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By calculating your carbon footprint - register at The Carbon Trust or National Energy Foundation. You’ll have a baseline to work with and to set targets from. Get some valuable support on how your practice could proceed from the Sustainable Action Planning tool.
The Royal College of General Practitioners has developed a web-based tool that will calculate the carbon footprint of GP practices together with Best Foot Forward, enabling GP practices across the country to calculate their current carbon footprint, and benchmark themselves against other similar practices. Importantly it will also identify areas to target that will help lessen their environmental impact.
The Sustainable Action Planning (SAP) tool is structured around two workshops, with case studies to share first hand experience. It allows staff to learn about sustainable healthcare, to focus in on their priorities and to implement an effective green action plan. Have a browse: sap.greenerhealthcare.org
Improve the insulation of the building and install a more efficient boiler system. Are you cooking in summer and freezing in winter? Use thermostatic controls to regulate temperatures. Use motion sensor lighting, and encourage everyone to ‘switch off not standby!’ with notices by lights and computer monitors.
Renewable energy providers: Ecotricity is an electricity company that invests money from its customers into wind parks. The ‘green’ electricity generated is then supplied to the customer (along with a varying amount of ‘brown’ energy form conventional sources depending on the type of plan chosen). Whilst Good energy, offers only 100% renewably-sourced electricity! www.goodenergy.co.uk. Choosing either as your new supplier would immediately greatly cut your carbon footprint. Switching your contract is quick and easy, so go ahead and change it now!
IIt sounds like a big job, but improving the buildings insulation and boiler efficiency will have both large energy savings and financial savings in the long-term. The simpler tasks also have large savings in store. Get hold of useful posters and stickers for your ‘switch off not standby’ action from the Carbon Trust. Prefer a more personal approach? Get in touch with the local schools and see if the children could help with some drawings. Install a Smartmeter so you can actively monitor your electricity and/or water consumption.
System optimisers otherwise known as compensating heating circuits, are computer controlled systems that monitor the outdoor temperature and adjust the indoor heating and thus the indoor temperature accordingly. Already used a lot in hospitals they can help keep your heating bills down and save energy too!
Get Active! Encourage cycle use through cycle incentive schemes. Encourage Lift Sharing, or set up your own practice arrangement. Could you be a one-car practice? Use this for home visits and everyone commute car-free. When cars must be used, organise visits so numbers of car-miles is minimised. Go one step further: switch to an electric car and provide a charging point at the surgery!
Through the Government’s Green Transport Plan NHS Trusts are geared up with the Cycle to Work Scheme and are offering their staff tax free bicycles! Let everyone at your practice know about this great opportunity and take advantage of it. Then you can join Spokes the NHS cycling network to facilitate your cycling experience, like ensuring happy cyclists by providing cycle racks and changing/showering facilities.
Check the mileage rates for cycling in your practice. Make them the same as a car and see if people switch! YOu will be improving staff health as well as the environment.
Not a bike fan… Do local bus routes need improving? Work with you local authority to get better services around your practice –benefiting not only the staff but patients too.
If a bus or bike just isn’t your thing - you’re likely to live close to someone else from your practice – why not lift share? With smaller numbers of familiar staff in GP practices it’s easy enough to organise.
And next time you arrange to see a drug rep, ask them to calculate the carbon emissions from their journey. Some GPs are now asking drug reps to “offset” their carbon emissions, which quickly gets management attention!
Encourage patients to walk or cycle to the practice – but you may need to lead by example! Increase the use of telephone triage before giving in person appointments. Set up phone-back appointments for follow-up patients who won't need to be seen in person. They’ll thank you for the saved waiting and travel time, and you’ll save on carbon…everybody wins!
One practical method to increase patient activity is to create an 800m walking zone around the practice. Appropriate landmarks are identified in an 800m radius and patients are requested to travel this last distance by foot. This has several advantages: improved air quality, reduction in traffic and car parking demands, opportunities for assessments of patients’ exercise tolerance (explain this to them), and finally provides a clear message about the health benefits of walking and exercise.
What bus routes stop near your practice? Work with the Local Authority to ensure there are as many as possible that stop within easy walking distance, and then publicise this with a poster in the waiting room.
Aim to cut your purchasing through maintaining, sharing and re-using where possible. Put recycling bins in every consultation room and waiting room. For internal communication, when paper is required use low grade recycled paper. What potential is there for reusable rather than disposable instruments?
Choose environmentally-sensitive suppliers, or alternatively request that your current suppliers adapt. (Remember, the annual turnover for a 4 GP partnership can exceed £1million – excluding salaries – that’s quite a lot of influence…) Try to single source to reduce transport costs. Use “whole-life costing” to include running and disposal costs when comparing products, and make use of Government Buying Standards before choosing to buy: www.defra.gov.uk/sustainable/government/advice/public/buying/index.htm .
