In Pharmacy In Practice
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Healthcare has a significant carbon footprint, accounting for 4.4 per cent of global CO2 emissions, while in England the NHS accounts for 4 per cent of greenhouse gas emissions. Medicines account for 25 per cent of emissions within the NHS, of which 79 per cent are prescribed in primary care and community services.
The NHS aims to reach its net zero target by 2040, with an 80 per cent reduction by 2028-2032. Northern Ireland has the same target, Wales is aiming for 95 per cent reduction by 2050 and Scotland for net zero by 2045.
Minna Eii, co-founder of Pharmacy Declares, a group of climate conscious pharmacy professionals, says: “The most important way that community pharmacists can get involved in reducing the environmental impact of the supply and use of medicines is to educate themselves about the environmental issues and impacts they have on healthcare. Making these changes isn’t just good for the environment - they are beneficial for patient health too and can also save pharmacists money on things like energy bills. Ultimately, a more sustainable pharmacy business will attract more customers.”
Elen Jones, RPS director for Wales, comments: “We know that medicines account for around 25 per cent of carbon emissions within the NHS. That means for us as pharmacists and the wider pharmacy team, we have a leading role to play in making medicines use more sustainable.”
Nuala Hampson, pharmacy lead at the Centre for Sustainable Healthcare, says: “Most importantly, we can help prevent disease and the need for medicines in the first place by providing health education, disease prevention advice, screening and vaccination."
Greener Pharmacy Guide and Toolkit
The RPS was commissioned by NHS England to develop guidance to help community and hospital pharmacy teams across the UK to reduce the impact of pharmacy services and medicines on the environment.
The RPS Greener Pharmacy Guide and digital self-assessment Greener Pharmacy Toolkit will enable pharmacy teams to assess their impact and improve through evidence-based actions and activities. The Guide is available now on the RPS website, while the digital Toolkit will be launched this spring.
Elen Jones, director lead for the RPS Environmental Sustainability programme, says: “We want to support teams to identify areas where they can make sustainable changes to decrease the environmental impact of the services and clinical care they provide.”
The Guide is divided into six domains: People, Clinical Practice, Travel, Resource use, ICT and Operations & Strategy. Each domain is divided into three levels: easy, moderate and hard. For example, in Domain 2: Clinical Practice, a level 1 action includes: “Routinely ask patients to check their medication in pharmacy bags before leaving the pharmacy to prevent return of incorrect or unwanted items.” A level 2 action includes: “Pharmacy staff promote safe and environmentally friendly disposal of all unwanted and used inhaler devices by engaging in discussions with all patients/carers or representatives.” A level 3 action includes: “Enrol pharmacy settings in available recycling schemes.”
The Toolkit allows pharmacy staff to track their progress on each of the six domains and to work from levels 1 to 3. They can display the accreditation once achieved. It helps pharmacists to self-assess their goals by uploading images, submitting evidence and writing reflections. Pharmacies are then awarded a badge of their green achievement level – bronze, silver or gold.
Climate change and health
The RPS has joined leading health organisations across the UK to call on the Government to take more action to protect nature for the benefit of the nation’s health. This comes on the back of a policy report from the UK Health Alliance on Climate Change (UKHACC) : Biodiversity, Climate Change and Health.
The report focuses on seven key areas where we all need to increase action to prevent further harm to health caused by loss of nature. Among these include calls to reduce plastic waste by banning the production and sale of unnecessary plastic items, along with efforts to incentivise reusing, recycling and the production of alternative compostable materials.
Commenting on the alliance, Jones at the RPS said: “Building on our 2021 initiatives, our full membership in UKHACC allows us to build on our commitment to climate action within pharmacy and healthcare more widely. A specific role that community pharmacy teams can undertake to protect our nature is to take every opportunity to remind patients about appropriate disposal of their medicines.”
“Making these changes isn’t just good for the environment - they are beneficial for patient health too and can also save pharmacists money”
Empowering patients for self-care
Nuala Hampson at the Centre for Sustainable Healthcare has this advice: “Some 10 per cent of medicines are overprescribed and up to half prescribed for long term conditions are not taken as recommended. Person-centred, shared decision making with patients can optimise medicines use, minimise waste and ensure appropriate disposal.”
