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Green Impact For Health

Updated on Thursday, 15 October 2020, 255 views

Green Impact For Health

The Green Impact for Health project has been developed for General Practice by the National Union of Students, GPs, trainees, and medical students. It’s supported by University of Bristol, NHS Health Education South West and the Severn Faculty of the RCGP. The web-based scheme is designed to improve the environmental performance of general practice while saving money and ensuring that the way we provide our services offers the greatest benefit to society as a whole.  

This year the Somerset PCIS Year 5  will include some criteria that will help you with this. The criteria are taken from the RCGPs Green Impact for Health award scheme which since it started 5 years ago has grown and now has over 700 practices working towards the scheme’s criteria.

Sustainable Healthcare is the concept of providing healthcare in a way that is beneficial to patients without harming the planet. Green Impact for Health (updated October 2020) provides guidance about the small changes that will improve quality, save money and improve the environmental sustainability of your practice. Each of the GIH’s small changes support the UN 2030 Agenda for Sustainable Development and making some of these small changes will be an achievement for any practice.

We know that some Somerset practices are already working through the required sets of actions to attain the bronze, silver or gold levels of the Green Impact for Health award. The GIH bronze level includes 24 actions worth in total 100 points. To gain the Bronze level award from RCGP a practice has to demonstrate that it has achieved actions worth 75 points.

We do recognise that not every practice will want or be able to do this at the moment due to the pressures of COVID 19 but we do believe that every practice will be interested in making a start on some small changes which are included in the bronze level of the scheme.  To qualify for the Somerset PCIS payment in sustainable healthcare a practice should;

  1. Practice manager and relevant other members of the practice individually register on the RCGP Green Impact for Health toolkit. Do this at https://www.greenimpact.org.uk/giforhealth/register    (The required registration code is 134)

       2. Select and complete actions worth at least 25 points from the bronze level. The LMC will be proactively supporting all practices to do                 this.

We have included below some ideas and links that will help you achieve some of the action numbers.

October 2020 - The action numbers have been updated and new numbers included.  

Action Number Criteria Points Notes
B001 now FOD001 EITHER all tea and coffee purchased by the practice for staff is Fairtrade certified
OR a poster is up in the tearoom explaining the benefits of buying Fairtrade products.
(This only refers to tea or coffee bought with practice money, not products bought by staff)
2

Link to Fairtrade tea poster or coffee poster

Link to Fairtrade website Fairtrade website for resources such as webinars, ideas and other resources

B002

now 

WR002

Clear guidance on how staff can double-side copy is posted within readable distance of each photocopier
AND the practice collects its waste non-confidential A4 paper printed on one side only, and rather than sending it for recycling, the practice reuses it or donates it to an organisation for reuse.

2

Most of the printers in Somerset practices are the brand Kyocera and have the Duplex (double sided) option, this can be set to print automatically or you can ask the printer to do this manually each time you would like to print double sided.  This link will take you to a number of posters that you could use to display.  

The paper printed on one side (non-confidential waste) could be made into note books for reuse in the practice.  

B004

now

WR001

All plain A4 white copier/printer/fax paper bought by the practice meets at least one of the following options:
• made from at least 70% recycled paper;
• made from [NAPM] accredited recycled paper;
• made from pulp from [FSC] [certified sustainable sources].
2

Link to PEFC ​​​​​​(Programme for the Endorsement of Forest Certification),

NAPM no longer in operation.  

B005

now

ENS001

The practice has used 3 years’ worth of energy bills to establish a rolling average of the energy use of the whole practice.

5

Link to Carbon Trust for posters. 

Get Smart Energy Poster for NHS Employers.

Link to NHS SDU ​​​​​​for resources and guides

Link to Smart Energy GB for information and guidance.  

If you can’t measure it, you can’t improve it.”
Energy suppliers can provide monthly readings. These should be separated into electricity, gas, or oil.

They will look for evidence that the energy use has been calculated for daytime use, usual shut-down and the improved shut-down procedures

Take a look at
NHS Property services can help GP tenants and others with buildings management see  https://www.property.nhs.uk/energy-and-environment/

 

B006

now

SOP001

At least one member of healthcare staff has engaged in learning or attended training on social prescribing and is identified as the practice Social prescribing champion or coordinator.

The champion should be aware of the benefits of Green and Blue prescribing, ( to nature or water). See S012, S015, S020 and G011 for the other steps in Social Prescribing.