Recycle as much as is possible – consider recycling of non-paper waste such as aluminium cans and printer cartridges. Ask your Primary Care Organisation to help if recycling facilities are not currently available. Separate waste - clinical waste costs about £500 per tonne, while recycled only £35.
Encourage your patients to lead a more active lifestyle and support them in taking an interest in, and a greater responsibility for their own health through information and education. Provide information, especially to older patients about improving insulation and available grants to finance it. Promote locally sourced food within your practice, improving nutrition as well as reducing food miles.
A healthier patient population means lower carbon living and less dependence on the NHS. ‘Carbon addiction’ is portrayed by many of the arteriopath patients you meet in your practices and can be treated as a full-blown medical syndrome! Read more about it at www.carbonaddict.org and distribute the 10:10 Decarbonising Care flyer to staff (on recycled paper of course!) to raise awareness.
Supporting patients to take greater responsibility for their own health is essential in order to lessen their dependence on the NHS, improve their health outcomes and thus achieve a more sustainable health service. Many GP practices are already very good at this. Ensure that your practice is too, by actively engaging patients. Allowing patients access to their own medical notes could be one method of this engagement. Explain their healthcare to the best of their understanding, answer any questions they may have and be able to direct them to further sources of information if requested. Encourage therapies that require their own commitment and motivation rather than simply prescribing a pill.
Regular exercise and access to natural outdoor space not only benefits patients’ physical health but their mental health too. Give a helpful point in the right direction by directing your patients to resources such as these:
Keeping warm at home in the winter is very important for elderly patients who are vulnerable to hypothermia. Blood pressure control is also adversely affected in patients living in a cold home. Improvements to home energy efficiency and heating in Glasgow flats reduced mean blood pressure from 142/85 to 122/73, and was associated with reduced hospital admissions for cardiovascular and respiratory disease over 4 years’ follow up*. The Energy Savings Trust offers grants for insulation instalments in homes. Make sure your vulnerable patients are aware of them and apply.
Find out what fresh produce is on offer in your area – perhaps there is a local famers market? Organise subsidised fresh food vouchers for low-income, vulnerable families when they attend for immunisations or antenatal care, or for patients on cardiac rehabilitation programmes.
* The effect of improving the thermal quality of cold housing on blood pressure and general health: a research note. E L Lloyd, C McCormack, M McKeever and M Syme. J. Epidemiol. Community Health 2008 62;793-797
Offer one-stop shops: BP, bloods, physio and medical consultation all on the same day. If bloods are needed consider how they can be taken on the same day as the consultation. Consider the carbon impact of making a referral or ordering an investigation…Is it really necessary, or is there a more suitable and lower carbon alternative?
The NHS Sustainable Development Unit have estimated that the carbon footprint generated by one single outpatient appointment is around 50kg CO2e (Carbon Dioxide Equivalent)*. So…by simply taking bloods on the day of the medical consultation you immediately save 50kg CO2! Combine that with their regular BP monitoring and you’re up to 100kgCO2 without paying a penny!
The NHS Institute for Innovation and Improvement is producing The Productive GP and some work on Sustainable Commissioning. Do look at their site for up-to-date tools and resources.
* NHS Sustainable Development Unit: Indicative carbon emissions per unit of healthcare activity. http://www.erpho.org.uk/Pages/viewResource.aspx?id=20967
Create a Green Community with help from the Energy Saving Trust. Work with existing local organisations like the Transition Town group, to develop a practice garden or local food group.
There are probably already a host of activities going on in your local area, with people eager to give advice and share ideas. If your area already as a Transition Town group this is a great place to start...if not, create one! After all, people’s health is affected by a multitude of factors and climate change affects all aspects of society. Join forces, let the creative juices flow and see what happens…the possibilities are endless! To get some inspiration visit www.energysavingtrust.org.uk/cafe.
Consider showing films like The Age of Stupid or Project Genie in waiting rooms or giving presentations at practice meetings. Use 10:10 material as screensavers and show it in the waiting room – let everyone know you’re a 10:10 GP practice!!
Considering that climate change has been described as the “greatest global health threat of the 21st century” (The Lancet, May 2009) does this mean that health professionals have a responsibility to make their patients aware and to advise them on cutting their carbon emissions? After all there is significant evidence that instructions given by a doctor are effective in changing behaviour.
Promoting the health benefits of a lower carbon lifestyle have already been highlighted in ‘decarbonising patients care’. But why not also provide some visual information through posters, pamphlets or digital images on screen, promoting awareness around carbon reduction. Explain how to calculate individual carbon footprints so patients can do it too. As part of routine travel advice encourage patients to offset their carbon emission with information on how to do so, and promote plane-free transport methods.
Encourage staff to adapt to the ethos of the practice and issue them with a copy of the Environmental Policy of the practice. Use a bank that promotes ethical investment and carbon reduction (for example the Co-op bank or HSBC). Check that any investment policies are invested in ethical investment companies.
Download a poster version of the 10:10 GP Checklist
