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Making the case for sustainable general practice This year’s RCGP Annual Conference in Harrogate will be our first-ever low-carbon footprint event. The venue has been specifically chosen so delegates can easily walk between the hotels and the conference centre. There will also be locally sourced food, a policy to limit printing, and delegates will be encouraged to car-share and use public transport wherever possible. Here, RCGP Sustainability Lead Dr Tim Ballard explains why the sustainability agenda is so crucial to the future of the College and wider primary care. The statement by Margaret Chan of the World Health Organisation that climate change is the biggest threat to health in the 21st century was reinforced by the report of the UCL/Lancet Commission on climate change and health published in May last year, the summary of which can be found at www.thelancet.com/climatechange. There is now an overwhelming view from climate scientists that global warming is a reality and that mankind’s activities are significantly contributing to this process. Health is likely to be affected in many ways, most of them adversely. There are the obvious changes such as changing prevalence of endemic diseases, increasing incidence of skin cancers etc, but the
really big problems with health are related to human conflict triggered by resource issues and the health consequences of mass migration. In common with much that influences health, the poor will fare the worst. This will be most noticeable in the third world where many of the world’s biggest cities, already with massive deprivation, are at sea level on estuaries. Unchecked, the projected rises in sea level are set to flood these cities. The possible human response to the effects of climate change can crudely divided into the two broad areas of mitigation and adaptation. Mitigation involves action aimed at minimising the environmental consequences of human activities. The major greenhouse gas is CO2.
How green is your garden? Dr Keighley and family (and dog and hens)
This is due to the sheer volume that is being pumped into the atmosphere. Many activities, in our oil based economies, can be reflected as the net CO2 that is produced as a consequence. Adaptation covers the strategies aimed at minimising the anticipated adverse effects of climate change. Many individual doctors have recognised much of the above and have begun to change their personal behaviour in response (see our story on Dr Keighley below left). To date there has been little in the way of a cohesive professional stance. I suspect that many doctors believe that the moral value of their clinical activities in some way insulates them from the massive environmental challenge that faces us all. Medical professionalism has been defined as ‘a set of values, behaviours, and relationships that underpins the trust the public has in doctors’. It would seem that the public have a right to expect that we do our best to raise awareness of the impact on health of climate change. We also need to develop strategies aimed at decreasing the contribution of healthcare delivery to the problem, as well as beginning to think about how we can deliver effective healthcare to those in most need in a lower carbon economy. It is estimated that the activity of the NHS is responsible for the production of 20 million tonnes of CO2 per year. It was in response to all of this that the RCGP began to act. I was appointed as ‘sustainability lead’ in October 2008. The strategic plan that we are working on has many facets. At its heart is the aim of including ‘environmental probity’ in the core understanding of what it is to be a GP. There are several work streams that we are developing. The first is the inclusion of sustainability as it relates to primary care in the curriculum and assessment blueprints. I hope that we will be able to look at the activities of individual faculties. The carbon reduction that can be achieved with faculties is likely to be small in the great
scheme of things but will still be an important area to focus on. We have also developed an environmental practice award scheme and this is currently being piloted. It is a web-based carbon calculator specifically designed for general practice and will enable practices to input their activities and demonstrate to them where appropriate savings could be made. There will then be a link to the Carbon Trust – which has confirmed that its interest free loans scheme will be available to practices. These can be accessed to fund the introduction of schemes and technologies that will reduce the carbon footprint of a practice. The RCGP has also been working with other Royal Colleges to look at how this topic can be introduced into undergraduate and postgraduate training prior to formal inclusion in curricula. There are also plans for five sustainability ST3 scholars at the Severn GP School. These scholars will have an extra month of study leave to enable them to focus on environmental issues relating to primary care. GPs are ideally placed to bring about change in the environmental impact of healthcare in the UK, both by modifying their own behavior as well as using their influence in commissioning decisions. We are held in high esteem by society, as shown by IPSOS MORI polls and NHS patient surveys. Patients trust and believe their doctors. Following the Doll report in the early 1960s doctors were at the vanguard of those stopping smoking and this was noticed by others, resulting in wider smoking cessation. Doctors stopping smoking was obviously motivated by direct self interest. The approach to personal and professional carbon use needs to be motivated not only by altruism but also by an intergenerational self interest – concern for our children and grandchildren. Hopefully patients and others in society will be positively influenced by the positive actions of their family doctors.
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going green: how one gP’s family is making a difference to the planet Dr Judith Keighley Former Partner, Broxburn, West Lothian now Locum GP As a family we have been selected as one of five UK finalists for the Environmental Award of Future Friendly Family 2010. I know some doctors feel that doctors should keep out of environmental issues. Sadly, it is clear that at some point soon, we will reach Peak Oil. Once we have passed this our current relatively cheap fuel will become much more expensive, having an impact on most aspects of daily life. It would seem that staying healthy and living sustainably go hand in hand. To be healthy we are advised to eat at least five portions of fruit and vegetables, limit our meat and alcohol intake and exercise at least 30 minutes five times a week. Fruit and vegetables per calorie need less farmland to be produced than meat does. If we walk or cycle all our short journeys we are fitter and use less fuel. The alcohol we drink has often travelled thousands of miles giving it a high embodied energy. So what did we do to get this far in the Award? Mainly the simple things. We insulated our house with additional loft insulation, double glazing, cavity wall insulation and a new boiler. This cut our space heating fuel usage to about one-sxth of its original level. To conserve electricity we have put in energysaving bulbs, we switch off appliances at the wall, don’t leave anything on standby and gradually replace old appliances with more energy efficient ones as needed. We recycle everything we can and once a year ‘audit’ our shopping and our waste to get an idea of where further improvements can be made. RCGP NEWS • APRIL 2010
When we were a two-income family I used to enjoy a bit of retail therapy. My shoe collection vied with that of Imelda Marcos. As many of these were rarely worn, I realised that the high of retail therapy is shortlived and addictive. I gradually stopped – wow! what a change to the bank balance. As the children started to grow up we began to walk to nursery, school, shops and for local visits. The car fuel bills dropped and kids’ shoe bills grew! Our diet has evolved from highly processed and pre-cooked one to fresh, largely vegetablebased. This came about as the children arrived and we prioritised time to cook for them – and us. We then worked in the garden with them growing bits and pieces of vegetables and fruit. Fresh raspberries just picked or peas out of their pods cannot be beaten. Are we perfect? Far from it – the TV still gets left on standby or we occasionally leave a light on in an empty room. We are, however, thinking about it and by definition that changes our behaviour, making us reduce, reuse and recycle. It is hard though when short of time and tired to think about anything. We have gradually made it easier to recycle and try avoid bringing things into the house which will end up in landfill. Added to sustainability and health going hand in hand, I feel we could also add financial stability. It’s cheaper to walk, buy locally (you don’t fall foul of all the offers) and just reducing what you buy makes life cheaper. This is so important but difficult for many people and patients trying to cope with the aftermath of the recession.
Sustainable
Primar Care growing healthy partnerships
■ Vote now for Judith and her family at www.futurefriendly.co.uk. The competition closes on Wednesday (31 March 2010).
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