5

Link to NHS Social Prescribing it provides guides and accredited online learning and resources.  

There are many links to useful information on the toolkit under the Further Information tab.  

B007

now 

PRS001

The practice has accessed the national [www.openprescribing.net] and has looked at the GP Dashboard for their practice, or uses their local preferred alternative (e.g. Eclipse). Someone in the practice receives regular email alerts on the prescribing trends.

5 You will have access to Eclipse within Somerset and have regular email alerts, you  can evidence this by showing any actions taken by reviewing.  

New

PRS002

The practice has delivered, or facilitated the access to, continuing professional development on environmentally friendly inhaler prescribing for all GPs, and nurses who undertake asthma or COPD reviews.  5

Auditors will be looking for evidence such as notes and names of attendees from CPD sessions on this. These could be virtual or face to face, in house or external. They should include the majority of GPs and nurses• Learning should include the optimal use of DPIs involved in respiratory care as well as other interventions to lower the carbon footprint of care when MDI use is needed. 

A good starting point for further information on this subject is: www.greenerpractice.co.uk and www.greeninhaler.org. Education should also include learning about the NICE patient decision aid for inhaler choice in asthma https://www.nice.org.uk/guidance/ng80/resources/inhalers-for-asthma-patient-decision-aid-pdf-6727144573

B008

now

NCM001

The practice newsletter or website has promoted the practice's participation in the Green Impact scheme.

2 You can add a link to the Green Impact Scheme on your surgery web page or add a section to your newsletter or TV screens, it could include what the practice is doing to work towards the scheme.  There is some suggested wording on the Further Information section that could be used for your website.  

New NCM002

There is a discussion with the practice team about the health impacts of climate change, raising awareness of the adaptation and mitigation required.
 

4 Providing information to the practice team demonstrates leadership by the practice, directly raises their awareness, and indirectly raises the awareness of their friends and family.  Please refer to the Further Information tab for ideas and resources

B010

now

WR003

All staff within the practice have been reminded about the difference between the waste bins (e.g. clinical, offensive, hazardous and domestic waste) within the last 6 months. Waste bins are clearly labeled.

 
5

Suggestion for evidence are;

  • A note in a practice newsletter
  • Posters and notices
  • Email out to all staff
  • a note on the practice website and/or TV screens

These should all be dated and within six months of your submission.  

It can be included in your waste policy which should have a description of the type of waste and how to dispose of it.  The suggestion to to have five basic bins in general practice,

  • sharps,
  • contaminated waste,
  • confidential paper for shredding,
  • paper for recycling
  • and non-recyclable waste.  

Link to Initial Waste where you can download posters for waste management.  

Link to CQC management of clinical waste 

B011

now

LE001

The practice has accessed appropriate on line resources about sustainability to access up to date information.

3

Links to sources of information about sustainability.

You will be expected to know about online resources.  

B012

now

VG002

The practice has made a plan to address the problems of fuel poverty within vulnerable population groups in line with NICE guidance. This plan should include the identification of vulnerable patients, asking these patients about keeping warm at home and a process for referral to a single point of access. 2

NICE guidance NG6 Excess winter deaths and illness and the health risks associated with cold homes can be downloaded from this link .  

The evidence could be;

  • minutes from meetings discussing and addressing fuel poverty,
  • Reviewing the NICE guidance
  • Any email communication regarding fuel poverty.  

This is a link to Somerset Community Foundation which help and advice people in fuel poverty.   

 

B013

now

VG001

The practice has ensured that over half of its "vulnerable to unplanned admission" patients have had a documented discussion on end of life care, including decisions of Do Not Attempt Resuscitation (DNAR), Treatment Escalation Plans (TEP) and ceiling of treatment. 5 You could provide the numbers of patients in your practice that have a TEP.  Write a piece of evidence around the local TEP/DNAR and how you approach this work.  e.g. you will have done a lot of this for COVID-19.  

B014

now

ENS002

The practice has an up-to-date written 'lighting and equipment responsibility plan' covering responsibility for all the main areas and key equipment within the practice and all relevant staff have been made aware of the plan.

2

This is a link to the Green Impact.nus.org.uk resource bank where you can find a lot of resources to help with the Green Impact Toolkit.  There are posters, templates for policies etc..

They will be looking for a calculation of the amount of energy used by lighting.Please see the Further Information tab on the GI site

I have linked the Lighting and Heating Plan template for you​ here it can be found under the Energy section .  

