How this PCN supported GP practices to become more sustainable

West Hove PCN has supported member practices to engage with the RCGP’s Green Impact for Health toolkit. Brighton and Hove GP Dr Abigail Fry explains

Global climate change is regarded by the World Health Organisation (WHO) as the single biggest health threat facing humanity, presenting a persistent and growing environmental burden of disease with significant public health consequences.

To play its part in reducing carbon emissions – which are by far the largest contributor to climate change – the NHS in England has set targets to reach net zero by 2040 for direct emissions, and 2045 for emissions it influences. Primary care contributes almost a fifth (23%) of the NHS’ carbon footprint (13% of which is due to asthma inhalers alone).

However, primary care professionals often find it difficult to know where to start on their journey towards environmental sustainability. GP practices are small businesses and the whole process can feel insurmountable.

Using the Green Impact for Health toolkit

As a GP in Brighton, East Sussex, I understand the sentiment because I felt the same way before signing up my practice to the RCGP’s Green Impact for Healthcare (GIFH) toolkit. This is a free, online resource which supports GPs in taking simple actions to become more eco-friendly, ethical and environmentally aware. 

It comprises five key levels of achievement ranging from a Bronze Award to a Diamond Award – taking practices through tangible actions to improve sustainability. The available awards are:

• Bronze: Your practice needs to achieve 75 points from the toolkit. 
• Silver: You need to achieve 150 points from the toolkit. 
  Gold: You need to achieve 225 points from the toolkit.
• Platinum: You need to achieve 300 points from the toolkit. (This was previously called the Gold plus award.)
• Diamond: You need to have gained a Platinum award and completed enough criteria on the Diamond theme to demonstrate that you have achieved net zero carbon status in your general practice. (This was previously called the Carbon award.)

Every practice that completes criteria (no matter how few) and submits for an award also receives a Green Impact for Health Pioneer certificate to demonstrate the commitment they have made.

At Mile Oak Medical Centre, we began engaging with the GIFH toolkit in 2020 and achieved a Gold Award in 2022. I signed up because I was worried about climate change – and about primary care’s contribution to carbon emissions – and realised that, through the toolkit, I could have influence in the place I work.

I started implementing it single-handedly at first; colleagues were very busy but supportive of what I was doing. I then had help from a trainee who was keen to use some tutorials to work on the toolkit and to do audits and quality improvement projects, that tied in with it. We found some easy actions to help us reach the initial awards.

Supporting other practices to become more sustainable

After going through these practical steps and eventually reaching the Gold Award, I knew that the process was less daunting than it first appeared. I felt certain that, with a little support, other local GPs would engage with the toolkit and their staff would be encouraged to become involved in discussions about reducing the carbon impact of their workplace.

I began talking about sustainability to colleagues across West Hove PCN and throughout the Brighton and Hove area, as well as speaking to people around the country and even internationally. Some were not aware of the GIFH toolkit, but those who were often said they did not have enough time or support to engage with it.

I was also approached by a number of GPs in different practices asking if they could visit me at work to see for themselves what we had accomplished, and to explain how we had achieved our Gold Award. This showed me that there was a hunger to become more involved in improving their practices’ environmental sustainability, but a lack of knowledge and confidence about how to get started.

I therefore decided to draw on my experience to provide support to the other practices within West Hove PCN and enhance their environmental sustainability. This would assist the NHS in reaching carbon neutrality, while also improving quality of care alongside making financial savings.

My ultimate aim was for all five of the PCN’s constituent practices (including my own) eventually to achieve the toolkit’s Diamond Award by becoming net zero; in practical terms, this meant supporting each of them to engage with the toolkit and then allowing them to build on this momentum to move through the different levels.

I was fortunate to receive £11,714 in funding from the Greener NHS Healthier Futures Fund to work on the project for one day a week for a period of six months; I launched the initiative at a PCN meeting in October 2022.

My first step was to send out a survey to each staff member in the PCN’s practices asking how they felt about the climate crisis and sustainability improvements, as well as the level of knowledge they had on these topics. I gathered the names of staff who were interested in further involvement.

