Hampshire & Isle of Wight Respiratory Sustainability Update

The Hampshire and Isle of Wight Integrated Care System (ICS) Respiratory Sustainability Group have been working collectively to support delivery of the ‘Greener Inhaler’ work stream in Primary Care.

This update is to explain more about how GP practices & PCNs may chose to approach this work, so that community pharmacy colleagues can be sighted on the current ways in which prescribing of inhaler products may change, and how they can also be involved in this work.

HIOW Respiratory Sustainability Group Objectives:

1. To support the NHS to deliver it’s Climate Change Act
   • 51% reduction in carbon footprint by 2025
   • 4% reduction by shifting to Dry Powder Inhalers (DPIs).
2. To improve patient outcomes and reduce environmental impact.
3. To share resources to effect changes to prescribing inhaled therapies.
4. Waste management and recycling inhalers.

It’s useful to know that PCNs are being incentivised to complete this work, therefore you will most likely start to see changes to prescribing behaviours around these products.

Updated Guidance:

• The Wessex Asthma Guidance has recently been updated: WAN_Guidelines_Full.pdf (westhampshireccg.nhs.uk) including direct links to inhaler technique videos, and information on the carbon impact of devices.
• The COPD guidelines have also been updated: COPD-Management-and-Prescribing-Guidelines-2022.pdf (westhampshireccg.nhs.uk)
• Further resources located here: Respiratory Sustainability | GP Portal (westhampshireccg.nhs.uk) including a full presentation designed to be used as a starting point for discussion between CCG pharmacists and GP practices / PCNs, however gives a good over-view of this work stream, and how GP practices may choose to prioritise patients.
• Greener Practice also have a wealth of useful resources: High Quality and Low Carbon Asthma Care – Greener Practice including posters and patient leaflets for GP surgery use.

Switching Devices:

HIOW ICS are not advocating any mass-switching of patients’ inhaler devices, as this should be a patient-centred decision.

There is however a requirement for patients to be switched from higher-carbon containing salbutamol devices such as Ventolin, to lower-carbon alternatives such as Salamol.

The group have been clear to all GP practices that they MUST involve their local community pharmacies ahead of any larger switching of patients to ensure stock availability and to allow for existing stocks to be used up first. Please do feedback if this is not happening.

How can Community Pharmacy get involved?

1. Pharmacies should be aware of the Greener Inhaler work stream.
2. Continue to assist patients with counselling on inhaler technique as part of NMS including signposting to patient information leaflets & videos.
3. Encouraging patients over-using their SABA inhalers to contact their GP surgery with any concerns over medication not being optimised or requiring review.
4. Be alert to any exacerbations or increases in symptoms, encouraging patients to contact their GP surgery for review.
5. Remind patients to return any used or unwanted inhalers to the pharmacy for safe disposal, rather than using their household waste (some pharmacies have been adding this to the dosage labels).