Doctors should reduce ‘unnecessary’ prescribing and blood testing to help tackle the climate crisis, according to a royal college.
A new ‘green toolkit’, produced by the Royal College of Physicians (RCP), suggests a range of actions doctors can take to ‘help mitigate and adapt to the impacts of climate change’.
The royal college argued that doctors have a ‘vital role’ to play in helping the NHS reach its net zero goal by 2040.
Currently, the NHS is responsible for around 40% of the UK’s public sectors emissions and 4% of total emissions.
The RCP’s new toolkit encourages doctors to reduce ‘unnecessary prescribing by using shared decision-making approaches with patients to reduce the environmental burden of medications that are no longer useful’.
It also recommends ‘reducing blood testing where clinically appropriate’ and ‘communicating with patients about climate change’ to help them understand the health impacts.
The college said that changes to clinical practice such as this can make an ‘important contribution’ to reducing the NHS’s carbon footprint.
Other suggested actions included:
- generating less waste;
- advocating for sustainable practices such as including sustainability as a standing item in all clinical governance meetings;
- limiting the environmental impact of travel;
- participating in sustainable quality improvement projects within your organisation through a Green Team competition.
RCP academic vice president Professor Ramesh Arasaradnam said doctors will see first-hand the ‘health effects of climate change’ and the need for action ‘has never been more urgent’.
He continued: ‘It can of course be challenging to prioritise sustainability at a time when there is very high demand for clinical care, but we have to keep in mind that reducing climate change and its health impacts is part of reduced pressure on the NHS in the long-term.’
Advice on limiting diagnostic activities
Blood testing
- Think twice: Before making a request, consider if the test is essential.
- Check twice: Check if tests have been done recently (in primary or secondary care) and whether they need to be repeated.
- Order once: Check with the lab if additional tests can be added onto existing samples taken within the past days to a week. Plan what is going to be requested in the coming hours/days and combine tests where possible.
- Take care: Samples sent in the wrong containers or with insufficient sample need to be repeated.
- Audit: Undertake audits of departmental or organisational practice to ensure sustainable testing is optimised.
Reduce diagnostic imaging
- Consider if an imaging referral is essential.
- Review the patient’s history to determine if imaging has been completed recently.
- Use the Royal College of Radiologists iRefer tool to improve the appropriateness of referrals.
Source: Royal College of Physicians
The NHS has set the goal to reach net zero for emissions it can ‘control directly’ by 2040, and a net zero goal for emissions it ‘can influence’ by 2045.
According to projections by the UK Health Security Agency (UKHSA), in a scenario with no further ‘decarbonisation’, heat-related deaths will increase from a baseline of 1,602 deaths per year to 10,889 deaths in the 2050s.
The agency has also warned that mosquito-borne diseases are likely to come to the UK in the ‘near future’ due to climate change.
In 2020, the BMA set out plans for general practice to be carbon neutral within 10 years’ time, with an estimate that between 65% and 90% of the carbon footprint in GP practices is associated with prescribing.
And the GP Committee later wrote to ministers calling for a ‘green fund’ to be set up to help GP practices cut carbon emissions.
Health ministers have previously pledged to ‘take action’ on overprescribing after an official review found that 10% of medicines dispensed in primary care in England were not needed.
Earlier this year, a study suggested that poorly controlled asthma is contributing to more than 300,000 tons of greenhouse gas emissions in the UK every year, most of which comes from over-reliance on reliever inhalers.
The recent suspension of a GP who took part in peaceful climate change protests caused outcry among doctors, with the BMA calling for a review of the decision.
How much carbon does a late diagnosis of rectal cancer cost resulting from dropping that “unnecessary” fit test? Or failing to identify inflammatory bowel disease because you didn’t want to splash out on a faecal calprotectin? Whats the carbon cost of not doing the CXR on the guy with cancer you thought “might” need one but didn’t because you didn’t want to bother the hospital? This casual advice spun out from organisations with niche interests seeking to influence clinical decision making has real consequences in the real world and some of it might not be anticipated. YES we need to reduce carbon emissions but trying to influence clinicians into not doing stuff that they might otherwise have done is not appropriate. I have no problem in a green agenda but don’t let this contaminate my clinical decision making please. If you practice long enough you will encounter situations where, in hind sight, you wish you had done things which for vague reasons you decided not to, and later regretted it. Subtle pressures on NOT making a referral and/or not doing a test for non clinical reasons are everywhere. No surprise this well meaning partly thought out advice is coming from the RCP. Predominantly virtue signalling I fear with zero danger of any blame for the stuff that might be missed. Easy words
Fully agree with A B. The consequences of missing a diagnosis are huge for both patients and clinicians. Too many naive clinicians will get the balance wrong and cause carnage. Someone please tell those morons to shut the hell up.
Yet again great advice from people who don’t see patients but feel they can offer advice. When you are up in front of the GMC or NHSE or the lawyers, the above will be a great defence. The RCGP told me to decrease investigations and prescribing. I still can’t quite understand why people pay to be told the above, which is of no use to anyone and down right dangerous and could possibly end your career. I stopped paying 10 years ago and it has funded some lovely things I actually have use for, including family holidays.
Carry on doing what you do. These gimmicks will not help till China , India and USA reduce their carbon emissions.
Aren’t we doing above already?
Are the RCP wanting GPs to de-prescribe drugs and de-order tests ordered by their other ‘practitioners’ now as well then?
Perhaps we should start by de-prescribing some of these alternative practitioners, and revert to use of ‘the drug doctor’ as described by the RCGP.
As to ‘check twice’ – what about the demand from hospital doctors in discharge letters that GPs repeat a test within a shorter timescale than the lab will allow, and don’t tell us they did it recently, and it does not show on patient records available to GPs anyway?
Is this some sort of parody?
Have these people not been into an A/E Department or a GP surgery since COVID?
Utter greenwashing nonsense from RCP. Best to send straight to recycle bin. It certainly reads laughably Pythonesque.
Anthropogenic climate change is real but the debate about it isn’t helped by stupid and ignorant stuff like this RCP missive.
Seriously this report is suggesting we alter our clinical management of the individual patient to satisfy an agenda completely unrelated to their health? Surely the GMC ought to take an interest….
Ah Mr de Seaze, there’s good news and bad news. Good news is, by refusing all blood tests and scans, you’re our Carbon points champion of the month (yay). Bad news you’ve got stage 4 cancer…
(Brought to you by RCP Productions)
And the bottom line is————-we will all comply
Comments here seem remarkably reactionary to what is quite sensible advice. Stop sending patients for unnecessary repeated blood tests. It takes 30 seconds to check. If you don’t you give the patient, the phlebotomist, the lab, and the person to review your unnecessary blood tests all more work, plus the associated costs. How is this in any way not sensible advice? And stop arranging unnecessary tests. Of course arrange FIT tests etc where appropriate, who said don’t use your clinical judgement? But don’t do MRIs on patients with 20 years of stable migraines without other symptoms, or X-rays on barn-door OA. Done right this will REDUCE workload, save money, save resources. Win-win-win. And don’t forget patient anxiety caused by unnecessary investigation which finds incidentalomas. Oh and yes Climate is a health issue. A massive one. Read the IPCC report not the Daily Mail, or indeed this comments section, for a sensible discussion of climate change.