Primary care.
Primary care is where prescribing decisions, patient travel and estate costs meet. It's also where the data is best — prescribing systems already know your MDI ratio and your appointment no-show pattern.
Every action, graded.
Evidence grades travel with every claim. Click through to the study behind each number.
| ID | Action | Evidence | CO₂e / yr |
|---|---|---|---|
| ACT-041 | Audit high-carbon prescribing classes first CMRO 2026 switching data — DOI 10.1080/03007995.2026.2628120 |
Cohort / modelling | varies |
| ACT-042 | Remote-review the follow-ups that don't need hands NHS travel modelling; CSH primary care unit publications |
Cohort / modelling | est. |
| ACT-043 | Right-size repeat dispensing intervals Practice-level audit pattern; no single trial — grade C honestly |
Estimated — local audit needed | est. |
| ACT-044 | Switch practice fleet and estate contracts at renewal NHS England estates guidance; Green Primary Care framework |
Cohort / modelling | est. |
| ACT-045 | Prescribe by environmental impact where NICE already lists it NICE decision aids; NHS net-zero patient pathway materials |
Cohort / modelling | context |
Before you start.
Your prescribing system is the baseline
No new data collection needed for ACT-041 — the reports already exist.
Travel is the hidden half
Appointment-pattern data shows which follow-ups never needed the trip.
The review serves the patient, not the ledger.
Every action on this page passes through this gate.
Remote reviews, inhaler switches, prescription intervals — each is offered where clinically equivalent, and declined where the patient's situation says otherwise: a frail patient who needs the surgery visit, a respiratory patient whose pMDI technique is what keeps them out of hospital. The audit finds where the savings are; the consultation decides whether to take them.
Case: the 3.1% with everything to gain.
Primary-care prescribing is 3.1% of the English NHS footprint — but nearly everything worth doing can be done here at once: inhaler switches (146 t/yr measured), remote reviews that delete travel, repeat-prescription intervals that cut both waste and trips, and estate contracts renegotiated at renewal. No other part of the system can save this much through a single prescribing system, with every saving measurable.
NHS England net-zero modelling; CMRO 2026 · DOI 10.1080/03007995.2026.2628120
Asked and answered.
What should a practice audit first?
Its inhaler ratio (pMDI share of respiratory prescribing) — it is already in the prescribing data, needs no new collection, and carries the largest measured saving per hour of audit time.
Do remote reviews actually cut carbon?
Yes, through deleted travel — patient and staff. The evidence base is cohort-level rather than trial-grade, hence grade B. The audit is trivial: appointments attended vs travel-mode survey.
How long until estate actions pay back?
Energy and fleet contracts renegotiate on 3–5 year cycles; the action is to put carbon criteria into the tender at renewal, not to wait for capital budget.