Why Sustainability Matters in Clinical Trials 

At DaRe2THINK, we are aiming to use innovative digital research techniques to lower the carbon impact of clinical research whilst remaining a community led project. Our fully remote trial uses NHS data to help prevent stroke, cognitive decline and premature death in people with atrial fibrillation (AF), while reducing unnecessary travel, paper, and clinic time. The trial team has recently achieved a Silver Award in the SOSUK Green Impact programme, and further adaptions to the way we work are planned for next year’s award, with the team pushing for gold!  

If you’re a healthcare professional or member of the public, we hope that this provides some inspiration to take simple, but high impact sustainable actions. General Practices can also sign up to the Green Impact Health Toolkit and start earning recognition for your practice. 

 

What we will be covering in this article 

1. What makes DaRe2THINK different… and more sustainable 
2. How our approach aligns with the NHS’s “three big shifts” 
3. What the SOSUK Green Impact scheme is and how UoB enables it 
4. Our progress so far and what’s next 
5. Practical actions & ways to get involved  

 

1) What makes DaRe2THINK different… and more sustainable

NHS embedded, digital, no additional clinic visits

DaRe2THINK is designed to use routinely collected NHS records for automated Primary Care screening, targeted enrolment, remote e-consent, electronic patient reported outcomes, and ‘no visit’ follow-up. This reduces avoidable travel and onsite activity while keeping participation simple for practices and patients.

Primary care = care closer to home

The study runs entirely in GP practices, giving local teams a leading role in research that benefits their own patients, removing the need for hospital-based research appointments. By recruiting through GP practices, DaRe2THINK promotes equitable access to research, facilitating a more diverse patient representation while reducing travel emissions and supporting community based care.

Real world data, less burden

DaRe2THINK is a collaboration between the University of Birmingham and Clinical Practice Research Datalink (CPRD). CPRD has over 1337 GP practices in the UK signed up to its services. By extracting anonymised coded Primary Care data and linking it to further national data resources the trial can efficient and pragmatically answer trial outcomes, while minimising data collection and physical paperwork for NHS staff and patients.

 

2) How our approach aligns with the NHS’s “three big shifts”

From Hospital to Community

The NHS Fit for the Future 10‑Year Health Plan highlights a deliberate shift from hospital to local/community care precisely where DaRe2THINK operates. 

From Analogue to Digital

The NHS has set a clear aim to integrating digital tools within Primary Care to make services more accessible and efficient. Our econsent and remote patient questionnaires embody this trajectory. Read more about our brand-new digital trial platform by clicking here.

From Sickness to Prevention

Earlier identification and prevention in Primary Care are central to a sustainable NHS. DaRe2THINKs primary objective is assessing younger AF patients to prevent strokes and vascular dementia before they happen. 

 

3) Green Impact at the University of Birmingham: what it is and how it helps

Our trial has sustainability built into its model, and by joining the Green Impact program we have been able to make further sustainable changes.

 

What is SOS‑UK Green Impact?

Green Impact is SOS‑UK’s UNESCO/UN‑recognised sustainability engagement and awards programme that turns practical actions into measurable impact across teams and departments. It’s used by thousands of organisations and has toolkits tailored for universities, schools and GP practices. 

 

How UoB enables teams like ours

UoB runs a full Green Impact Awards programme with a toolkit, training, and access to a community of teams across the institution. It is straightforward to join, log actions, and gain Bronze, Silver, Gold or Platinum status. Our trial Sustainability Champions Abigail and Arcella attend regular meetings and events to engage in improvements being made around campus and forge connections with the wider community on campus.

This year, the DaRe2THINK team achieved the Green Impact Silver Award – a milestone we’re proud of and a springboard for future changes. To reach Silver we made group and individual changes, such as reducing our own office travel emissions, committing to cutting out single use plastic, using AI responsibly and many more.

Impact at scale on campus

Engagement is growing fast at UoB, with record participation and awards in 2025, evidence that practical sustainability can mobilise whole communities. 

 

4) Our progress so far—and why this model is greener by design

Minimal burden, maximum impact

Because our trial workflows are digital, automated, and embedded in Primary Care, clinicians save time while patients avoid extra travel. Recruitment and study delivery are supported by the NIHR Research Delivery Network (RDN), which exists to enable inclusive, accessible research across England and to help Primary Care teams plan and deliver studies. 

National reach, community roots

Almost 500 GP practices across England are already taking part in DaRe2THINK. Recruitment is fully supported, processes are simple, and no additional hospital visits are required. So, it’s easy to get involved and contribute to lower carbon research without extra clinic load. Want to find out for yourself? Book a meeting with our friendly team that fits your busy schedule here.

 

5) What we’re doing next

Re-thinking the way we communicate

We recently decided to change the communication methods we use with our practices to cut down on unnecessary CO₂ usage. By adopting a text based monthly bulletin and web noticeboard rather than regular graphic emails we are more than halving our CO₂ output without compromising on sharing key messages to our enrolled GP practices.

Developing a long-term strategy

Our sustainability champions are working hard to create a framework to push DaRe2THINK to the next level. We plan to combine what we know about the Environmental, Social & Governance (ESG) framework and the NHS “three big shifts” to report our progress to you regularly and clearly.

Expanding our network

We have exciting discussions occurring behind the scenes to be able to bring the DaRe2THINK trial to even more GP practices across England. Book a meeting below or send us an email to find out if your practice is eligible!

