Suffolk and North East Essex (SNEE) ICB has approximately 60% of inhaler prescriptions prescribed as Metered Dose Inhalers (MDIs) resulting in some of the highest prescribing proportions within the country. As such it was decided that we needed to take a multi-disciplinary approach to reducing the carbon impact of inhalers within our ICB.
We started the project by creating a working group which consisted of our ICB sustainability lead, respiratory lead pharmacists from each alliance and transformation representation. This group then utilised the expertise and support of secondary care respiratory specialists, local GP leads for Greener Prescribing and LPC representatives. The project so far has had 3 main focuses:
• To ensure the respiratory guidelines and formularies support practices in choosing lower carbon options. We worked with our secondary care respiratory specialists and sought advice from our local GP lead for Greener Prescribing to review and adapt our guidelines and formularies to:
• ensure a low carbon option is available at every step of our local asthma and COPD guidelines
• incorporate high and low carbon symbols for all inhalers on the guidelines to enable clinicians to easily identify lower carbon options
• include advice around the appropriate disposal of inhalers
• To develop of an ICB guideline on the reduction of the carbon impact of inhalers. This guideline includes practical advice regarding the reviewing, switching and monitoring of inhalers. It also includes locally tailored switching recommendations for inhalers commonly prescribed within our ICB, recommending lower carbon formulary alternatives. As part of the development of this guideline, we linked with our local LPC leads to promote the use of the New Medicines Service to support practices in educating and monitoring patients who have changed their inhalers and to ensure that our local pharmacies had the knowledge and expertise to advise on the use of the inhaler devices being recommended.
• To develop and run ICB wide training sessions to ensure that primary care clinicians are trained and confident to prescribe the most appropriate, lowest carbon containing inhaler for their patients. These online sessions were run via Teams as multi-disciplinary, cross-alliance training sessions and repeated on multiple occasions to ensure maximum attendance. They explained the background of why we need to reduce the carbon footprint of our ICB, led by our ICB sustainability lead, our current ICB position of prescribing and the top 5 switches being recommended and practical advice on going about safely switching patients. These sessions were attended by 111 practice, PCN and alliance staff. We also provided personalised training sessions to the Suffolk Respiratory Group, Breathe Easier North East Essex Respiratory Group (BENEER group) and several PCN pharmacy teams. Through these sessions staff representatives from 85% of our practices within SNEE received training on this project.
We are now approaching the remaining practice to offer training. We are now in the process of moving on to phase 2 and we have welcomed a member of the ICB communications team to our working group. The focus of this phase is:
• Patient focussed communications, publicity and resources developed through co-production to raise awareness of the carbon content of inhalers and the work being carried out by our practice teams
• Development of additional resources to support practices in the conversations they are having with patients.
