Wes Mountain/The Pharmaceutical Journal
Climate change affects us and our patients — from the air we breathe, to the water we drink, to the places we live and work.
The NHS contributes 4% to England’s total carbon footprint and, as the country’s largest employer, it has a role to play in leading the way to a greener future.
The NHS has pledged to be carbon net zero for emissions it controls directly by 2040 and carbon net zero by 2045 for emissions it can influence. A quarter of the NHS carbon footprint comes from medicines, chemicals, anaesthetic gases and inhalers — items that fall directly under the pharmacy umbrella.
To achieve net zero targets, all pharmacy staff need to be committed and engaged in this agenda, and there is great work going on in pharmacy settings around anaesthetic gases and inhalers, but where do we go after that?
The climate crisis is worrying and while plenty of us try to make sustainable choices at home, sustainability does not always overtly affect pharmacy practice. For me, this changed when a colleague recommended the Yorkshire and Humber Future Leaders Programme (FLP). This multidisciplinary leadership development programme offers the chance to develop personal leadership skills while undertaking a project that addresses current NHS priorities. Following my appointment to the project on medicines sustainability hosted by NHS England School of Pharmacy and Medicines Optimisation (North East and Yorkshire), I was excited by the opportunity to learn how environmental sustainability and healthcare intersect and better align my personal and professional values.
Increasing awareness
From informal conversations with pharmacy colleagues and looking at the literature, it became clear that there was limited understanding about pharmacy workforce feelings on incorporating environmental sustainability into pharmacy practice.
Considering this, I conducted a survey of pharmacy staff in the North East and Yorkshire region to explore the knowledge and opinion of staff on sustainability both in general and in relation to pharmacy practice. The survey and five follow-up interviews provided details on the barriers and enablers experienced in practice when trying to implement sustainable initiatives.
Including sustainability in guidelines or policies is a particularly helpful enabler as this may remove the individual onus to drive the agenda
Some 122 registered and unregistered pharmacy staff, working in a variety of healthcare settings in the North East and Yorkshire, responded to the online survey. Respondents ranked environmental sustainability an average of 8.2 in importance on a scale of 1 to 10 (with 1 meaning ‘not at all important’ and 10 meaning ‘extremely important’). The majority of respondents (86%) thought that environmental sustainability was a healthcare issue and 93% wanted their workplaces to be more environmentally sustainable. This is encouraging as it highlights the importance of environmental sustainability to pharmacy staff.
Three-quarters of respondents (75%) said they wanted to be involved in environmental sustainability work within their team and common enablers for engagement were personal interest, a supportive employer, inclusion of sustainability in guidelines or policies, and access to pharmacy specific resources.
Including sustainability in guidelines or policies is a particularly helpful enabler as this may remove the individual onus to drive the agenda — which can be off-putting — and helps incorporate sustainability into “business as usual” practice, which will be necessary to achieve net zero targets.
Identifying barriers
Barriers experienced by staff in practice when trying to engage with environmental sustainability work were lack of time, competing priorities, lack of knowledge or skills, and lack of awareness of opportunities. The latter two highlight how separate the sustainability movement is from most staff on the ground. Lack of time and competing priorities are intrinsically linked to the workload pressures being seen across all pharmacy settings that are unlikely to ease any time soon. However, these barriers give us an opportunity to think differently about sustainability in pharmacy practice.
These barriers give us an opportunity to think differently about sustainability in pharmacy practice
Instead of sustainability being a ‘nice to have’ add-on, how can we incorporate it into our daily work and make sustainable activities a valued part of the everyday? As one of the interview participants said: “How can we make it simple for people, people already struggling with capacity and demand?”
We can view routine activities of pharmacy practice through a sustainability lens. For example:
- Medicines optimisation activities? Reduced waste — sustainability benefit;
- IV to oral switch? Reduced use of plastic and consumables — sustainability benefit;
- Correct disposal of pharmaceutical waste? Reduced pollution of waterways — sustainability benefit;
- Virtual meetings? Reduced travel and associated emissions — sustainability benefit.
Then, from this starting point, that good clinical pharmacy can be green, and we can make environment sustainability part of our daily conversations and actions.
This project has sparked many conversations across different settings, encouraging staff to consider how their current work already has sustainability benefits and where there is still progress to be made.
Sarah Cowans, clinical leadership fellow — medicines sustainability, school of pharmacy and medicines optimisation (North East and Yorkshire), NHS England’s Workforce, Training and Education Directorate
