Sustainability is increasingly becoming a key issue for the NHS. This case study of the sustainability audit of a small GP surgery shows how this is affecting primary care providers by looking at three critical areas.

  • Understanding the sustainability drivers for the NHS at a local level
  • Evaluating the sustainability impact of a GP surgery
  • Identifying solutions to improve sustainability performance

Policy drivers

As a large public organisation, the NHS has strong drivers for sustainability. The coverage of issues by policy is mixed, with some areas, particularly greenhouse gas emissions, having comprehensive policies and implementation strategies in place.

In general, high-level government policy is relatively complete. Further down the hierarchy, coverage is less good, especially at the PCT level where there is a lack of policy and guidance directed at care providers.

Sustainability Aspects and Impacts

Energy and Carbon

Energy use and carbon emissions are the most pressing concerns of the sustainability agenda and there is significant scope for action to reduce environmental impacts and costs.

The practice’s main areas of energy use, and hence carbon emissions, are in gas powered heating and hot water and in electricity consumption, with energy use of approximately 65,000 kWh and 18,500 kWh per annum respectively. The resulting CO2 emissions are approximately 12t and 10t per annum from each source.

The key recommendations identified for energy and carbon reduction were to improve the energy performance of the surgery building, improve management of the heating system and to move to a low-carbon electricity supplier.


Waste is a key issue encompassing legislative compliance, environmental impact and cost savings and was identified as one of the surgery’s primary sustainability impacts. The nature of clinical waste led to staff having a good awareness of waste issues. Most waste streams were identified and separated, with some exceptions such as batteries.

The surgery’s waste sent to landfill can be reduced by means of behaviour change and the implementation of technological solutions such as phasing out paper towels and increasing the number of recycling points.


Water conservation is seen as crucial to the NHS achieving its sustainability goals. At a surgery and PCT level, there is also the potential for cost savings from water conservation.

The practice consumes 518 cubic meters of water each year and during the audit we identified a number of simple solutions, such as water hippos and spray inserts for taps, to reduce water consumption by more than 33% at almost no cost.

Built Environment

Many of the energy efficiency improvements available to the surgery lie within the material and management of the building itself, with a direct link between energy performance, carbon emissions and the cost of running the practice. This is likely to be the case across the NHS estate, particularly as many surgeries are still housed in relatively old and non-purpose-built buildings

The surgery had already implemented a number of energy efficiency initiatives in the buildings, such as double-glazing, but has the opportunity to make further improvements. The key areas where improvements can be made are:

  • Improved insulation (loft and walls)
  • Complete installing double glazing
  • Improved building management systems to provide data for monitoring

Green spaces and biodiversity

The importance of cultivating and maintaining green spaces and biodiversity in the NHS is gaining prominence due to the positive impact on health and the value of eco-system services. There is scope for action to be taken at any level, including a GP surgery. A number of simple actions such as installing bird feeders and insect nests can increase biodiversity and provide an example to patients.

Transport and travel

Patients tend to make short journeys to the surgery, averaging less than two miles, predominantly by car. Older patients will walk more frequently than younger patients, and women are much more likely to walk than men. Encouraging active travel methods such as walking or cycling would have a positive health impact on patients who are able to change.

Staff travel highlights three different groups of commuter: those who travel under three miles, those who live between three and 10 miles away and those who live over 10 miles away. The car is the most frequently used mode of transport for all three groups. Staff commuting creates around 3.2 tonnes CO2 per annum.

There are good opportunities to encourage active travel modes, especially with those patients and staff who live less than 3 miles away, such as providing cycle parking and changing facilities.

Community Engagement

Community engagement is an important issue for the NHS, particularly in the context of achieving good public health behaviour change and can be used to encourage more sustainable behaviour. This has been recognised by NHS policy makers, but there are not currently any firm policies from the PCT on this issue. The surgery however does undertake some ad hoc activities in this area such as providing facilities for the Citizens’ Advice Bureau.

The key findings of the audit were:

  • There are significant drivers for sustainability in the NHS although these have mainly affected hospitals as yet, with limited impact on primary care.
  • Drivers in the primary care sector have mainly operated at a higher level than individual care providers to date. There has been a failure by PCTs to translate policy into effective action at a lower level at this time.
  • Staff have a willingness to engage with sustainability but they currently have a narrow understanding of the issues and the impacts of the Surgery

Overall, the Surgery is performing relatively well on sustainability issues. However there are a number of opportunities to improve performance for relatively little effort and low or negative cost. In particular, there is scope to improve:

  • Energy efficiency, especially of buildings
  • Non clinical waste management
  • Water efficiency
  • Sustainable travel