Reflecting on the lessons of the recent heatwaves, Dr Emma Rowley-Conwy calls on NHS managers to take the climate emergency seriously and provide practices with the help they need to keep staff and patients safe
Climate change has impacted significantly on all our working lives this summer. As I write this, most of us are in the midst of our second heatwave alert and struggling to provide a safe service to our patients. It is no longer something that might happen in the future, but something that is happening right now.
Research has shown that cognitive function and complex task performance suffer significant negative effects from heat stress1, which increase the risk of staff making errors when working in overly hot environments.
But the advice we receive from NHS England and NHS Improvement as part of planning for a heatwave focuses only on how to identify potentially vulnerable patients. It offers no guidance about how to mitigate the impact on our staff and ways of working.
As employers we are required to provide a ‘reasonable’ temperature in the workplace.2 Yet it feels as though GP partners are being set up to fail; how can we achieve this when working from substandard estate? This isn’t something that can be easily fixed by the partners or practice manager – it requires a strategic plan from NHSEI and support from local NHS management.
In England, all PCNs have been required to undertake an estates review, with consultancy support provided. But how many of us have seen any overall estates strategy for our ICS area to come out of these reports? In our ICS, I understand there is a budget of just £3m to address the needs of more than 200 practices, yet even newly completed buildings need immediate adaptations and retrofitting to reduce the impact of heat. There are changes that can be effective in keeping buildings cool, such as installation of heat deflecting shutters, and blinds to shade windows. Where will the funding for this come from? Such changes are needed now, or at the very least within the next year, so that we can continue to provide a safe service to our patients during high temperatures.
As a GP partner I have been involved in three practice building development projects, and although the practice was engaged in the process, we had little influence or control, despite being the end user. In the most recent project, completed in 2021, our practice ended up with a new suite of rooms in a multi-tenant building, of which only one clinical room has any air conditioning. So in the latest heatwave, we were back to balancing air conditioning units on chairs so the exhaust hose could reach the window, in order to make other clinical rooms tolerable. This is not an acceptable standard of design.
It is vital that capital projects being undertaken now and in the future incorporate proper design specifications to make them safe and comfortable workspaces that are suitable for high temperatures. Ways to modify buildings are well known, but there seems to be no acknowledgement of this requirement at national level. When capital budgets are so small, these vital adaptations are pushed down the priorities list and may never be funded.
Capital projects also need to enable primary care to deliver on the wider green agenda. The Green Impact for Health Toolkit3 has laudable targets, but many are unachievable and outside a practice’s control. Our practice in a multi-tenant building has no electricity meter of its own, and we have no influence in the choice of utility provider. Even if we want to seek a greener supplier, we can’t.
Climate change, with higher temperatures and potential flooding, not only impacts on staff and patients, but also our equipment. We are now highly dependent on well-functioning IT systems, but they are vulnerable to heat and flooding. Not all of us have servers in temperature-controlled rooms, so we urgently need support from NHSEI to ensure our IT systems are resilient as possible. This also applies to our secondary care colleagues; if a leading trust in London can experience a major IT failure in high heat, as Guy’s and St Thomas’ did in July, how many others are vulnerable?
We have also seen the impact of heat on our pathology services. Blood samples need to be kept at between 15-25 degrees Celsius from collection to being processed in the laboratory. Too cold, and we will get anomalies of hyperkalaemia, and too hot, hypokalaemia. In frail patients where the K is clinically critical, an abnormal result can lead to a visit to A&E in the night, which can start a chain of events with a disastrous outcome for the patient. How many of us and our couriers have a temperature-controlled space to store samples?
When will NHSEI wake up to the fact that action can no longer be delayed?
Dr Emma Rowley-Conwy is a GP in south London and clinical director of Streatham PCN
References
- Taylor L et al. The Impact of different environmental conditions on cognitive function: a focused review. Front Physiol. 2015; 6: 372. Link
- HSE. Temperature: what the law says. Link
- RCGP. Green Impact for Health Toolkit. Link
And still no funding to prepare for the Zombie Apocalypse; don’t say you were not warned.
You care, they don’t.
That perpetual abyss, between the altruist and narcissist. They’re still working on the NHS Zero Tolerance poster.
But, don’t worry – they now have a NHS Net Zero Expert Panel. And aim to get “it” sorted by 2040. Actually. In 18 years time, they’ll figure it out, or be seconded to some American corporate or consultancy firm who will really watch you sweat it out, and beg for water and a break to breath.
Employee health is of little care to this juggernaut, you do all the hard graft and thinking whilst they choke you – they stole your water bottle on the wards (infection control), messed with your mind and brainwashed you to put others first, and be a passive scapegoat without lunch break, and enslaved you on nights and careless home visits. The rat race. No, you can’t have your holiday, sorry, there’s no ward cover then. Remember those days?
Now, they brand cheap token “wellbeing” tsars and webinars, on following some Venn diagram on bio-psycho-social factors and following GMC good doctor guidelines whilst you’re “burnt out”. To say they “did something”. Box ticked. You carry on.
Your estates and mental clarity means nothing to “them”. Who is “them” anyway?
Those surveyors that came around, you know, that private company, was an intelligence stunt to essentially do you over at a later date. One cannot believe that some fell for that PCN buggery.
Until 2040, keep throwing away those sterile single-use plastics and plasters, that went “off” last week and collecting all those prosecco-induced urine “cystitis” samples in plastic bags and red and silver bottles, and blue bottle calprotectins for the bloating Burger King type, for mere incineration and plastic waste giggles. Normal no action. Remember those relabelled “expired” PPE stunts they sent you? That’s the same “lot” you’re talking to here.
There is continued sympathy for some hospital colleagues who work without a window or natural light and fear of a toilet break incase their bleep goes off, or someone actually finds them, urinating something.
This NHSE lot are like politicians, similar characteristics of power-tripping inertness, permutating and deliberating ideologies and gimmicks at home, on their Zoom meeting. They love a bullet point, and box to fill, but have learnt little themselves. Talking via “spokespersons”. It’s coming to bite though. They care nothing for the arid, pungent smell of the high street and public gutter you’re sitting in. The flies are gathering and yes, it is ugly. People are fed up. Nurses, receptionists and everyone, even the courier.
One may need to do a delivery dump outside NHSE. Of soiled nappies, or some other waste material when the bin collectors go on strike. The CQC will probably make you do all your premises changes yourself under their 2028 new GP consultation and require all staff to have Tesla cars and use of pencils only, not plastic. That’s what they did to you last time. You buy it. Upgrade it yourself.
The more they enslave you to your chair, the more this is important. Good to highlight, and good that you know that you’re worth it and that they’re sleepwalking.