This article was first published on healthandcare.scot

By Frankie Macpherson

The nation’s leading body for pharmacists says a shared decision-making approach in healthcare, and better education and information on medicines’ environmental impact are essential to addressing the climate crisis.

Following the launch of the Climate Emergency and Sustainability Strategy for NHS Scotland, the Royal Pharmaceutical Society (RPS) Scotland welcomed the publication and has highlighted its key areas for improvement.

RPS Scotland says that addressing climate change is a “top priority” and its director, Clare Morrison, adds that education and longer-term health discussions as part of realistic medicine will be crucial:

“It’s important that we take a shared decision-making approach and a person-centred approach to care – I don’t think it’s too big a jump when you talk about it from a prescribing point of view to say that if you include someone in the decision about their medicines, we can expect better outcomes.

She adds that this does not mean avoiding medicines altogether and individual discussions with prescribers is key:

“We’re quite clear that there are absolutely times when the medicine is appropriate and I should be really clear, we would always say to patients never to just stop taking your medicine and always go and talk to your prescriber. But it can be sometimes be that a social prescribing route is more appropriate for an individual and in that case, we’d be absolutely supportive.”

She explains that these are core elements to the realistic medicine strategy – already supported in the Chief Medical Officer for Scotland’s 2021-22 report – which focuses on individual conversations with patients to enable them to make informed choices about their treatment.

Ms Morrison – who has years of experience as a pharmacist and has been awarded an MBE for services to healthcare – says “medicines waste equals environmental harm” and that taking a realistic medicine approach can reduce this.

Sharon Pfleger, RPS Expert Adviser on environmental sustainability policy and consultant in Pharmaceutical Public Health at NHS Highland added that better practising realistic medicine can both optimise care and lower the pharmaceutical carbon footprint.

On NHS Scotland’s climate emergency publication, she says RPS Scotland was pleased to see the focus given to much-needed medicines action:

“We were genuinely really pleased to see from the draft through to the published strategy, the changes that had been made – clearly all the sections that we commented on related to medicines during the consultation, had been listened to.”

In a joint statement from RPS Scotland and Royal Colleges, four of their six calls were related to making environmental information about medicines clearly and directly accessible.

With medicines accounting for 25% the NHS carbon footprint, Ms Morrison says it is imperative to address them from manufacturing and procurement to waste.

She considers education on medicines waste as a good starting point for both patients and prescribers:

“I genuinely don't think people understand that medicines have an environmental impact and there's a responsibility we have at a wider level around informing and making people aware that these environmental impacts exist.”

Ms Morrison adds that supporting people to get the most out of their medicines via this person-centred approach will help Scotland avoid unnecessary medicines prescriptions that become waste.

She says information on how people can safely return unused medicines should be made nationally available to avoid people flushing them into water streams. Working across healthcare to create consistent and clear messaging is vital, and combined with a collaborative approach is better for patients and for limiting waste:

“I can draw on my experience as a community pharmacist and the literal big rubbish bags of returned medicines that have been prescribed for someone, but perhaps never taken – and it really isn't the patient's fault but what that means is the system hasn't worked for them.

“If they weren’t involved in the decision about whether that medicine should be prescribed in the first place perhaps, they were, but then got side effects and weren’t offered a check and weren’t comfortable raising it – it could even be a problem with the repeat prescription service.

“It’s about that person-centred approach, it’s about shared decision-making with patients because if you involve patients in decisions, you're much more likely to end up with sustainable prescribing.”

RPS Scotland is calling for the Scottish government to establish supportive infrastructure for green social prescribing to “enable the delivery of a Realistic Medicine approach to prescribing”.

The joint statement also calls for a switch to electronic prescribing and echoes calls for environmental impact to be formally included in all prescribing guidance. Ms Morrison explains:

“All prescribers have medical information formularies produced by health boards – and within that there is information on clinical and cost effectiveness but there isn’t anything about environmental impact.

“We need to see that information included as part of these formularies so at the point of prescribing they have this information which can then be shared and discussed with patients.”

Measuring and monitoring the carbon impact from pharmacy is “absolutely essential”, says Ms Morrison, to ensure action is being taken on the ground to address the climate crisis.

She adds that, as RPS are not direct providers of healthcare services, the challenge is about ensuring increased awareness amongst the public and professionals – and getting other organisations to sign up:

“We need to actually get movement on all of these areas now and tackle the big carbon and ecological impact that medicines are having. So, reaching right across the public, professionals, government and other organisations and ensuring that we move forward.

“We can’t just put a policy out and say, “This is what we’d like to do.” We now need to make sure that we move forward with that and work with government to achieve some of what was in that joint statement.”

Ms Morrison this week discussed such actions going forward in tackling climate change with the Chief Pharmaceutical Officer and the Chief Medical Officer, who agree pressing on with implementing the strategy is the priority now.