cartwright
Can I ask, so do I need to be a GP to join greener practice?
Jo Stutchbury
No. It’s anyone working in primary care, is my understanding.
Neil Cartwright
So I’m ‘green curious’ and I work in primary care, and I’m interested in finding a local group. Where would I go for that information?
Aarti Bansal
So you’d be able to find that information on the website, Neil. We’ve got a page on the website which, if you put it in about us and you’ll be able to see local groups and it will give you a list of the local groups and you’ll be able to look and see which group you can join. But also it’s worth sort of saying at this point, that we’ve also got national discussion groups. So we have these special interest groups, what we call them, that might want to discuss particular topics, so you might be particularly interested. I know, Neil, you’re interested in primary care estates, so you might want to look join our non-clinical carbon group, if you’re really interested in respiratory care, you might want to join our respiratory and clinical group. There are people who do a lot of education, they might want to join our education group. So we have these other discussion groups that are national -focused as well where people can share ideas as well.
Neil Cartwright
So what’s the website?
Aarti Bansal
greenerpractice.co.uk.
Neil Cartwright
That’s it? All one word?
Aarti Bansal
Yes all one – well with the dots
Neil Cartwright
With the dots. OK, great stuff. So Rumina, I think that’s really interesting you’re talking about communication because I tend to use my family as a sounding board. And if I start talking about CO2, I watch them visibly glaze over and start to avoid me. So I’m just really curious from colleagues about how do you get the message if we’re not talking about bizarre phrases like net zero or or tonnes of CO2? Matt?
Matthew Sawyer
For me I think that it’s using the problems or the terminology that people are actually facing so greener practice, greener healthcare, is actually just good healthcare. And so we start talking about better outcomes for patients. We know that practices have been under a lot of stress financially for example or staff morale. So we talk about how these actions also save the practice money or improve staff morale. So I don’t think we need to necessarily talk about the amount of carbon dioxide that is being emitted by travelling to work. But we could talk about a person’s health or people who actively commute to work have got better productivity in the workplace or our role models. So I think that we changed the focus from saying’ this has to talk about net zero’ to talking about the financial problems that people have gotten, saying actually, if you lift share, you’re more likely to have money in your pocket. We look at plant-first diets and they tend to be cheaper than those that contain meat. So actually it’s talking about person’s health or person’s finances, rather than thinking, but, but we just need to talk about how much carbon dioxide a beefburger’s got in it. Well, actually, we talk about the things that, that, that mean something to people. I think one of the problems has been is that net zero is a bit like the fun police. They come along and tell you that you can’t do things. And actually I’m really impressed with the stuff that Aarti and Rumina and others do that actually make these things fun.
They’re the actions and the activities that we want to do. I’ve just done some training and I was asking people, what are the things that you’ve done over Easter and invariably they say I spent it outside. I went walking, I was spending time with friends and family, I went out for some nice food. Well, actually, all of these things are good for health and good from a planetary perspective, and they’re all fun. They’re what people want to do it’s what people spend their time doing, their spare time, their disposable time doing, so I think that for me, it’s translating those almost doom and gloom fun police messages into something which is much, much more positive. What about yourself, Rumina?
Rumina Onac
Yeah, absolutely, Matt. And I think in that line as well, making the messaging really fun and positive and a lovely example of that locally is the issue of sort of, along waste, which I’m really interested in, might sound a bit odd, but there we go, each to his own, and we’ve done loads of work nationally on trying to, you know, save money, as Matt was saying on using the correct waste streams, but you know, giving things an interesting, catchy title can really make a massive impact, so down in Derbyshire they’ve got an project going on called ‘to roll or not to roll’, which is all about reducing inappropriate couch roll use- locally we’ve got something similar going on called Couch to seven K and it’s 7000 pounds, so it’s better if you see it, but the idea is that we’re trying to encourage people to use resources mindfully, appropriately, and still maintaining the same high standards of patient care, but will save money and will save resources and you know, as Matt and Aarti both said, that’s largely what a lot of this is about, so giving it an interesting and relatable title.