Her top tips include:
- Support medicines optimisation at every contact
- Support patients to understand and use their self-management plan
- Improve communication with prescribers to ensure review of repeat prescriptions which are not being taken as prescribed
- Ensure patients check their medicines are correct before leaving the pharmacy
- Encourage patients to return unwanted medicines to the pharmacy and never dispose of them at home to reduce pharmaceutical pollution and antimicrobial resistance.
Plans for a more sustainable 2024
CENTRE FOR SUSTAINABLE HEALTHCARE
The Centre for Sustainable Healthcare engages with healthcare professionals, patients and the wider community to understand the connections between health and environment, and to reduce healthcare’s carbon footprint.
“In 2024, our focus will be on supporting pharmacy staff and managers to contribute to the net zero carbon goals. Any member of the pharmacy team can join the Pharmacy Sustainability Network to ask questions or share resources.
Greener NHS and the Centre for Sustainable Healthcare have produced two free half-hour taster modules on Environmentally Sustainable Healthcare,” says Hampson.
YEWMAKER
Founded by genomics expert Dr Nazneen Rahman, YewMaker is a sustainable healthcare solutions company.
“In 2024, YewMaker is launching MCF (Medicine Carbon Footprint) Classifier, which is a suite of applications designed to estimate, classify, benchmark and visualise carbon emissions of medicines. The first launch is MCF Formulary, a free website that will allow people to view the carbon footprint ratings of thousands of everyday medicines, alongside medicines used in similar clinical contexts.”
There are many resources on www.yewmaker.com and you can subscribe to the weekly blog Healthcare for a thriving planet.
“It would be wonderful if community pharmacies could spotlight the use of wasted medicines in 2024. If every pharmacy was able to review their own practice and select one sustainable medicines area to focus on in 2024, collectively it would have a huge impact,” says Dr Rahman.
PHARMACY DECLARES
Pharmacy Declares was set up to encourage pharmacy professionals to tackle the climate crisis by reducing the impact of medicines on the environment. Co-founder Eii is lead author of the RPS Greener Pharmacy Guide and Toolkit.
“In addition to this, Pharmacy Declares has been invited to join forums outside of pharmacy. We are now involved in mentoring pharmacy students and technicians to enable them to lead their own presentations on sustainability. In this way, we are building education among pharmacy staff.”
ROYAL PHARMACEUTICAL SOCIETY (RPS)
Repeat prescriptions make up an estimated 75 per cent of all prescription items. “This means that it’s really important that repeat prescription arrangements ensure that patients’ requirements for medicines are checked at every issue. Otherwise, medicines waste occurs when every item on a repeat prescription is automatically ordered but not all are needed,” says Jones.
The RPS, in collaboration with the Royal College of GPs, has been commissioned by NHS England to streamline the repeat prescribing processes. Over the next 18 months, a working group will shape a toolkit, develop an implementation plan and assess the Toolkit’s impact on patient care in GP practices and pharmacies.
Pharmacy case study
Priory Pharmacy, Orpington, Kent - Prabjaudt Singh Channa, pharmacists and owner
“Last year we installed 7kw solar panels and a Tesla powerwall battery in the pharmacy. Any leftover energy produced by the solar panels gets stored in the battery, so in the summer, we had minimal spend on energy and only used what we had created.
We’ve also become 80 per cent paperless in the last year. There really isn’t a need for printing out prescriptions these days. If the NHS was to adopt this nationwide, we could all save so much energy and resources. We also recycle everything we can and have LED lights.
For next year, we are looking at ways we can become even more sustainable. We want to increase our number of solar panels so that we can create enough energy to see us through the winter months as well.
Our customers have really got on board with what we’re trying to do. For example, we now ask patients if they need their repeat prescription slip printed out and most say they don’t. We are launching our own patient App this year and that will mean even less printing out is needed.
At medicines reviews, we ask patients about correct use of their medicines - whether they still need them all, whether they need each item every month. It’s about having an open conversation with your customers.
I’m also a director of the South East London Pharmacy Alliance. We are trying to get contracts and funding together for an inhaler recycling scheme that would be used throughout our area.
There are so many community pharmacies in the UK. If we all invested in a digital workflow and changed our energy sources, we could make a huge impact.”