Sustainability in general practice

Greener inhaler prescribing

Will a change in inhaler prescribing make a difference to climate change? Watch the quick and fun educational videos about greener inhaler prescribing produced by Dr Mike Poplawski, a GP in Salford, with support from Salford Clinical Commissioning Group Innovation and Research Fund.

Climate crisis explained
Green inhaler prescribing
How to do an asthma medication review

Greener inhaler prescribing resources

To get you started, you may like to listen to a podcast of a conversation between Dr Joanna Bircher of GP Excellence and Dr David McKelvey, Greater Manchester Primary Care Sustainability Lead, about inhalers in the context of sustainability.

PCN implementation guidelines have been developed. And, yes, we have edited them down to two pages (as long as you don’t count the appendix)! The guidelines include links to resources including the following.

Greater Manchester Medicines Management Group (GMMMG) guidelines

Greater Manchester Medicines Management Group (GMMMG) guidelines on:

Links to data on tableau* for:

Links to data on tableau* for:

*To access tableau, you need to use an email account.

Inhaler posters

Greater Manchester inhaler posters for:

Additional resources
  • There are some excellent national guidance and resources available from Greener Practice that have been approved by NHS England and NHS improvement inhaler working group.
  • MART training video (training led by Lynn Elsey, Lead Respiratory Pharmacist at Manchester Foundation Trust)
  • MART action plan option
  • Address list for ordering dummy inhaler devices and whistles
  • Suggestions on how to deal with push back from patients when changing their inhaler

Improving inhaler technique through community pharmacy

Most pharmacies offer a New Medicines Service (NMS). This is an enhanced scheme where the pharmacist or pharmacy technician supports patients starting new medication, including inhalers.

When a patient starts a new inhaler you should make it clear on the patient’s prescription that you would like the pharmacist or pharmacy technician to follow up with respect to the patient’s inhaler and inhaler technique. 

Improving patient outcomes

This service can improve patient outcomes through:

  • Assessment of inhaler technique
  • Improved patient understanding and adherence with inhaler therapy
  • Optimum use of inhaler therapy
  • A reduction in adverse events associated with inhaler treatment
  • Ensuring that patients who smoke are offered appropriate advice about stopping smoking
Reducing waste

It can also reduce waste of inhaler therapies through:

  • Improved inhaler technique and improved use of therapies, leading to a reduction in wasted doses
  • A possible reduction in prescribed inhalers for poorly controlled conditions
  • Patients being encouraged to order only the prescription items they need

Greater Manchester Greener Practice Group

Greener Practice is a primary care climate and sustainability network which recognises the climate and ecological crisis is the leading public health issue of our generation. The aim is to promote general practice actions for the health of patients and planet.

A Greater Manchester Greener Practice Group has been set up by some local enthusiasts. This is for all workers in primary care who would like to explore ways to provide healthcare in a more sustainable and environmentally friendly way.

It is a friendly group meeting every eight weeks online or in person and has an active WhatsApp group. If you are interested in joining, please email:

Green Impact for Health Toolkit

The Green Impact for Health Toolkit is a comprehensive and structured way to approach reducing your practice’s environmental impact. It is aimed at general practice, but many of the ideas could be used in other primary care settings.

It is well thought out and allows a practice to work to gain awards at different levels. This can be a great way to get started, or even use it for project ideas for students or trainees.

Learning more about your carbon footprint

GP practices can check their own carbon footprint (excluding prescribing) using this free tool.  This can be a good starting point to thinking about areas you can work on reducing.