Greener path to hand surgery transforms care for patients
A new approach to treating carpal tunnel syndrome is showing how patient care can be faster, simpler and greener at the same time.
The initiative, known as the GreenHand pathway, is helping patients receive diagnosis and treatment more quickly while reducing unnecessary hospital visits, cutting costs and lowering carbon emissions.
A common condition with a long journey to treatment
Carpal tunnel syndrome is one of the most common conditions treated in the NHS. It affects the nerves in the wrist and can cause pain, numbness and weakness in the hand. It is also three times more common in women than in men.
For patients with moderate to severe symptoms, surgery to release pressure on the nerve is the most effective treatment and tens of thousands of procedures are carried out across England every year.
Traditionally, the journey to surgery can involve several separate appointments. Patients are often seen in clinic, sent for tests, placed on waiting lists and then brought back for surgery in a busy operating theatre before returning again for follow up care.
The GreenHand pathway takes a different approach.
One visit, one team, quicker treatment
Launched in November 2025 and supported by NHS Net Zero funding, the new model rethinks the whole patient journey. It begins with a simple digital questionnaire that helps clinicians assess symptoms early.
Patients who are suitable are then invited to a one-stop clinic led by a senior clinician. At that single appointment, patients can be assessed, examined and, if appropriate, have their carpal tunnel surgery there and then under local anaesthetic.
Instead of using a traditional operating theatre, the procedure is carried out safely in a dedicated procedure room using a wide-awake technique.
This means fewer steps, fewer hospital visits and quicker access to treatment.
Follow-up care and rehabilitation can often take place virtually, supported by online physiotherapy resources. For many patients, this means less time travelling to and from hospital and a faster return to normal life.
Better for patients and better for the planet
The environmental benefits are also significant. Operating theatres are among the most energy-intensive areas of any hospital, using three to six times more energy than other clinical spaces. By safely moving suitable surgery into procedure rooms and reducing the number of hospital visits required, the GreenHand pathway dramatically lowers the carbon footprint of care.
Based on recent activity at the trust, applying the pathway to around 972 patients each year could save more than 63,000 kilograms of carbon emissions. That is roughly the same as the electricity used by over 100 homes in a year.
It also reduces clinical waste and frees up theatre capacity for other complex operations.
Patients are already seeing the difference. Early feedback shows very high levels of satisfaction, with people valuing the convenience of a single visit and the speed of diagnosis and treatment.
“By building strong evidence we hope to create a blueprint that other NHS organisations could adopt. GreenHand shows that by redesigning care thoughtfully, we can improve the patient experience, reduce waiting pressures, save money and support the NHS journey to net zero.”
Mr Noel Peter, Consultant trauma and orthopaedic surgeon
Building evidence for the future
Consultant Trauma and Orthopaedic Surgeons Mr Noel Peter and Mr Will Mason along with orthopaedic registrar Mr Harold Akehurst and physiotherapist Elaine Willmore have spearheaded the development of the new pathway.
Mr Noel Peter believes the approach could have a much wider impact across Gloucestershire, saying, “We are now looking at the next stage of GreenHand. With many people living with carpal tunnel syndrome locally, we want to expand and formally evaluate the model at scale, including delivering care in community settings.
“Our aim is to understand whether one-stop clinics outside hospital can maintain the same high standards of safety and patient experience while reducing carbon emissions even further.
A full economic, social and environmental analysis of the pathway is due to be carried out in spring 2026 by the York Health Economics Consortium.
If the model proves as successful at a larger scale, the benefits could reach far beyond Gloucestershire, offering a new way of delivering common procedures across the NHS while keeping both patients and the planet in mind.
- More about GreenHand