Sian Evans, Consultant in Public Health, Public Health Wales and Bevan Fellow
Amidst the growing pressures on NHS Wales — particularly within primary care — it can feel daunting to add yet another expectation to already stretched workloads: practising in a greener and more sustainable way. For some, this agenda has been viewed as something for the “eco-warriors” among us, a “nice to do” rather than a “must do.”
I would argue the opposite. Embedding environmental sustainability in health care is essential for the survival of our services, for the health of our citizens, and for the wellbeing of future generations. The co-benefits for patients, the planet, and for practices themselves are now undeniable.
From Idea to Action
Greener Primary Care Wales was born out of growing concerns over climate change and its impact on patients and citizens in Wales. When we first began this journey, an optometrist said to us:
“We don’t need a few people doing it perfectly. We need millions doing it imperfectly.”
That statement has become the heart of this work.
The Greener Primary Care Wales Framework and Award Scheme, launched in 2022 by the Primary Care Division in Public Health Wales, was designed to help primary care teams reduce their environmental impact while improving health outcomes. The Scheme supports the four contractor professions — general practice, community pharmacy, optometry, and dentistry — and enables practices to register online, implement actions, and be recognised for their progress through an award system.
Driving Change at Scale
Since its launch, the Scheme has exceeded all expectations. We set an initial goal of engaging just 5% of the primary care workforce (around 2,000 practices). Within eight months, we achieved it — and by the end of year three, more than 25% of practices in Wales were registered.
To date, over 5,300 sustainable actions have been implemented across participating practices, ranging from carbon management and energy-efficient buildings to prescribing low global-warming inhalers and promoting active travel. Collectively, these actions have contributed to an estimated 51,300 tonnes of CO₂e reduction — the equivalent of driving more than 130 million miles in a petrol car.
We’ve even had patients contact us directly, asking to be signposted to “greener” practices that align with their personal values. It’s heartening to see the public increasingly view environmental sustainability as a marker of good, modern healthcare.
Co-Benefits: People, Planet, and Practice
The environmental gains are only part of the story. Practices consistently report financial savings, improved staff wellbeing, and stronger community connections as a result of adopting greener approaches.
Many actions are low-cost or cost-saving — such as reducing waste, switching to reusable products, and optimising energy use.
Ultimately, this work is about improving health and preventing illness in ways that don’t harm the planet — an ethos perfectly aligned with Prudent Healthcare, the Well-being of Future Generations (Wales) Act 2015, and A Healthier Wales.
The Bevan Experience
The Bevan Commission has played a central role in shaping both the project and my personal journey. Initially accepted as a Bevan Exemplar project in 2022 (Cohort 7), the Bevan Programme raised the visibility of the Scheme and provided a platform for us to promote the work. One of the greatest benefits was the guidance and support provided by the Commission in determining how best to measure the performance and impact of our work.
Once you are part of the ‘Bevan family’, it’s hard to leave, so I applied to the Fellowship Programme and joined Cohort 1 in January 2024. Being part of this programme has allowed me to meet and network with some fantastic innovators leading great work across Wales. It has provided a safe space for healthy challenge from respected peers, as well as time and space to broaden my thinking and perspective on what we are trying to achieve with Greener Primary Care Wales.
One of the personal benefits I’ve seen from the programme is an increase in my confidence, leadership skills, and self-belief that we can do this. I am still grappling with the research agenda and publication aspects of the Fellowship Programme, but I am committed to working with the Commission to publish something in the near future regarding the Scheme.
Learning and Challenges
There have been challenges along the way. Keeping climate change on the NHS agenda amidst competing priorities requires constant effort. Interest and visibility can fluctuate, but having strong policy alignment — from Net Zero Wales to the UN Sustainable Development Goals — has helped sustain momentum.
High-level endorsements, from Welsh Government officials to NHS Wales award recognition, have also been critical in maintaining visibility and legitimacy. Another key learning has been the importance of flexibility — listening to feedback, adapting the Scheme, and refining our approach year on year.
We’ve learnt not to let the perfect be the enemy of the good. Early on, we launched before fully defining our measurement framework — something that goes against public health instincts — but waiting for perfect data would have meant missing the moment. Instead, we acted, improved as we went, and proved that progress is possible even amid uncertainty.
Looking Ahead
Our ambition now is not just to maintain the Scheme but to make sustainability business as usual in every primary care setting in Wales. We have achieved a lot over the last three years, but there is still a lot to do to support primary care to reach Net Zero Wales targets.
While the framework currently supports all four contractor professions, we recognise that one size doesn’t always fit all. Work is underway to tailor the Scheme even more closely to each professional group, engage head offices of multiples and consider an offer for clusters whilst ensuring actions are practical, relevant, and measurable.
The Scheme will continue at least until 2030, during which time we aim to publish a full evaluation of its impacts at both practice level and on the wider system.
Final Thoughts
The Future Generations Report 2025 puts it best:
“The challenges we face are significant, but they are not insurmountable. Delaying action makes change more expensive and difficult. Change will happen — by crisis or by choice. We must act now.”
For me, and for everyone involved in Greener Primary Care Wales, that’s exactly what this work is about: choosing to act now. We’ve shown that greener healthcare is achievable, beneficial, and vital. It’s good for the planet, good for our patients, and essential for the sustainability of NHS Wales.