You know, people understand what couch to 7K means and people understand what couch roll is. It’s a really tangible thing that all patients come into contact with, so often, starting with those sorts of things that are very visible, can get lots of people on board. We call this mindset shift, don’t we? And whilst they may seem very small, they’re very easy, which is another thing that can often make it practical when you’re talking about busy, working, healthcare professionals. So that would be something that I would definitely chime with.
Neil Cartwright
Thank you, Rumina. In terms of my work, I suppose the document that I come back to the sort of the touchstone for us is delivering a net zero NHS which as a document I think seeks to break down the elephant that is the NHS in terms of individual facets. Could you just give us a sense of, from a primary care perspective, what the breakdown of the impact of the environment is, in terms of your clinical services, medicines, property….?
Emma Castle
I’d say, so when we’re looking at, when I was learning more about all of this and realising just how much impact sort of our day-to-day life as as GPs or as any of the staff in primary care has on the environment and on, if you look at the sort of the the carbon emissions and things like that on a national scale for the UK and the percentage that the NHS is thought to be responsible for – about 5% of the whole of the UK’s carbon footprint.
And I think what’s really powerful is that when you see, we see the breakdown of how, how we impact that. So that’s in terms of our – particularly our prescribing – 60% of our the emissions that are involved with direct clinical care coming from prescribing, but also in terms of the patient travel and the use of consumables, all that sort of thing, but as Rumina was saying, I think the fact that so much of the changes that need to be made in order to reduce our impact on the environment are exactly the same things that will also improve health on a wider scale. They’re often involved with, engaging with and building local communities getting out into nature, looking at social prescribing and things like that, and I think it can be very easy to feel, I think we’ve known for many years, haven’t we, about the impact of the climate crisis on the world. And sometimes you can feel quite disempowered by that. It just feels like such an enormous issue. And as you said, looking at the NHS as a whole and delivering net zero as a whole NHS can feel almost impossible.
So I think when that can be broken down into actually what we can practically do day-to-day.
And particularly when that’s going hand in hand with local groups or with your practice or with your network that often also brings it more fulfilling work for us, but also better patient health. Then actually you can realise what a difference you can make.
Neil Cartwright
Brilliant, thanks Emma. Aarti?
Aarti Bansal
I just really want to echo what Emma said about the actions often in primary care or in general practice that we would want to take to reduce our, I guess our impact on the climate, are exactly the same things we’d be doing even if there wasn’t a climate crisis. But there’s an urgent climate crisis. So it’s an even bigger reason to do it.
And you know, sometimes these things are called co-benefits. So people talk about things like, well, actually, if you take the climate action, you also improve health, you reduce costs, you reduce workload, you know, all of these other things come at the same time because the action is what we need to take for public health or for patient benefit anyway.
So, for instance, that 60%, two thirds of the carbon footprint that’s in the clinical realm in general practice, if we think about the kind of things that we might want to do to reduce that footprint, then it’s about how can we make sure that people don’t become unwell in the first place? So it’s that whole health creation and prevention agenda.
Are there alternatives to prescribing? So that might be our nature-based prescribing and our social prescribing, our connected communities agenda and then within prescribing, how can we prescribe in a way that is most beneficial to health and you know, listeners will know that there are many harms sometimes in prescribing that perhaps isn’t entirely appropriate. So, for instance, opiates for chronic pain or, you know, perhaps people don’t need to be on that fourth blood pressure medication. That’s not necessarily going to be that helpful or people who are on lots and lots of medications and then just the sheer number of medicines is actually causing interactions that might be unhelpful. So this is the over-prescribing or polypharmacy agenda. So all of those things are things that we may well want to be doing anyway.
And then having an impact on those is helpful for your patient, but it’s also helpful for the planet because as we reduce the carbon footprint, we’re reducing the impact on the climate crisis. But we’re also reducing water pollution, you know, we’re reducing waste and all of the other things that come with that.
So it’s these are all virtual cycles that we can be part of. And one of the things that I find really helpful if people are trying to think of a framework to understand what we mean when we say sustainable healthcare or when we’re talking about greener practice is to think about what can I do to prevent people needing to use healthcare in the first place, and that’s often linked to preventing ill health or empowering people to manage their healthcare. And what can I do to make the health system more effective or more efficient? And that might be reducing duplication in the system, making sure that care gets to the people who need it the most. Reducing waste in the system and also then considering low-carbon alternatives.
