“Within whose remit it should be?”: views of multisectoral experts on the institutionalisation of blue-green prescribing in Scotland’s healthcare system

Background and objective: Blue-Green Prescribing (BGP) is a healthcare approach that uses nature-based social prescribing and eco-directed medicines prescribing to reduce pharmaceutical pollution and promote planetary health. Due to its novelty, its institutionalisation requires consultation with practitioners and policymakers from health, environment, and water sectors. This study explored key sector experts’ views on the factors that could influence the institutionalisation of BGP in Scotland.

Methods: This qualitative study is part of an exploratory mixed-methods research. Using snowball sampling and a semi-structured topic guide, we interviewed key experts from health, environment, and water sectors. Interview data underwent hybrid coding and codebook thematic analysis with audit trail. To account for the complexity, interrelationship, and behaviours of key experts, we also used systems and behaviour change lenses in data analysis.

Results: Scotland’s natural resources and existing BGP-related pilot interventions offer opportunities for BGP institutionalisation. There is an increasing awareness on the health benefits of nature and the impact of pharmaceuticals on the environment translated to high interest and commitment from health, environment, and water sector experts on the institutionalisation of BGP. However, these opportunities are challenged by limited local evidence on the effectiveness of BGP-related interventions on patients; limited skills, tools, and capacities of healthcare professionals; and the need for policy changes on health human resource, environmental management, and sectoral collaboration.

Conclusion: Highlighting the need for nature-based social prescribing and reducing pharmaceutical pollution in NHS Scotland’s Climate and Sustainability is an essential first step in institutionalising BGP. Despite a relatively siloed approach to sectoral interventions related to BGP, there is an existing collaboration between health, environment, and water sectors that could be strengthened. Moreover, challenges in developing an acceptable and appropriate BGP in the context of the Scottish healthcare system need to be resolved.