The updated Investment and Impact Fund (IIF), which is voluntary, introduces a target for practices to reduce the proportion of pressurised MDIs they prescribe 'as a percentage of all non-salbutamol inhaler prescriptions issued on or after 1 October'.
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NHS England is currently aiming for just 25% of non-salbutamol inhalers prescribed across the NHS to be MDIs by 2023/24.
The new target forms part of a significant expansion of the IIF, which works in a similar way to the QOF but at a PCN level. The expanded fund includes several other new indicators, including targets for online consultations and reducing appointment waiting times.
NHS England recommends that all inhaler prescriptions, structured medication reviews or planned asthma reviews taking place in primary care 'should consider moving or facilitating patients to lower carbon options where it is clinically appropriate to do so'. It says that it will provide additional guidance to help clinicians have conversations with patients about switching from MDIs, adding that research suggested most asthma patients using MDIs would change device for environmental reasons as long as the new inhaler was as effective as their current medication.
The NHS has committed to reducing the carbon impact of inhalers used in the treatment of respiratory conditions by 50%.
NICE published a patient decision aid in 2019 to encourage prescribers and patients to opt for the most environmentally friendly option when faced with a choice of suitable devices. MDIs have estimated carbon footprints of 500g CO2eq per dose, compared to 20g in dry powder inhalers, according to NICE. They made up 70% of UK inhaler sales in 2011, compared with fewer than half in other European countries and just 10% in Sweden.
Overuse of asthma reliever inhalers was reported earlier this year to be a major contributor to CO2 emissions in respiratory care.