And if you look at it from that point of view, it’s exactly the same as good high-quality cost-effective care. So it’s for many of us, it’s absolutely hitting all of our core values in terms of the things that we feel we really came into being health professionals in the first place, you know, wanting to make things better for our patients and better for our populations.
Neil Cartwright
Brilliant. Thanks, Aarti. Rumina, do you want to come in on that?
Rumina Onac
I was just wanting to highlight something that Emma just said actually about being overwhelmed, and I think it’s a really important point because people are already busy and you know, we are thinking about our futures and what we can do and it can seem really bleak at times and I think it’s actually really important to talk about that. Going back to one of the benefits of having a local group is the ability to just chat about these sorts of issues and try and keep each other floating really and to discuss what barriers are likely to come up, because if we prepare ourselves for the negative things that people might say when we say, Oh well, you know, actually plant-first diets, this might help your health and we get obviously lots of people are not willing to try or it’s tradition, it’s culture, it’s living in a farming community, it’s livelihood – it’s all sorts of reasons. And actually if we’ve chatted through what those barriers are likely to be first, we’re much more prepared. And there are ways that we’ll feel sort of, you know, prepared with in order to try and help those people and save ourselves the stress of coming up against it, you know a brick wall. So I think another benefit of the local groups is that we really try and support each other to not feel overwhelmed and not feel like we are working in isolation.
Neil Cartwright
Brilliant. Thanks for that, Rumina. I’m still shattered by- as a vegan myself- at being part of this contingent of the vegan fun police – I need to – I need to think about my own language. Matt, do you want to come in on that?
Matthew Sawyer
Yeah, it was really a couple of points. Firstly, I think that one of the beauties, I think of greener practice and those of us who are here today and those who will be listening is I think that one of the things that green practice does really well is it takes the slightly dry NHS net zero documents and translates them into something which is practical and positive and achievable. And I think that that really, really helps because as we’ve said, we don’t want to keep reinventing the wheel and if we can find a way to make it that bit more acceptable for practices who and for practitioners who are otherwise busy, actually, that really really really helps. And I know that NHS England do a really good job, but the documents that they produce are not always, I think, appropriate for, you know, a busy practice manager or GP or practice nurse or healthcare assistant to be able to translate.
And we know so, for example, this week there was a survey out which said that nearly 90% of people globally want to do things they want to do greener actions. They want to do environmentally sustainable actions. So we have got this silent majority of people who want to do something, but it’s the what and the how. And I think that’s really where greener practice sort of steps in and helps to do that. And I really just then wanted to emphasise Artie’s point about prevention being really important, both from a planetary perspective and a person perspective, and I’m going to mention three quick examples. So The Lancet last year came out with the debenture said that 50% of dementia is preventable. So suddenly in the UK, we’ve got a million people who suffer from dementia. One in 10 of the over 65s – we could, as a society reduce that by half. Wow. Imagine that halving the number of memory clinics, halving the number of memory medications, halving the amount of dementia care settings that we need, halving the number of families who go through a terrible disease.
Cancer Research UK came out and said that more than half of bowel cancer is preventable and it’s things like too little fibre, too much processed meat, too much obesity. Well, actually, we as a society could do something, which means that we’ve got reducing processed meat. Actually, that’s better for patients, better for populations and better for planet.
And finally, the HPV vaccine. So cervical cancer in women in their peaks, in the women in their early 30s, absolutely horrendous disease. Starting your childbirthing years, in the middle of your career and suddenly you get this horrendous disease – HPV vaccine started being given to 12,13-year-old girls studied by the Scottish Public Health last year, found zero people who had cervical cancer who’d had the vaccines. So for me that prevention message is far better for patients. And if we can get that message across, are we preventing cervical cancer from bowel cancer and dementia because it’s environmentally better? Or are we doing it because actually we get people and populations and society better as a result. And I would say that it’s that co-benefit. It just happens to be better from a planetary perspective as well. So it’s really just to back up, support, emphasise Aarti’s point there.
