Barna, S

Gillam, S

English

University of East Anglia digital repository

Sustainability in generalpracticeStephen Gillam MD FRCP FFPH FRCGPGeneral Practitioner, Luton, UK and Director ofPublic Health Teaching, University of Cambridge,UKSteﬁ Barna MPHSustainable Healthcare Education Network Co-ordinator and Lecturer in Public Health, Universityof East Anglia, Norwich, UKThe links between health and sustainability havebecome increasingly accepted in health policy.For many practitioners, however, sustainabilityand climate change remain marginal to day-to-day practice. The lack of modelled best practice,combined with GP trainers’ uncertainty about con-tent expertise, has resulted in a skills gap for newregistrars. We suggest teaching sustainabilityskills at three levels: patient care, practice man-agement and leadership/commissioning. The fol-lowing activities relate to Ten Practical Tips forDoctors1 and the work of the Sustainable Health-care Education Team.2 Consider asking yourregistrar to take on activities in each of theseareas.1. PATIENT CAREDecarbonising patient care. Read the NHS Carbon Reduction Strategy3 andanswer the following questions: What com-prises the NHS carbon footprint? What are themain areas in which it can be reduced (e.g.energy, travel, prescribing, procurement)? Onein eight cars on the road is said to be on NHS-related business. How can NHS road milesmost easily be reduced in your practice (e.g.telephone consulting/tele-medicine; staﬀ ride-share, ensuring patient access to public trans-port for clinic visits)?. List the most commonly used medical devices inyour practices. Which are reused or recycled?Which are single use, and what quantity of wastedoes this amount to in one year? Find out whatwaste management policy is in place and identifypotential improvements.. Document a patient journey through treatment fora common diagnosis, and identify opportunitiesfor more sustainable practice. What potential ben-eﬁts and threats do these options have for provid-ing patient-centred care?Improving consultation skills. Explain the health co-beneﬁts of reduced carbonconsumption. For an overweight or a newly diag-nosed diabetic patient, identify some of theextended beneﬁts of exercise. Start with thehealth related (for diabetic prevention or control,on heart, lungs, musculoskeletal system, mood,etc.) and move onto others (general ﬁtness, ﬁnan-cial, ecological, example to others, etc.). Whatmight be the health beneﬁts to patients of, say,improved home installation (respiratory, cardiac,seasonal mortality shifts in older people, ﬁnan-cial, etc.)?2. PRACTICE MANAGEMENTCalculate your practice’s carbonfootprint. Begin asking the registrar to calculate their owncarbon footprint. Share the results with the rest ofthe practice team, encouraging their thoughts andsuggestions as to how they might reduce carbonconsumption. Register at The Carbon Trust orNational Energy Foundation. Use the SustainableAction Planning tool (www.sap.greenerhealthcare.org) to estimate the practice footprint. Sign up tothe ‘10:10 Campaign’.Develop or amend the practice’ssustainability strategy. Identify a model for sustainable general practice.What practical priorities might be identiﬁed? Whattargets can progress be measured against? Whatare the challenges to developing shared owner-ship? This exercise can be used to highlightaxioms of change management: the importance ofa shared agenda, clear goals, commitments andprogress measures, the diﬃculties of eﬀectingchange in the face of scepticism or negativity, howto win friends and inﬂuence people.3. COMMISSIONING,LEADERSHIP ANDMANAGEMENT FOR SYSTEMICCHANGEIdentify levers to reduce carbonconsumption in the secondary carecontracting process. Learn about sustainability initiatives taken by GPcommissioners in model practices and make sug-gestions as how consortia can be held to accountto use the commissioning process to ensure thatproviders deliver on NHS targets.Keywords: general practice registrars, generalpractice training, sustainability36 Teaching exchange # 2011 Radcliﬀe Publishing LimitedIdentify organisations working in thecommunity to advance sustainablelifestyles. List the services and activities that might helppractice members or patients to reduce theircarbon footprint and achieve practice goals.Among the Royal College of General Practi-tioners’ curriculum areas these exercises can belinked to are the general practice consultation,personal and professional responsibilities includ-ing clinical governance, clinical ethics andvalues-based practice, promoting equality andvaluing diversity, and evidence-based practice.Teaching on sustainability would help in develop-ing competences relating to primary care man-agement, holistic care, community orientation,holistic and contextualised care.References1 Griﬃths J, Hill A, Spiby J, Gill M and Stott R (2008) Tenpractical actions for doctors to combat climate change.BMJ 336: 1507.2 Teaching materials (lesson plans and slide sets) areavailable at: http://greenerhealthcare.org/sustainable-healthcare-education (accessed 02/11/10).3 www.sdu.nhs.uk/publications-resources/3/NHS-Carbon-Reduction-Strategy/ (accessed 02/02/11).Correspondence to: Stephen Gillam, Director PublicHealth Teaching, School of Clinical Medicine, Adden-brooke’s Hospital, University of Cambridge, CambridgeCB2 0SP, UK. Email: sjg67@medschl.cam.ac.uk.Teaching exchange 37

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