Greener Leader Blog Series: Going Greener in General Practice. By Vasumathy Sivarajasingam

Although GPs may well be aware that the climate emergency is also a health emergency, many may not make the connection with what they can do in clinical practice to reduce general practice’s carbon footprint.

As GPs and primary care teams, we are on the frontline, and already encountering some of the resulting health impacts of climate change in our consulting rooms, such as the implications of air pollution, and we can already begin to anticipate the pressure we will be under to keep services running in extreme weather conditions that are likely to escalate as the crisis continues.

GPs also have a pivotal role in tackling health inequalities, which climate change is set to widen. We already know that disadvantaged groups are more likely to be susceptible to the negative consequences of the climate crisis with less ability to adapt, making them even more vulnerable.

General practice is both the cornerstone and the gatekeeper to the NHS. Around 90% of NHS patient contacts are via primary care. According to a report, around one in twenty GP consultations resulted in a secondary care referral, suggesting the remaining consultations have been resolved in-house with generalist skills. Given our prominent role in healthcare, primary care teams are ideally placed to drive environmentally focussed behavioural changes, both amongst our patients and the wider NHS. As trusted healthcare professionals, we have the perfect opportunity to engage with our community and raise awareness of the threats of climate change on our collective health. We can make many adjustments to how we work and interact with patients; some may be small and incremental changes, though others may involve larger changes that require deeper preparation and additional support.

To reduce carbon emissions across GP practices in Ealing and in line with the National Health Service England’s ambition of becoming the world’s first health service to achieve carbon-neutral by 2040, the Ealing Borough Primary Care Team decided to take the lead and implement the ‘Green Initiative’ as part of their local primary care specifications in April 2022. These requirements are designed to provide a quality framework for primary care. The aim was to embrace the climate movement and inspire as many practices as possible to start making small incremental changes that will improve health and well-being for generations to come.

Action on climate change requires leadership along with a shared, purposive, and coherent strategy involving a multi-professional team. As the primary care clinical lead for the Green Agenda, I had the opportunity to drive this innovation by working in collaboration with the GP practices including its extensive multi-disciplinary team and the local council – working to improve health and the local environment. The specification was broken down into ‘Essential Components’ (identify a ‘Green’ champion member of staff; ensure the champion attends the suggested training over the year) and ‘Bucket List’ items where practices had to sign up for 5 or more additional activities. The Bucket List items focussed mainly on inhaler changes, green travel, efficient appointment timings, recycling, and medicine usage. The practices had to audit their use at the beginning of the year to evidence their change in practice and were encouraged to complete the Green Impact for Health Toolkit.

We supported GP practices in our area by sharing simple, bite-size practical tips/guidance on how to achieve these objectives via weekly newsletters. Email reminders were sent and communication groups set up which began initially with just 4 people but has expanded well beyond that now. Celebrating achievements, however small, was promoted as it seemed to motivate staff and keep the momentum. The assessment of attainments of essential and bucket list items was performed on the 31st of March 2023. A total of 64 GP practices achieved the Green Initiative targets in 2022/23 and our accomplishments and achievements were shared with the larger UK’s primary care sustainability network via the national Greener Practice website.

The Borough Sustainability Team soon realised the importance of collaborative leadership within our communities, patients, partners, and staff to take steps in tackling climate change. Through shared responsibility and accountability, the health of the population can be improved. This led to the development of the 10-point green plan for GP practices and their patients which emphasises a clear vision and visible objectives with actionable goals. We believe this demonstrates to both the staff and patient population that their practice takes their health and future seriously. For the second year, we incorporated the ideas from the 10-point green plan into the ‘local primary care specification’, Green Initiative (2023-24).

Our goal was for the primary care team to reduce their environmental impact and embed sustainability into their daily work without imposing a considerable amount of additional work. In order to achieve this, it is fundamental that we view clinical and non-clinical activities through the sustainability lens and as one interdependent system where humanity, public health and nature are not separate entities, but one entangled web in a delicate balance. The co-benefits that climate action has on our natural world and on human health are a testament to that point.

We believe an enhanced focus on greener practice improves holistic patient care and staff well-being, contributing to a happier, healthier, and more productive workforce. While improving staff morale and practice efficiency, it can also reduce GP workload and practice expenses (through improved population health and reduced prescribing) along with improving health inequalities as mentioned above. This is fundamental in securing a strong future for general practice which, at present, appears to hang in the balance.

For sustainability to work in primary care, it must be accepted as a core value and not as an additional demand. Sustainable value of healthcare intervention can be determined using the concept of the ‘Triple Bottom Line’ as it considers the combined financial, environmental and social impacts along with patient outcomes. In primary care, the needs of people include the staff, patients and the community. “Triple Win” for sustainable healthcare embraces the delivery of the best possible health outcomes for patients and the population with marginal financial and environmental costs while adding positive societal value at every opportunity. Ultimately this would support NHS England’s ambition of becoming the first healthcare system to achieve net zero.


Photo of Vasumathy Sivarajasingam

Vasumathy Sivarajasingam

Vasu is an accomplished General Practitioner with over two decades of experience as a GP partner at Hillview Surgery, a family-oriented practice located in West London. Her extensive journey in the medical field began when she graduated from Ninewells Hospital and Medical School in 1995, where she also completed an intercalated BMSc in Pharmacology. In 1999, she finished her vocational training scheme at Royal Devon and Exeter Hospital, solidifying her clinical foundation. Vasu’s clinical expertise spans diverse areas, with a particular focus on women’s health and family planning. Beyond her clinical responsibilities, she has actively engaged in non-clinical roles, notably in Health and Human Resources.

In her capacity as the Primary Care Clinical Lead for Adult Mental Health, Green Agenda, and Patient Engagement in Ealing Borough, Vasu demonstrates unwavering dedication to enhancing healthcare sustainability and patient well-being. She champions the integration of environmentally conscious practices into primary care, spearheading the pioneering ‘Going Greener’ initiative at her practice. This effort earned them the prestigious ‘Green Impact for Health gold plus certificate’ in 2021 and the inaugural PROactive Practice Award, accredited by the RCGP in 2022. Recognizing her impactful contributions, the Ealing Council has declared Vasu one of its local ‘climate leaders.’

With a strong belief in knowledge dissemination, Vasu actively imparts her expertise and skills to inspire the widespread adoption of sustainable and healthy lifestyles. Her commitment extends beyond clinical boundaries, as she is deeply devoted to addressing critical social issues. She has displayed heartfelt dedication to supporting patients facing domestic violence and abuse. Her active collaboration with the Self-Care Academic Research Unit (SCARU) as part of the NWL Research Trailblazers Group initiative involves a national eSurvey and interview-based study aimed at raising awareness about domestic abuse and integrating short screening tools into routine health and social care interactions. Ultimately, this contributes to the reduction of health inequalities.

Declaration of interests:

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.


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