Neil Cartwright
Brilliant. Thank you ever so much. I’m really curious as well about. GPs in training.
I wonder if any of you are able to speak to the curriculum in the context of planetary health?
Aarti Bansal
Yeah. So going back to when I talked about the RCGP declaring a climate emergency, one of the actions that came from that climate emergency was that they would review their curriculum and as a result of that, planetary health is now a thread in their population health section of the curriculum, which we’ve helped write in greener practice. We’ve also helped write health education England’s model for training GPs, which has 10 strands, of which one is planetary health. So yes, now all GP trainees should be learning about planetary health. It should be integrated into everything they learn, so they should be asking the question of how does planetary health influence what I’m seeing in front of me? You know, because we all understand as GPs that healthcare is much more – or health is much more influenced that by things outside of healthcare. So people’s housing situations, people’s education situations, people’s local community, all of these things, their ability to have a healthy diet, are going to impact their health. And those things are impacted by planetary health and so many things are interlinked. So for example, the quality of the air that you’re breathing has an impact on your health, but the things that are impacting on the quality of the air, are probably going to impact on the climate crisis by increasing the amount of carbon dioxide in the air as well as the particulates in the air, which are then having all the noxious gases that are there are impacting on your health.
And so how does planetary health impact on the person that I’m seeing now and what can I do in my management that improves the health of this person and in a way that harms planetary health the least, or is beneficial.
So yes, GPs in training should be learning about planetary health and greener practice and one of the things that we have suggested is that they all have the opportunity to not just learn the theory but also have the experience. So actually have the experience of doing some kind of quality improvement in practice that helps them make a change. And one of the things that’s going to come out with our new website is lots and lots of quality improvement actions that people can take, that are good for people and also good for the planet. So for example, you might want to do a project on reducing opiates prescribing in chronic pain. That’s good for patients, it’s also good for the planet and that’s a small quality improvement project that a GP in training or GPs in training have to do quality improvement activities so it’s project that they can just take. There’ll be more than sixty of these on our platform and we’ll be hoping to grow them all the time. So yeah, and GPs in training are a really fabulous resource. We’ve learnt time and time again that they’re very interested in this area. They ask for training in this area all the time, but they’re also a workforce asset for us, in that they do have to do, like I said, these quality improvement activities. So, they’re a real opportunity for us to drive this change in general practice.
Neil Cartwright
I think I’ll just make an observation as well around the profession as a whole. I always find myself drawn back to – there’s a veracity index that’s undertaken, it’s a poll that’s undertaken by Ipsos, around most trusted professions and when asked the question, for each profession, would you trust them or not? The top three are nurses, engineers and doctors.
I think that really speaks to the weight that the words of clinicians have in talking about and conceptualising what we’re what we’re talking about here, around sustainability, around emissions reduction, but also thinking about climate adaptation as well. We’re going to see a changed future.
Could you could you give me some examples of? I want to ask two questions and I don’t mind who fields this, but if I’m overwhelmed, where do I start? How do I get off the starting blocks? Where do I start that and then could we get some examples of projects that have taken place in our north east and Yorks region? So who wants to take that first, Emma?
Emma Castle
Yeah. So I think there’s a couple of things that we did. Just I was fairly recently a trainee and I used Aarti and part of the team made it, made some tool kits in the greener practice website which was one of the QI projects that I did. And it’s led to a real interest in respiratory care because that’s a massive place – that we can all of those steps of prevention, self-care, how we deliver the service and then our prescribing – it sort of goes into all of those areas that the exact same ways that we improve the impact on the climate of our asthma management is definitely also what NICE is now recommending and is vastly better for our patients’ health as well.
I think when I came into my practice, we started with the green impact for health toolkit, so that’s really available. You can sign up online and it outlines loads of different types of actions, from your prescribing, how your organisation is set up, energy use, waste and it goes from sort of quite easy wins, things that you can tick off, or things that you might already find that you’re doing that can start a bit of momentum within your practice because you realise actually you’re already doing some of this stuff, right through to sort of advice on how to do some of the larger scale projects and things in your practice and in your community.
