Becoming a sustainable GP practice

In a busy surgery, the last thing a GP may want to think about is how they can reduce their environmental footprint, but it may be easier than you think.

The NHS is an enormous contributor to greenhouse gas emissions in the UK, releasing around 21 million tones of CO2 per year. It's an unpalatable thought that in our desire to provide healthcare to our patients we are contributing to ill health in this, and other countries, along the way.

Many GPs also understandably feel that the value to society of providing high quality clinical care in some way negates the need for us to minimize the associated CO₂ production and other environmental impact of modern health care. Of course the primary focus for us as GPs always needs to be the consistent delivery of high quality care, but we need to think about how we can do this with a smaller environmental footprint.

GPs are well placed to make our health care system less carbon intensive. We can do this in many ways from making changes to our own surgeries to using the commissioning process to challenge and redesign traditional care pathways.

GPs are an innovative group of professionals, and are able to use their local knowledge to develop new patterns of activity. We are at the heart of many communities and our activities do not go unnoticed. There is evidence that the early adoption of smoking cessation by the medical profession spurred on many others to change as well. GPs also think holistically and can grasp and deal with complexity like no other group I know.

Changes in the surgery

A good place to start is to try to quantify the carbon footprint of your surgery. At its simplest this involves taking account of your utility costs and looking at procurement of office and medical consumables.

The RCGP has been working with Best Foot Forward to develop a web based tailor made carbon footprinting toolkit for surgeries. This is currently being piloted by over a hundred practices and two PCT areas. There are plans to make this much more widely available in the near future.

There are some simple steps that you can make. The good thing with this approach is that many of the options are likely to save you money:

1. Make sure that your surgery is well insulated, it may be beneficial to arrange for an independent survey.
2. Make sure that all of your lighting is low energy wherever possible.
3. Consider the use of green energy microproduction and benefit from the Government's ‘feed-in' tariff system.
4. Have a locally sourced fruit bowl rather than a biscuit tin.
5. Develop a practice Fair Trade policy.
6. Encourage staff to become involved with the task of using less energy by offering to share the savings on utility costs between staff and GP partners. Get all of the staff together and talk about the issue, explain why you want to make the changes and help them to understand what is at stake and why this is important for them as well.
7. Think about adopting a Sustainable Action Plan. An example and help with doing this can be found at the Centre for Sustainable Healthcare www.greenerhealthcare.org
8. Recycle what you can. This can be difficult given current arrangements for treating practices as private businesses. Please let us know if this has been difficult for your practice. The RCGP is currently lobbying for a change to this approach.
9. Don't put domestic non-clinical waste in the clinical waste or sharps bins. Ask your PCT to share in the savings that will accrue for them when this happens.
10. Adjust your printer settings or install a programme that uses less printer ink.
11. Try to take account of mileage when allocating home visits and consider encouraging an active travel policy for staff and patients.
12. Where possible encourage the ‘one stop' approach to healthcare.  Try to take samples from patients while they are with you. This saves on future appointments, reception time and patient travel.
13. Use telephone consultations if this is clinically appropriate, and think about using other forms of technology such as e-mail for patients with appropriate problems.
14. Effective family planning for patients can make one of the biggest differences of all. An unplanned pregnancy has a lifetime of associated carbon costs.

Dr Tim Ballard is a GP in Wiltshire and sustainability lead at the RCGP. Dr Caroline Jessel is a GP in Kent and sustainability lead at NHS West Kent.

You can find out more about the CQC's forthcoming sets of regulatory requirement on surgery premises at a Pulse seminar in October.