As one of the first ICB's to implement the reduction of Metered Dose Inhalers (MDIs), via inhaler pathway alignment and a push towards DPI's, Somerset were already ahead with the national targets to reduce carbon emissions from MDIs. We wanted to build on this incredible progress by producing and implementing additional workstreams for carbon reduction.
We started by creating a spreadsheet with all our ideas for carbon reduction within medicines, prescribing and pharmacy. This included workstreams already in place, to be worked on immediately and ideas that require more thought and exploration, for example non-pharmacological options such as social prescribing. We picked out some of the measurable workstreams to set up searches, this led to the creation of our “Green Scorecard Trend”. The scorecard trend currently measures 14 indicators:
1\. Triptorelin 22.5mg as % of all GnRH analogues (6 monthly injections vs 3 monthly)
2\. Respimat refills as % of all Respimat
3\. Spiriva 18mcg refills as a % of all Spiriva 18mcg
4\. Sumatriptan 6mg / 0.5ml injection refills as % of Sumatriptan injections
5\. Vagirux 10mcg as % of Estradiol 10mcg vaginal tabs (reusable device)
6\. Synjardy as % patients prescribed both Empaglifozin & Metformin
7\. Vokanamet as % patients prescribed both Canaglifozin & Metformin
8\. Xigduo as % patients prescribed both Dapaglifozin & Metformin
9\. Low carbon MDI salbutamol as a % of total salbutamol MDI inhalers
10\. Insulin penfill cartridges as % of Insulin penfill cartridges and pre-filled pens
11\. Semaglutide as % of all GLP-1s (weekly injections vs more frequent)
12\. Combo Tamsulosin 400mcg/ Dutasteride 500mcg as % patients prescribed Tamsulosin & either Dutasteride or Finasteride
13\. Reduction of BGTS from baseline (due to expansion of CGM use we expect Blood glucose testing to fall)
14\. % of T2 Diabetic patients not using insulin or SU or glinids using BGTS
As you can see there is a focus on increasing the use of refillable / reusable devices, combination products and low carbon formulations as well as deprescribing*.
These indicators are shared and implemented in practice. Despite the well-known hardships being experienced in Primary Care and Pharmacy we have made positive progress with 11 of these indicators, between April 2022 and year end March 2023. This shows what can be done in a small space of time with the commitment of our healthcare employees to reduce our carbon emissions. We are going to keep building on this scorecard and try to achieve increased engagement over the coming months.
*Deprescribing is an extremely important workstream we are undertaking as a team, by constantly highlighting ways to implement and explaining the importance. It reduces carbon emissions in multiple ways (manufacture, transport, prescribing and dispensing processes, side effects causing need for more medications/ interventions/ potential hospitalisation etc.) however it is much harder to measure outcomes making it a long term, larger piece of work.