So I think that’s a really good place to start. And I think what’s nice is that then, so two quick examples. So you’ve got the clinical side of things. So that might be looking at your how your practice does in terms of its prescribing, looking at areas where actually across your whole team, you might be able to make little tweaks to prevent over prescribing or to encourage people to look at how they’re taking their medications or that sort of thing from a clinical side of things.
But what we’ve got in our practice, which is wonderful, is we’ve got a green team and one of our nurses, Anne, is absolutely fantastic and she’s been partnering with the Wildlife Trust and we got a little tiny corner of our staff car park, which was just disused sort of shrubs. It was just a place for people to put litter, really. And they – the Wildlife Trust – help us helped us to clear that, build some raised beds, dig in a pond, make a little herb garden and we’re going to put a bench there and currently a local artist is working with the local community to paint a mural on the side of the wall there, with the idea that it’s now become a space for staff to be able to go in their breaks. But also there’s a weekly drop in, so the social prescribers and the nurses and healthcare assistants when they meet patients, they can signpost them to something that is right in their local area, builds a bit of a social space for connection and also just gives people a bit of outdoor time after their appointments and things like that.
So I think something like that is actually also wonderful for a practice to be involved with because everyone can get on board and it and it doesn’t feel, as Matt said, we’re not, you’re not sacrificing anything, they’re not telling you you need to be giving up everything that you enjoy in your life in order to have a greener practice, actually it can be adding to your experience of working in primary care.
Neil Cartwright
Brilliant stuff. Fun police(!) Jo
Jo Stutchbury
Thanks. Such a lovely example. Thanks for sharing that. Yeah, I guess I just wanted just to say for people sort of starting out with it, really just a quick signpost really to resources. So Emma’s mentioned the high-quality low carbon asthma tool kit, which is on the greener practice website and then there’s shortly going to be launched into this new platform which is going to have loads of quality improvement projects. So that’s really exciting and the green impact of health tool kit is something that we’re we’ve recently signed up to my practice. So we’re working our way through that and it again it just gives you these actions to do without you having to do the research behind it all yourself, which is really helpful.
I also just wanted to do a shout out for Matt’s website, see sustainability S E E, it’s got loads of really good resources on it as well. So that’s just a really good place to start really. And the greener practice website in general actually has got some really good talks on it and some patient resources as well.
Neil Cartwright
Aarti
Aarti Bansal
Yeah. So I mean, I can give the example of asthma. So inhalers, some people might know are a particular carbon hotspot in the prescribing section they are 13% of the direct clinical carbon that all the emissions that come from direct clinical care. The reason for this is that there are different types of inhalers, but the ones that we most commonly use in the UK are metered dose inhalers and these contain propellant gases. Now if you think about how do we reduce the impact of this particular carbon hotspot? Actually, it’s exactly the same thing that we need to do to improve asthma care. So traditionally in asthma, we’ve got two types of inhalers. We’ve got the inhaler, which we call the preventive inhaler, which is used to reduce the swelling in your airways. And that keeps you well, it stops you having asthma symptoms. It stops you being at risk of asthma attacks. But you have to take that usually regularly, and then there’s an inhaler that you’re meant to use only when you have symptoms. Now, actually, if asthma was well controlled, people would be using their preventer inhaler all the time and hardly ever needing to use their rescue inhaler. But in this country, many, many people have uncontrolled asthma where they’re not using their preventive inhaler regularly. And they’re relying on their rescue inhaler. And 2/3 of the carbon footprint is coming from overuse of these reliever inhalers.
So just improving asthma care is the best way that we can reduce the carbon footprint.
But then equally, it’s about making sure that we make sure people are on the right medicine and that it’s getting to the right place. If we just gave them a choice of a lower carbon inhaler, the vast majority of people would be able to use this lower carbon inhaler better because they don’t need to coordinate pressing down and taking a breath in very slowly. They don’t need to use a spacer device, they’re actually a lot easier to use. They all come with dose counters, so it’s actually the right clinical choice. And actually there’s new asthma guidance now, saying we should actually just give them the medicine in in combination so we now have inhalers that combine these two medicines and we can give those in low carbon options. So that’s one example of how we can look at improving healthcare by reducing the carbon footprint but also doing the right thing for our patients as well.
