Travel is not the only carbon lever in general practice. Prescribing is another, and inhalers are a large part of it: NHS England puts them at about 3% of the whole NHS carbon footprint, because the propellant gas in some inhalers is a powerful greenhouse gas.
This guide explains how a practice can plan remote clinical pharmacist sessions for respiratory medication reviews. It covers how to organise the service. Decisions about any individual’s treatment belong to the reviewing clinician and the patient.
Why inhalers matter for net zero
NHS England estimates that medicines account for about 25% of NHS emissions. Two groups stand out because the emissions happen when they are used: anaesthetic gases at about 2% and inhalers at about 3%.
Its net zero plan lists optimising prescribing and substituting high-carbon products with lower-carbon alternatives among the ways to reduce these emissions. Respiratory reviews in general practice are one place where that work can be organised.
What NICE asks clinicians to consider
The 2024 BTS, NICE and SIGN asthma guideline asks clinicians to base the choice of inhaler on four things: an assessment of correct technique, the preference of the person using it, the lowest environmental impact among suitable devices, and an integral dose counter.
A patient decision aid explains the carbon footprint of different inhalers. It is clear that nobody should stop their treatment without speaking to a clinician: poorly controlled asthma is dangerous, and it also has a higher footprint because of extra reliever use and appointments.
Sources: NICE NG245: asthma recommendations, choice of inhaler · BTS, NICE and SIGN: asthma inhalers and climate change decision aid
Where a remote clinical pharmacist fits
Respiratory medication reviews by telephone or video can be planned as defined remote sessions. The pharmacist does not travel to the practice, and the review covers control, technique, preference and environmental impact together, so any change of device comes out of the whole review.
Agree in advance which patients the clinical lead wants reviewed, the practice formulary and templates, whether the pharmacist prescribes or makes recommendations for a prescriber, how inhaler technique will be checked where video is not enough, and who follows up.
Sources: NICE NG245: asthma recommendations, choice of inhaler
Put the plan in the cover brief
Write the review work into the brief, so the pharmacist can judge whether it matches their experience and the practice can check the support is in place.
- The review list and how it was selected by the practice.
- Templates, formulary and local respiratory guidance to follow.
- Prescribing arrangements and who authorises changes.
- How technique checks and in-person follow-up are arranged.
- Escalation to a GP during the session.
- How outcomes are recorded and reported back.
Measure what you can show
Count the reviews completed and the outcomes recorded in the clinical system. If your practice wants to report a carbon figure, base it on actual prescribing data and a stated method, and avoid assuming a fixed saving per patient.
Keep public claims to what you can evidence. The government’s Green claims code expects environmental claims to be truthful, accurate and backed by evidence.
Sources: GOV.UK: Green claims code
Common questions
Can a remote pharmacist change a patient’s inhaler?
Only as part of a clinical review, with the patient’s agreement, within the pharmacist’s competence, prescribing role and the practice’s protocols. A change made for carbon alone, without regard to control and technique, is not what NICE describes.
Can inhaler technique be checked remotely?
Sometimes, by video. Where a remote check is not adequate, arrange in-person follow-up with the practice team before relying on the result.
Do we need a prescribing pharmacist?
Not necessarily. A pharmacist who does not prescribe can review and recommend changes for a prescriber to authorise. Agree which arrangement applies before the sessions start.
Official sources
Sources checked . Requirements can differ by country, employer and role; use the current guidance relevant to the work.
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