Putting sustainability in the GP curriculum

In February 2024 Lancashire and South Cumbria (LSC) ICB appointed a clinical lead for net zero in primary care. The purpose of this post was to increase engagement with clinicians in primary care with the NHS net zero target.

The NHS has declared that it will reduce by 80% the emissions it has direct control over between 2028 and 2032.

The clinician appointed was a general practioner with a background in medical education and through their links with the GP training schemes a series of workshops were offered. Four training schemes were sent an invitation offering to deliver the workshop and three accepted. The workshop was delivered four times, as one scheme asked to run it twice for different year groups. Around 100 GP trainees therefore attended the workshops overall.

The workshops content included explaining about the net zero targets, background scientific information about climate change. The impact of climate change on health and ways in which healthcare is damaging the environment. The workshops also looked at tools to support sustainability in primary care including the LSC ICB 10 point green plan for practices and the RCGP sustainability toolkit.

Some important themes were looked at that they want the whole ICB to adopt, including inhaler optimisation (inhaler propellants are 23,500 times more potent at warming the climate than carbon), reducing unnecessary PPE use and reducing unnecessary liquid medication use (the carbon foot print of liquid paracetamol is 15% higher than tablets for example).

There was then time for the GP trainees to reflect on sustainability issues in their own workplaces. These ideas were discussed as a group and encouragement given that trainees take these ideas back to their workplaces and put the ideas into practice as their mandatory quality improvement project or leadership project.

One trainee has already submitted a completed quality improvement project. A meeting was organised at their workplace and the practice staff chose areas where they would like to make improvements. This included medication optimisation, rationalising infection prevention and reduced resource usage.

The GP trainees were also given the opportunity to join the local greener general practice group. Initially, contact details were collected but interest was high and so a QR code was used to allow people to join the WhatsApp group directly.

With the numbers of the greener general practice group growing, it has allowed for a regional group (Lancashire and Cumbria) to be formed in the greener practice network, whereas previously the group linked in with Manchester, Chester and Merseyside.

Sustainability themes generated in the workshops

Wastage

• Trainees had witnessed waste in several areas including unwanted, unused medicines having to be thrown away, excessive use of paper roll on examination couches, the wrong rubbish being put into the wrong type of bin, pre-packed clinical equipment (for catheters, coils or minor operations) having unwanted items that are thrown away without being used.

Printing

Trainees were aware of variations in the requirement to print.

• Some workplaces allowed electronic requests for bloods and x-rays etc but others had to print out the forms.
• Some workplaces sent sick notes electronically whereas others printed them (requiring additional patient journeys to collect them as well as the printing itself).
• In hospital some handovers were electronic and done with TV screens whereas other departments relied on large volumes of print outs.
• In general practice, most trainees took a print out of the patient record on home visits and received printed discharge letters when patients came out of hospital.

Energy saving

• They had noticed lights and computers were not switched off fully, they wondered if the heating was turned off at the weekends and whether surgeries invested in insulation and solar. One was concerned not all workplaces had natural light and ventilation and relied on air conditioning.
• Some trainees considered transport and whether remote consulting could be more widely used, they were interested in car sharing and were worried that even if they had a sustainable commute they would still need a car for home visits.
• The discussion allowed some existing schemes to be shared. It was possible to proved reassurance around reducing PPE use by discussing the Gloves Off campaign. The facilitator was able to discuss their own experience of a waste audit and the huge financial and carbon savings made by switching from yellow to tiger stripe bags (we saved 825kg of CO2 per tonne of waste by making this switch). Trainees learnt how to access a funded waste audit for their own practice. The facilitator was able to talk about how to apply for a grant for a practice bike (or e-bike) to do home visits on and was able to testify to the health and wellbeing benefits for them if they do.Trainees were also made aware of how to apply for a funded carbon audit for their practice to understand the carbon footprint of their workplace and take steps to reduce it.
• Initially trainees were anxious about leading change, there was worry about failing to adhere to policy and guidelines that were already established. Through sharing good practice ideas and by highlighting that the General Medical Council and Care Quality Commission both mandate active involvement in improving sustainability, trainees were motivated and confident to take the lead on ideas going forwards.

Feedback

“Good knowledge about how to keep our environment cleaner and safer. Worthwhile.”

‘Very enjoyable and got some useful ideas for a quality improvement project.”

‘Really interesting and relevant topic, thank you. Particularly like the ideas for a future quality improvement project.”