Neil Cartwright
That’s fantastic, Jo, thank you ever so much, Matt. You’ve literally written the book on this, haven’t you?
Matthew Sawyer
Well, I was actually going to say to Emma, first of all, that is a great example of one of the things that we’ve done locally is worked with some practices who have written up a case study effectively of greening a bit of their space as an inspiration for other practices to do the same. So it would be great if at some point there was a series of photos and how we did this and even better if we’d done this bit first or whatever to help other practices go ‘We could do that’ and we’ve also got a couple of practices locally who’ve put solar panels on and have found a huge amount. One of the GP partners messaged me the other day and said that so far in April there have been 93% self-sufficient with energy. Have they done this because it’s greener? Partly. Have they done this because they don’t want to keep paying giving money to an energy company? Absolutely yes. So that they are much more self-sufficient when it comes to when it comes to energy practice and writing these up as case studies and,
You know, Highlighting them through our group through the York and North Yorkshire Group or the North East or other groups is really, really helpful because it says that other people like you have done something and this is what we’ve learnt. So maybe you can do it as well and there’s loads of examples. We’ve got a really good – Rumina manages, a really good Trello board for that, for our group with loads of examples of great things that other people can pick up and run with in the projects that that we are undertaking locally.
And I really wasn’t here to plug a book at all, but environmentally sustainable primary care is available from all good books sellers and some bad ones as well (!), It’s basically written by 35 people. So Mike Thompson and I, who’s another retired GP, wrote it really to try and help lots of people have a voice and show all of the great things that are being done in primary care generally. So general practice, dentistry, ophthalmology and pharmacy and it’s there for everybody and I would advocate people buy one book and lending it, write notes in the margins. Hand it on. Don’t buy a copy each use it, read it, make, take what you can from it and then pass it on to somebody else so that they get the benefit of all of your notes and scribbles as well.
Neil Cartwright
Can I just ask you just to come back briefly? Thank you ever so much for that, Matt, just what’s the Trello board and how do I find it?
Matthew Sawyer
Certainly – through the greener practice York and North Yorkshire Group, you’ll send an e-mail to either myself or Rumina or Margaret, you can join our group. We can get you all of the details. So for anybody who’s in the York or North Yorkshire region and nationally can of course access it, but it’s there for, for our members and we put all of the videos of our talks on and all sorts of other bits and bobs that we’re doing locally and some of the stuff that Rumina’s done over the last couple of years, in terms of recycling pharmaceutical packaging, you know there’s some great examples of stuff that’s gone on.
Neil Cartwright
Brilliant. Thank you, Matt. We could go on all day, couldn’t we? I’m really conscious that we’re running out of time. Aarti, I think I’m probably going to give the last word to you, if that’s OK.
Aarti Bansal
Yes. Well, thanks. It’s been so wonderful to hear from everyone today. I think I would just want to say yes, if you’re interested in this area, if you want to learn more, if you want to find out how this connects with your work in general practice and you want to get started, have a look at the greener practice website that people have mentioned, the green impact for health tool kit, which is a great resource for telling you all the list of things that you might want to do and the new website that will launch will give you examples of how to do those things. So we’re very much connecting in to the green impact for health toolkit. And also you’ll be able to connect with other colleagues. So we’re going to make it really much, much more possible for people to join the network, whether that’s a national network, or your local network and share ideas, share inspiration, share best practice, share case studies as Matt said, and we’ll make it much, much more possible for you to get started on your greener practice journey.
Neil Cartright
That’s incredible. Just I think you may have mentioned this before, but greener practice is a community interest company, this is a nonprofit user-led organization?
Aarti Bansal
Yes, absolutely. So we’re all people who are working in primary care. And so we’re very much sort of primary care driven clinicians working for our community’s benefit and we are a not-for-profit organisation, yes.
Neil Cartwright
Fabulous. And we’ll try and collate some of the information that’s been discussed today and we’ll put them in the notes that that accompany this podcast. So but just want to say thank you so much. Rumina, Emma, Jo, Matt and Aarti for joining us. That’s been incredible. Thank you so much.
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