The destructive force of climate change has been centre stage with the powerful spotlights of COP 27 and The Earthshot Prize illuminating high-level responses and ingenious projects to repair and regenerate the planet.

But, after the photo opportunities, the struggle to tackle global warming returns to ground level where everyday changes, switches and initiatives are needed to redress the balance.

It is a challenge that needs to be met at policy and pavement level.

Read more: The PDA's guide to 2022: Climate emergency and a war in Europe

Community pharmacies operate at the frontline of the climate crisis and are emerging as an increasing influence on patients and customers to follow a greener path.

 

Everyday changes to tackle climate change

 

The UK’s over 14,000 community pharmacies have already adopted changes and service tweaks to their businesses such as bicycle powered deliveries, plastics-free packaging, solar panel installation and LED lighting as well as injector pen recycling and using materials made by environmentally friendly 3D printing.

Every ounce of carbon neutralised is critical as the healthcare sector is responsible for almost 5% of global greenhouse emissions – if it was a country it would be the fifth highest polluting nation – and medicines account for about 25% of carbon emissions within the NHS.

“These statistics really illustrate the important role community pharmacies have to play in sustainability,” Laura Wilson, policy and practice lead for the Royal Pharmaceutical Society (RPS) in Scotland says.

Read more: 'Global emergency': GPhC sets £50k aside to improve environmental performance

“As pharmacy teams, we should recognise our role in society. We are accessible, trusted professionals and leaders within our communities," she continues.

“Our patients listen to and are influenced by us. We can lead by example and use our social platform to help inform and support our patients to make the changes in their own lives.”

This social thread is critical to NHS England’s ambition to become the world’s first net zero national health service by 2045. The NHS has already warned suppliers they risk being removed from contracts if they do not align with the plan adding balance sheet pressure to ethical imperative.

But influencing the public to join the journey without compromising their health outcomes or choices is a harder equation to balance.

“It’s clear that the vast majority of the public now recognise the scale of the challenge of climate change and want to identify areas where they could make changes in their own lives, says Ms Wilson.

Read more: Meet the pharmacies striving for a more environmentally friendly, greener sector

“However, it’s probably fair to say that the link between climate change and healthcare and medicines use, is not widely known,” Ms Wilson adds.

This link should start to be explained, she says.

“We’d encourage all pharmacy teams to begin to explain this link to their patients and include them as equal partners in changes to their treatment to become more sustainable.

“We’re certain that this approach will not only lead to better, more sustainable care, but also taking that person-centred approach and discussing things that matter to patients means they feel empowered to be part of their own care and builds the relationship between the patient and the pharmacy team.”

 

The Welsh pharmacy leading the way

 

Andy Evans, who runs the independent JDS Evans Pharmacy in Newport, south Wales, is committed to a green future and was an early mover, installing solar panels eight years ago to trim 60% from his energy bill.

He was selected for a pilot Greener Primary Care scheme last December and believes JDS Evans Pharmacy has become the first net carbon zero pharmacy in Wales.

He puts this success down to improving his carbon profile across 32 different activities, including staff travel to work, lagging the premises' loft and replacing lighting with LED alternatives.

“These issues are important to me and I’m always looking at ways to improve the sustainability of the pharmacy,” Mr Evans says.

“I’ve developed my carbon literacy over the last couple of years and it is relatively easy to figure out your carbon footprint.

“The pilot scheme, which was completed in April, gave you extra parameters to make improvements.”

Read more: Climate change, asthma and hayfever – why pharmacy teams can expect more queries

Mr Evans also committed to planting four trees a year to offset the carbon emissions that could not be reduced by practice changes and believes interactions with patients and customers are an area where sustainability advances can be achieved.

Switching asthma patients from metered dose inhalers (MDIs) to dry powder inhalers – with consultation and consent – is a prime example of how pharmacists and patients can work together on climate change.

“MDIs have hydrofluoroalkane, which is 1,000 times more potent than CO2 as a greenhouse gas so switching just one patient to a dry powder inhaler could save a half tonne of carbon annually,” Mr Evans adds.

“It is an improvement for most patients, irrespective of the carbon footprint benefit, so we are all doing our bit for the planet.”

Mr Evans goes on to describe the additional benefits of the change.

“I’ve seen 30 patients over the last two months and 29 have been happy to change, with one being fearful of his asthma worsening because it was quite brittle.

“The patients understand the health benefit and the climate message and together we have saved 15 tonnes of carbon for a year.”

 

“Widespread ambition” to do more

 

The promise is clear but community pharmacies face huge challenges. Advocacy is powerful but its progress is potentially glacial while measures such as streamlining suppliers to reduce deliveries comes with cost implications that are not underpinned by support or funding.

The Greener Primary Care pilot, which also included GPs, dentists and opticians, was successful but has yet to be fully funded and rolled out nationally.

If Mr Evans wants to concentrate his orders to one supplier – rather than his current profile of a main wholesaler and six short liners – any extra costs fall on his balance sheet.

The RPS is pressing for greater government support across funding for innovative schemes, medicines development and use, and sustainable healthcare education.

“With the pressures facing the sector, we know from speaking to our members that beginning to make changes to your practice and your team’s ways of working to be more sustainable can be daunting – and it can be difficult to know where to start,” Ms Wilson notes.

Read more: Podcast – How I’m helping pharmacy become greener

The RPS has published a Climate Change Charter to help pharmacies adopt greener practices and radiate their experience across the sector and initiatives such as national injector pen recycling and antibiotic amnesty schemes are gathering pace.

“We are making good progress in reducing our environmental impact,” says Natalie Gourlay, head of environmental, social, and governance at Boots.

The multiple's 2,100 pharmacies get their energy from renewable sources.

“Another important role community pharmacy can play in sustainability is to continue to support patients to take their medicines appropriately and dispose of them safely,” Ms Gourlay adds.

And it seems as though taking a greener approach is becoming more popular throughout the community pharmacy sector.

“The response and enthusiasm we’ve had to our work on sustainability really does indicate that there is a widespread ambition across pharmacy to do more on climate action, so I’m really confident that pharmacies are [going to] play a strong, progressive role in sustainability,” Mr Evans says.

“It’s important, though, to remember that each individual and each pharmacy will make their own changes tailored to their circumstances and at their own pace.

“But as a profession we’re incredibly well placed to make a real difference.”