GPs lead calls to consider climate in prescribing decisions

The environmental impact of medicines must be considered in decisions over what is made available locally for prescription, senior GPs have said.

Scottish health boards are currently advised on all aspects of medicine use by local Area Drugs and Therapeutics Committees (ADTCs).

Recommendations are then adopted into the local list of available medicines for prescription, known as a formulary.

But decisions on what drugs take the first-choice spot are often strongly influenced by financial considerations.

Dr Chris Williams, Joint Chair of the Royal College of General Practitioners (RCGP) Scotland and a Highlands GP, argues this must change.

“We need to be moving toward a point where the considerations around which medicines appear in a formulary are based on their environmental impact,” he told attendees of NHS Scotland’s Sustainability Conference.

“For that to happen, there needs to be in place arrangements whereby manufacturers are supplying those sorts of details to the bodies that make those choices, to the ADTCs and beyond.”

A long-awaited sustainability strategy published yesterday highlighted clinical practice as a key driver of the health service’s carbon footprint.

Chief Medical Officer Dr Gregor Smith, himself a GP, said “Our over-investigation and over-treatment is wasting our precious healthcare resources… There’s never been a more important time to change the way we practice”.

The strategy also pledged action to address the environmental impact of the NHS supply chain, including the manufacture of medicines.

For many issues that are not necessarily medical in nature, Dr Carey Lunan, chair of the Deep End Group, which brings together GPs serving deprived communities, said there was a tendency to “reach for the prescription pad” when issues could be solved by non-medical interventions.

GPs must “think big picture” and look for alternatives, especially in mental health and obesity treatment, Dr Lunan, herself a former RCGP chair, argued.

“Some of that is enabled by longer appointments, or by having embedded workers within practices who help with mental health support or with financial advice or as a community links practitioner, linking in with assets in the local community.

“Some of it is about having access to being able to prescribe green spaces, or having access to gyms. And some of it is about decision aids that are health literate appropriate, to be able to help patients come to shared decision about whether or not medication is entirely necessary or whether there are other alternatives.”

Dr Lunan added: “When we do have to prescribe, we have to be thinking about, ‘so how do we do that in the very best way possible?’. Can we have formularies from health boards that offer us the low carbon options?”

Work is currently underway to develop a ‘Once for Scotland’ approach, with single board formularies being merged into combined guidance for east, north and west regions.

In its NHS sustainability strategy published yesterday, the Scottish government says it is committed to developing accurate assessments of the carbon footprint of the NHS supply chain, despite acknowledging that accurate monitoring of emissions resulting from the purchase of goods and services is currently ‘challenging’.

This story has been supplied through our partnership with our friends at healthandcare.scot. Click here to head over and have a look if you haven’t already.

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