A Greener Well Street Surgery

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We opt to contact our patients by means of a text messaging service rather than posting letters where possible. Digital transformation is one key area highlighted within the NHS Green Plan, which suggests that NHS organisations ‘harness existing digital technology and systems to streamline service delivery’. 

We reduce the number of blood forms which are printed – save time and paper waste by saving forms electronically and only printing when the patient requests the form for collection or attends for their test. Clinicians will use scrap paper or online note pads instead of post it notes or buying note pads.

Greener Inhalers

Some inhalers have a much higher carbon footprint than others so you may want to review your inhalers. The most common inhalers used in the UK at the moment are metered dose inhalers (MDIs), also known as aerosol spray inhalers or puffers. These contain propellants which are potent greenhouse gases thousands of times more powerful than carbon dioxide. This is why inhalers contribute to 3-4% of the entire NHS carbon footprint. Other countries use far more dry powder inhalers (DPIs) which have a much lower carbon footprint as they do not contain propellant gases. Many patients find DPIs much easier to use too.

You can learn more about inhalers and the environment on the Green Inhaler website here.

If you are concerned about the possible environmental impact of your inhalers it is very important that you discuss this with your doctor or nurse, rather than just stopping your inhalers, so that any changes can be agreed and made safely.

If you use inhalers and wish to reduce the environmental impact of your treatment there are three main things you can do:

• Make sure your disease control is as good as it can be by attending regular reviews 
• The most important issue is that the best treatment regime for you and the planet is the one which controls your asthma or COPD well. If you need to use your reliever (blue/Salbutamol) inhaler more than three times in a week, this can be a sign that your asthma is not well controlled.  If this is happening, you should talk to your doctor/nurse/pharmacist about this.
• Review your treatment with your doctor, nurse, or pharmacist

Dry powder inhalers can be used by most people with asthma and need a quick and deep breath for the medicine to reach the airways. They usually come with a dose counter so you can track your medication use and don’t need a spacer device. Starting or changing to a dry powder inhaler is a good way for many people to improve their care and reduce its environmental impact. But for some people MDIs will remain the best option. It’s really important that you talk about any changes to your inhaler device with your doctor, nurse or pharmacist. If your doctor or nurse doesn’t know about the environmental impact of inhalers you can tell them about the ‘For GPs’ section of this website which has more information.

Do not throw used or unwanted inhalers in the bin. Return them to the pharmacy.

There is lots more useful information on the Green Inhaler website.

Disposal of medicines and devices

All unused medications, and used hormone patches or empty hormone gel packets should be returned to pharmacies for disposal to avoid medicines going to landfill or getting into water courses. Empty inhalers can also be returned to pharmacies for recycling.

Worldwide, over 600 pharmaceuticals or their transformation products have been found in sewage or waste water treatment plant sludge. This leads to an increased antibiotic resistance and interference with growth and reproduction in aquatic organisms. Recognised negative effects include: 

• Unnecessary animal suffering and potentially human suffering 
• Biodiversity loss 
• Speeding up ocean acidification 
• Additional costs to society and public organisations 

And there are likely to be further affects that we do not yet know! 

Please return all inhalers and other medications to pharmacies, where they will be sent for clinical incineration. This is much better than disposing of them in household waste as if they end up in landfill the propellant gases are released into the atmosphere contributing to climate change. At the moment there are no widespread inhaler recycling schemes (there is a small scale scheme in Leicestershire, see in the Local Groups East Midlands Section). Don’t put your inhaler in kerb side recycling as it won’t be recycled.

Medication reviews

Tests, treatments and procedures are not always necessary and can do more harm than good. Medications are often necessary and help us to stay well. You should never stop or change your medications without speaking to a healthcare professional. When people are on lots of medications this can lead to harmful drug interactions and difficulty with taking the medications correctly. This is known as problematic polypharmacy. Regular medication reviews are good opportunities to discuss the need for regular medications with your pharmacist or GP based on your particular needs and goals.

You can use this review to tell us about any difficulties with taking your medication, any uncertainties or questions, and to decide together which treatments are still worthwhile for you. As a practice, we will invite you in for medication reviews and you are also able to request a medication review with our pharmacist or GP.

Most of the carbon emissions in primary care come from our clinical care, so making sure that what we do is evidence-based, person-centred and free from harm is one of the most useful things we can to make sure healthcare is better for patients and planet. We try to make shared decisions on investigations and treatments based on the best evidence and your individual circumstances and needs. 
Sometimes medicines are ordered unecessarily and this can cause stockpiles of medications at home. Please ensure you only order medication you need to support the NHS Greener Plan.

Active Travel

Active travel is a way of incorporating physical activity into necessary journeys, so you help your own fitness and the planet at the same time. Our recent experience with lock down has shown us how active travel, by walking or cycling, can be an enjoyable experience when the roads feel safer. Cyclists are exposed to less pollution than car drivers or bus passengers, and have the added benefit of keeping fit as they travel to work. 

Saving one car journey a week of 16.7 miles (average daily commute) reduces the equivalent of 230kg of CO2e per person over a year.

If you are not confident riding on the roads, Bikeability is a charitable organisation offering training for children and adults. Hackney Council also supports free cycling lessons for children and adults at all stages in their cycling journey.  If cycling doesn’t appeal, could you walk to work? Is there a route that you could take that would go through a park and away from roads, to make the walk more pleasant?