Trainee GP case study: Making Bloomfield Medical Centre more sustainable

For my leadership project during my GPST3 year, I decided to pass on some of the knowledge and information I gained from one of our teaching sessions relating to making GP practices more sustainable. I relayed information regarding why this was so important (for environmental and economical reasons, as well as the fact that some of these changes have a direct link with improved patient care, and are also assessed by the CQC), and offered suggestions as to how we, as a practice, could become more environmentally friendly.

I outlined some of the main NHS contributors to climate change, and discussed generic, everyday decisions/behaviours that can impact on our ability to be a sustainable practice. Areas I focussed on were medication, infection prevention measures and to reduce unnecessary usage of resources.

For the medication aspect of the presentation, I discussed the importance of medication optimisation (less wastage and will also reduce healthcare contacts needed). To do this, some of the pharmacists had already begun auditing various medications that are prone to wastage, and have switched them to “variable use repeats” rather than standard “repeats”, meaning that the medication only gets issued if it is requested by the patient. Some examples of these medications are inhalers, warfarin and insulins. The disposal of medication was also discussed, and we have since sent out a mass text to all patients informing them that they can take unused/unwanted medication (including “empty” inhalers) to a pharmacy to ensure suitable disposal. We talked about the use of tablets rather than oral suspensions as the tablets are much better for the environment (lighter in weight (and so better for transportation), less packaging, less medicine waste (longer shelf life and reduced risk of excess medications) and they can be dispensed in larger quantities, negating the need for as many patient journeys). One study found that the carbon footprint in the production of paracetamol tablets was 15 times lower than its equivalent in liquid form!

Infection prevention measures were next on the agenda. I covered two areas: to minimise glove usage, and the use of tissue paper to cover examination couches. Current NHS guidance for glove usage is: “Gloves must be worn when exposure to blood and/or other body fluids, non-intact skin or mucous membranes is anticipated or likely”. There was little in the way of evidence surrounding tissue paper to cover examination couches (both for and against its use). I performed several google searches and liaised with the local infection prevention nurses. The conclusion reached was that there seems to be little-to-no added benefit to support the use of tissue paper to cover examination couches. From an infection prevention perspective, the couches should be wiped down in between patients regardless of whether there is tissue present or not. When discussing the issue with the infection prevention nurse, her advice was that there was no use for tissue roll “unless there is anything particularly messy”. Therefore as a practice, we are going to reduce the use of these couch rolls.

The final area (reduce unnecessary resource usage) covered several aspects. These included to reduce electricity wastage: we discussed menial matters such as turning off lights and computers etc. We also discussed reducing unnecessary kit use: for example, we now order the components of the previous “coil kits” separately. Before this was done, an entire pack was needed to be opened to retrieve a single piece of equipment should a clinician need to remove a coil. Lastly, we discussed ways in which we could reduce our paper usage. We have looked to try and change our practice in two areas. The first is to offer the patients the option of having fit notes emailed rather than printed: often the patient needs to email these into their place of work, and so having it in electrical form is more convenient, and in turn will reduce paper waste. In a single month we issued >300 fit notes! The second is to change our method of sending out DNA warnings to patients. Previously we have sent each patient a letter, whereas now we have decided to either email or text these out to the patients instead.