 

6) How you can act today

For GP practices

• Join DaRe2THINK: take part in a low burden, no visit study that aligns with NHS priorities for digital, preventative, community based care. Book a meeting with our team to talk it through here.
• Adopt Green Impact for Health in your team or PCN: start with quick wins (switch off protocols, greener procurement, digital patient comms), then scale to Silver/Gold.
  Already taking part? Please email us your progress! We would love to shine a light on your great work.

• Champion digital first research processes (econsent, ePROs) and evidence based prevention in primary care. 

For members of the public

• If your GP practice is enrolled onto our study and you fit the relevant criteria you will be contacted automatically about DaRe2THINK, alternatively you can share our details with your practice if you are interested in taking part and not contact us directly.
• Join the sustainability movement: ask your local surgery or employer about Green Impact to see if it’s a good fit for their goals. 

 

Conclusion

Sustainable clinical trials are possible. The DaRe2THINK trial shows how NHS embedded digital primary care research can deliver high quality evidence with a lighter footprint. Backed by the University of Birmingham’s commitment to sustainability and our Green Impact Silver Award, we’re delivering a model that aligns with national priorities and is easier for GPs and patients alike. Now, we’re inviting you to take the next step: GP practices can join a sustainable, low burden, prevention focused study and members of the public can support greener healthcare by participating and spreading the word.

Start today: explore Green Impact and register your team; or talk to us about taking part in DaRe2THINK and making sustainable research the default in primary care. 

Key takeaways

• Cardiovascular disease remains a major concern in cities, with poor outcomes and high societal cost often driven by unequal access to healthcare.

• A pan-European consortium of 34 international partners launch an ambitious project to reduce the burden of urban cardiovascular disease and ensure that every citizen can be reached regardless of gender, poverty, disability, background or culture.

• The initiative will focus on obesity, high blood pressure, elevated cholesterol and diabetes, which are common yet treatable causes of death, heart disease, stroke and vascular dementia.

Cardiovascular disease is the leading cause of death globally, accounting for over 20 million deaths per year. The cost of cardiovascular disease for the European Union is greater than its annual budget.

Around three quarters of the European population now live in urban areas, where the risks of developing cardiovascular disease are heightened by factors such as poverty, lack of access to healthcare and lifestyle issues.  While there are many interventions for cardiovascular disease, a lack of effective implementation means these often fail to reach individuals who would benefit the most. This is particularly evident in underserved city populations, such as those experiencing poverty, and in certain ethnic groups, the disabled and women.

The Cities@Heart project was designed to address these complex issues through an integrated whole-city approach, changing health policy through co-production of interventions with communities and community leaders. A pan-European consortium of 34 international partners, this public-private partnership is led by the University Medical Center Utrecht (Netherlands), the University of Birmingham (UK) and Novartis (Switzerland). 
 

Starting in January 2026, and funded by the European Union Innovative Health Initiative, the Cities@Heart consortium will design, pilot and evaluate a series of city-level strategies to improve cardiovascular health for all. This ambitious project aims to help reduce the burden that cardiovascular disease places on urban environments, as well as reducing the health inequality gap.

The initiative – led by Professor Dipak Kotecha – will leverage existing infrastructure from seven city councils across Europe, embedding new health technologies and innovations from industry partners to tackle the huge scale of the challenge of urban cardiovascular disease. 

The strategies will target obesity, high blood pressure, elevated cholesterol and diabetes which are key drivers of common cardiovascular diseases, such as heart attacks, stroke, heart failure, atrial fibrillation and vascular dementia. These disproportionately impact underserved and disadvantaged communities in urban areas, leading to avoidable deaths.

Professor Dipak Kotecha, Global Director of Cities@Heart, Professor of Cardiology in Birmingham (UK) and Honorary Professor in Utrecht (Netherlands) comments:
“Huge strides have been made to better manage disease of the heart and circulation, but they still remain the world’s biggest killers. Cities@Heart aims to address the major driver of poor outcomes – inequalities in health and access to healthcare that affect many communities within our cities. We will jointly develop approaches with affected citizens, community leaders, city councils, clinicians, health policy leaders and industry partners to achieve long-term change.” 

The project consortium involves a broad range of public and private partners, as well as the World Health Organization (WHO) European Healthy Cities Network, World Heart Federation, European Heart Network, European Society of Cardiology and European Public Health Association. City-wide strategies will be tested and implemented in Belfast (Northern Ireland), Birmingham (England), Cork (Republic of Ireland), Izmir (Turkey), Łódź (Poland), Udine (Italy) and Utrecht (Netherlands). Succcesful strategies can then be scaled across the WHO’s network of Eurpean cities and beyond.

Jesús Ponce, Therapeutic Area Head for Cardiovascular-Renal-Metabolic at Novartis, comments:
“Cardiovascular disease remains a leading cause of death and morbidity globally. At Novartis, we envision a future where preventable cardiovascular deaths are no longer a reality. Cities@Heart represents a vital opportunity to address the unmet needs of underserved populations in Europe through bold partnerships and collaborative innovation.”

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The consortium’s vision is that awareness, evidence-based prevention, early detection, and management of cardiovascular disease are universally accessible in urban areas, supported by new developments in health technology. Cities@Heart aims to reduce the economic burden of cardiovascular disease on society and improve quality-of-life and life expectancy for millions.