The new GP contract published last week includes a new incentive to encourage lower carbon inhalers.
See pg 60: Reducing the carbon impact of inhalers
37. The NHS has committed to reducing the carbon impact of inhalers used in the treatment of respiratory conditions by 50%. These impacts are described in the 2019 BTS/SIGN Asthma guidelines and by NICE in its 2019 Shared Decision Aid on Asthma. All inhaler prescriptions, Structured Medication Reviews or planned Asthma Reviews taking place in primary care should consider moving or facilitating patients to lower carbon options where it is clinically appropriate to do so.
This will be backed by funding through the £6.25m Investment and Impact Fund.
See pg 49: TABLE 6: 2020/21 IIF INDICATORS AND THRESHOLDS- Metered Dose Inhaler prescriptions as a percentage of all inhaler prescriptions (excluding salbutamol
Note that:
- The scope is non-salbutamol inhalers (of which 51% are MDI currently)
- The target is to shift from 51% to 45% MDI in 20/21- not specifying alternatives
- The approach is expected to form part of informed shared decision making at point of prescription and review.
- This approach should save over 20,000 tonnes of CO2 per annum by the end of 20/21
The https://openprescribing.net/measure/environmental_inhalers/ dashboard provides a picture of the current levels of MDI prescribing in this scope.
I think it will be non-salbutamol as the focus because this has more potential to save money, compared to salbutamol switches which will tend to cost more financially. This analysis shows that you could switch all inhalers and still reduce financial costs:
Wilkinson, A. J. K. et al. (2019) ‘Costs of switching to low global warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England’, BMJ Open, 9(10), p. e028763. doi: 10.1136/bmjopen-2018-028763.
Hi Christelle. This is true, however there are more risks and challenges with changes in SABA medication, where a significant proportion are for rescue medication. 97% of SABA are MDI while 51% of non-SABA are MDI. With Non SABA there are already some GPs that prescribe 45% MDI. It is a case of incentivising the rest to join the best. The incentive as it stands should enable a carbon reduction of 20-25,000 tonnes per year. Equivalent to taking 4-5,000 cars off the road.
Also there are issues of volume. The incentive should mean changes in medication for around 250,000 patients over the course of a year, with any changes discussed, where clinically appropriate, as part of a holistic asthma or structured medication review. Where these occur they will need to be accompanied by device training. The same target applied across SABA could potentially impact 1.7m patients, potentially placing a considerable burden on primary care.
There are things that can be done fairly easily with SABA medication though, it is also possible for patients or dispensing pharmacist to at least halve the carbon impact per device by considering which Salbutamol MDI to use. GSK have published carbon footprint for Ventolin (https://thorax.bmj.com/content/75/1/82) that shows it has a footprint of about 28kg, other salbutamol MDI inhalers have far lower footprints, as they use less HFA propellants.
This incentive is the 1st tangible step on a long road!
BW Jerome