There are other things you could think about to motivate staff like using energy meters to show energy use, give them a responsibility for an area of energy saving even if its putting up posters, or developing something for the waiting room  or the waiting area TV screen.  

New 

ENS004

The practice has asked their energy supplier to provide readings on a monthly basis for gas and electricity. 2

The practice understands the energy use by the heating system using total energy (including gas and oil) bills.

You will be asked for your monthly readings, your energy supplier will be able to help you with this.

New

ENS005

The practice understands the energy use by the computers, peripheries, and other plug in electrical equipment (including kettles and fridges etc).The practice has measured the number of electronic devices in use, an estimate of the length of time used per day and the amount of energy used. 2

The practice has had an assessment of heat loss e.g. through loft insulation, windows, doors, walls etc.

cost monitors are readily available to buy. For more information on the benefits of energy monitoring, please view the Carbon Trust's guide to monitoring energy.The link in the further Information is not working on the toolkit, however you can get a free booklet here https://www.carbontrust.com/resources/effective-energy-management-for-business-guide . Energy used by electrical equipment can be calculated by measuring a range of individual pieces of equipment. This can include daytime use and overnight use if left on standby. Practices can then convert this into expenditure using the cost per kWh on their energy bills.

Auditors will look for a calculation of the amount of energy used by electrical equipment.

New

ENS006

The practice understands the energy use by the heating system using total energy (including gas and oil) bills. 3

 

You could build a spreadsheet with the monthly costs of electric, gas and oil and evidence with the costs.

New

ENS007

The practice has had an assessment of heat loss e.g. through loft insulation, windows, doors, walls etc. 2

https://www.ofgem.gov.uk/publications-and-updates/heat-loss-assessment-questionnaire

The link above takes you to a questionnaire for assessment of heat loss, or you could ask your supplier if they provide an assessment.

B015

now

PRS003

The practice has reviewed the proportion of dry powder inhalers (DPIs) used compared to metered dose inhalers (MDIs) AND the proportion of low volume Salbutamol MDIs used compared to high volume Salbutamol MDIs used AND the proportion of inhalers which use HFA227ea.

3

This is part of the Prescribing Scorecard this year for the Incentive scheme.  The team regularly update practices on their performance so you could evidence this through the scorecard data which is sent out monthly.  

This indicator supports the work around rising greenhouse gas emissions and the increasing rate of climate change.  There is a website that compares the carbon footprint of inhalers https://greeninhaler.org/inhaler-comparison/

B016

now

PRS004

The practice has a system in place to review patients on 10 or more prescriptions in the first step to preventing unnecessary polypharmacy.

6

the average number of prescriptions per patient per annum increased from 11.9 to 18.3 between 2001 and 2011, an increase of 64%. It is good practice to avoid high risk polypharmacy.There are tools that can be used to review patients.  You can set up some searches on your clinical system looking at patients aged 65 and over taking more than 10 medications to start with, then you could move onto "clinical at risk groups" using the same principle.  

The Medicines Management support technician or pharmacist could help you identify the patients and you could then review.  

This link is the NICE guidance for Multimorbidity and polypharmacy  ​​​​​​it has good advice on using appropriate tools such as STOPP/START and medicines optimisation.  

B017

now

LE002

All GP trainees and/or Foundation doctors have received at least one tutorial on career resilience and have submitted feedback forms. 2

All GP Trainee's have are provided with training on resilience as part of their programme.  There are also resources on the BMJ careers website and the RCGP has a wellbeing resource page .

It is important to support the workforce as they are at risk of burnout and as you are aware incentives in the contract to support and retain GPs.   

Auditors will view evidence, which may include (but is not limited to):
• Trainee portfolio screenshots;
• Videos of tutorial;
• Trainee and assessor feedback on the process

B018

now

QIP001

The practice encourages patient self-management with guidance for at least one named condition (as chosen by the practice).

5

You only need to choose ONE named condition. 

There are a lot of good self-management examples in our practices in somerset. 

The Further Information tab has lots of resources to help.

We provide rescue packs for COPD patients, treatment plans for patients with long-term conditions such as Asthma and Diabetes.  There are some support groups which have been set up which hep with self-management.  You will need to demonstrate/evidence this with photos of the group in action, evidence of a treatment plan that the practice use or upload a plan from one of your patient's WITHOUT the patient detail.    