Following this, I attended an all-practice meeting at each surgery, explaining to staff how they could gain most of their Bronze Award points for activities they were already doing; I also offered to share posters from my practice. I then spoke to staff in their smaller, specialised teams (for example, managers, GPs, nurses, pharmacists and admin teams) to discuss the toolkit areas that were most relevant to them and support them to make changes.

Doing this effectively involved adapting my engagement techniques for each practice and each team. Different people are motivated by different aspects of the toolkit from the sustainability improvements to making financial savings, improving patient care and attracting staff. For those with a competitive spirit, I set up a local league table, promising the practice with the highest increase in points from their baseline after six months a (sustainable) hamper.

I realised that earning a Bronze Award could be the inspiration that practices needed to engage with the toolkit further and encourage staff to feel proud of their achievements as a team.

Although three practices had already registered for the toolkit, one had achieved only four points, another had accrued two and one had yet to gain any points, so it was easy to build upon these scores. I gained each practice’s consent to sign up to their toolkit account so that I could develop personalised ‘quick wins’ sheets for them with actions I knew they could easily accomplish.

For example, simply requesting monthly gas and electric statements earns you two points, while evaluating social prescribing adds four. Avoiding the use of paper when communicating with patients brings in five points.

Regular updates showing the current league table status helped to encourage friendly competition between practices, and once people began to see the improvements in sustainability brought about by the behavioural changes they were making, the culture of each practice gradually changed too.

Spreading good practice

The GIFH toolkit makes measuring change easy, as points are earned for specific actions. One example of an activity that can be used to gain points towards an award includes plotting monthly fuel bills to observe trends and conducting energy audits. On average, practices can reduce 20% of their energy usage through simple behavioural modifications.

After two-and-a-half months of running my project, four out of the five PCN practices had received their first Bronze Award (and were on their way to achieving Silver) and my practice had achieved the Platinum Award. This made it the fifth practice in the country to have reached 300 points. By the end of my six month project, another practice had reached Silver Award status.

Since the project ended, the majority of the practices have continued to add points to their toolkits and I have been told by staff across the PCN that the project has had a powerful ripple effect. It has also led to behavioural changes at home, such as people switching off lights, or becoming socially conscious consumers.

Another positive outcome is that other ICBs, PCNs, research groups, medical environmental groups and conferences have been interested in finding out about my project. This means that news of the toolkit – and how to use it – has spread outwards from West Hove PCN to other areas in Brighton and beyond.

Some health organisations have established similar initiatives in their own areas and are using a variety of strategies to encourage more practices to join in. These include providing financial incentives for practices achieving the toolkit awards, identifying sustainability champions within PCNs and ICBs and involving GP trainees and medical students in primary care sustainability so they can assist practices in making changes.

Ongoing progress

Our practice is still working towards its Diamond Award. We’ve changed to LED lighting with the help of a grant from the Brighton and Hove council’s Shared Prosperity Fund and are in discussion with our landlords about fitting solar panels.

We are also in the process of developing our back garden into a community garden and have just received a grant for the set-up costs of a project to move from plastic speculums and single-use metal forceps and scissors to sterilisable versions of each instrument. The sterilising will be done at the hospital and our pathology collection service will be transporting the equipment back and forward.

However, reaching a Diamond Award will take a bit of time as we need to prove we are a net-zero business, which means gathering sufficient data. We are aware that prescribing will be the most challenging carbon footprint to counteract.

In the meantime, I am continuing to spread the word about the benefits of the toolkit. Later this month, I will be speaking to members of the Greener Healthcare and Sustainability Project (GHASP), who are predominantly hospital-based health professionals, about what’s going on in primary care. I am also helping Greener Practice to develop resources that will assist practices to work through the GIFH toolkit.

I believe it’s vital for the NHS, as such a large employer, to take this journey towards greater sustainability. This also helps to raise the profile of the green issues within communities and prevents us from causing avoidable harm.

Dr Abigail Fry is a GP partner and trainer at Mile Oak Medical Centre, Brighton and Vice Chair of the Greener Practice Leads group.