B019

now

QIP002

The practice has planned at least one quality improvement project, which aims to improve the sustainability of the healthcare system in question.

6

The QI should be around reducing waste, saving money or reducing your carbon footprint at the practice.  You could develop a QI around this tool and implementing the process and have cycles around the indicators.  You would ave plenty of evidence.    An idea from the toolkit is to reduce the number of unnecessary PSA blood testing.  

The evidence needed is you QI plan and be able to talk about what you did.  

Here are some links that may be of help. 

B020

now

ENS003

The practice uses rechargeable batteries for medical equipment 1

Rechargeable batteries are useful mainly for high-consumption devices such as cameras, flashlights, and electronic toys, which require frequent recharging.

You will be expected to evidence the use of rechargeable batteries.  You could provide a spreadsheet of your medical equipment and which one has rechargeable batteries and the make.  

B021

now

LE003

The practice has engaged in at least one activity to enhance the sustainability of local training resources, for example sharing across practices. 2

Sharing resources and reducing travelling may increase efficiency and GP trainee experience.
This criterion may be achieved by having a training programme in place designed to maximise local training resources with other practices, including joint tutorials, peer-to-peer sessions, podcast tutorials, video link (eg zoom) tutorials and sharing of training resources.Development of a website which makes training resources available to others would also be appropriate.

Work that is shared across PCNs would be a good example for this action.    

B022

now

TAE001

The practice promotes physical exercise to patients and staff and promotes a culture of physical activity and role modelling. All practice staff are aware of benefits of physical activity and physical activity prescriptions. 6

There are toolkits, information and inspiration at the RCGP active patient charter -  link

There are also 10 toolkits for specific conditions which can be sed for consultation or short conversations it is called Moving Medicine.  

You can also set up lunchtime sessions for staff by doing a 15 minute exercise group, walking, Jo Wicks session from You Tube, join a park run.  Some practices in Somerset have already been taking part in this kind of activity with great success.  It also helps teams to bound and break down any barriers within teams, especially when a reception memebr is doing press ups with a GP or the cleaners are star jumping with the nurses.  

Auditors will expect that the practice to have knowledge of the UK current national physical activity guidelines  https://www.gov.uk/government/publications/physical-activity-guidelines-infographics . Resources and tools to deliver physical activity within patient care (such as moving medicine) should be easily accessible to all staff members. The practice will have shared learning on the benefits of physical activity in patient care. Examples of shared learning include a practice meeting, a CCG/PCN session delivered by your regional PHE physical activity clinical champion (please contact  physicalactivity@phe.gov.uk , or e-learning by  https://www.e-lfh.org.uk/programmes/physical-activity-and-health/  on the benefits of physical activity. Examples of use of resources to prescribe physical actvity (eg active use of Moving Medicine ) will be sought.

B023

now

NCM003

The practice changes its default internet search engine to Ecosia which plants trees when people use the site. 2 Link to Ecosia.  When you select Ecosia it will link to your default page and the any profit it makes it will plant trees where they are needed.   Your bookmarks are saved, just set up and go!

B024

now

FOD002

The practice adheres to the basic principles of welcoming breastfeeding on site and has accessed online resources for up-to-date information and training for staff to support women to breastfeed.
 

2

The evidence needed for this would be patient feedback or posters in the waiting areas and on your practice website on how to access support and information.  

It would also be an idea to provide training for all staff and document the date of training and/or hve as part of induction.  

This link takes you to the NHS Breastfeeding page  which are a good resource for staff and patients.  

This link will take you to Unicef Breastfeeding resources for posters you can display.  

WA001 Any dual-flushing toilets have been labelled so that users know which button is for the half flush. 2

Dual-flushing toilets are increasingly common but often do not make it obvious which button creates a shorter, water-saving flush. Recycled water or rainwater can be used to flush toilets.

Auditors will look for signs/labels in toilet areas and/or cubicles
ZC001 The practice can show evidence of learning around carbon literacy for healthcare staff with at least one member of clinical staff and one member of management staff having undertaken Carbon Literacy learning. 5

Raising the awareness of carbon literacy and the climate crisis is vital. The impact on human health and the practicing of healthcare will be substantial.

The Carbon Literacy Project and the Centre for Sustainable healthcare provides appropriate courses. For bespoke GP courses, see https://seesustainability.co.uk/health-carbon-literacy

The evidence will need to be certificate of learning attendance. 
Total   100  

 

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