General practitioners as ‘eco-warriors’

Vasumathy Sivarajasingam is a GP in West London and an honorary clinical research fellow at Imperial College London. She is on Twitter: @vasu27765631

An evolving public health threat and a shared responsibility

Climate change is an existential threat to humanity but also an evolving threat to public health, needing urgent action. Institutions and individuals alike have a responsibility towards helping to reduce their carbon footprint. Around 90% of NHS patient contacts are via primary care.¹ As first-contact personal health care services and gate-keepers, general practice provides over 300 million patient consultations each year.² On average, GPs are in touch with 41 patients a day – via face to face appointments during the surgery, home visits, telephone and email.³ This highlights the perfect opportunity the GPs have in engaging with our community and raising awareness of the benefits and threats of climate change on our health.

In essence, the primary care team should view clinical care through a sustainability lens to benefit the health and well-being of current and future generations. If we are proactive, we can support our patient population to tackle the climate crisis.

So why has there been a slow movement in ‘greener’ education in primary care? Although the GPs may well be aware that the ‘climate emergency’ is also a ‘health emergency, many of us do not make the connection with clinical practice when it comes to taking action. We often fail to realise that the majority of a general practice’s carbon footprint results from clinical activity.

How can GPs support greener practice?

WHO describes the 21st-century primary health care as a whole-of-society approach, addressing not only the individual and family health needs but also the broader issue of public health and the needs of defined populations – health promotion, disease prevention, treatment, rehabilitation and palliative care⁴ – this vision is the basis to combat climate change.

Every opportunity must be taken to link health problems with climate change during our consultations. Humanity, public health and nature are not separate, and it is crucial to see them as one to fix the climate crisis. For instance, increased physical activity, improvement in air quality, improved access to nature and green prescribing would not only improve the physical and mental health of an individual and a community but would also contribute to mitigating the climate crisis.

Identifying ‘teachable moments’ in primary care is crucial – the ability to identify and explore patient concerns and recognise opportunities to link them with unhealthy behaviours; increases the patient’s willingness and commitment to change behaviour.⁵ Regular conversations promoting a cleaner more sustainable human life might motivate our society to take charge and focus on creating a world that human wants to live in.

Tailor the information to the patient’s needs

There is a wealth of information about the climate crisis on social media, which can be overwhelming and disempowering. In primary care, we are trained to give evidence-based, person-centred advice, and have the capacity to connect and build meaningful constructive relationships with our patient population over a period of time. Also, as the most trusted healthcare professionals in the UK⁶ we can provide essential health information and guidance about health and climate change in a way that is acceptable to most of our patient population.

Everyone has a role to play in climate change. By considering what matters to each patient and tailoring the information to each individual’s needs and wishes during our consultations, we can empower and encourage behavioural changes, however small they may seem. This is much more sustainable in the long term.

Break the downward Spiral of Silence

Humans are social beings, who want to blend in with society. We tend to monitor our social environment and modify our behaviour accordingly. Mostly, we want to feel accepted and respected by everyone, pressing us to agree superficially. Fear of isolation strongly affects our willingness to express our personal opinions which can set the ‘spiral of silence in motion.⁷ As respected role models, GPs could influence people in developing high self-esteem and an environmentally conscious society that is willing to speak up, breaking the spiral of silence and helping fight climate change.

Self-care and self-management

We need to promote the importance of self-care and self-help measures as a part of daily living – lifestyle medicine (regular physical activity, healthy sustainable eating, adequate sleep, stress management, avoidance of risky substances, forming and maintaining relationships, reducing loneliness); self-limiting minor ailments with over-the-counter medications. Support for patient self-management interventions for long-term physical health conditions and mental health problems is a positive strategy for reducing unnecessary visits to the surgery, environmental costs of overprescribing and costly medical interventions.

Have a list of practical tips

In primary care, it is unpredictable who comes through the door and how busy the day could be. Hence, it is helpful to have a list of some practical tips that we can refer to and share with patients. Given the time pressures associated with patient consultations, we only need to focus on one piece of practical advice at a time that is tailored to the patient’s needs that requires a behavioural change to make a difference. Such small steps would not only improve an individual’s health and wellbeing but could also have a ripple effect on their loved ones, ultimately leading to positive societal influence in fighting climate change.

Here is a list of practical tips to consider that can be shared, discussed and updated regularly. Some are easy, some are hard and not all of them work all of the time – for example if your packed lunch involve more energy use than a bought meal!

Health promotion /Lifestyle intervention:

Food

• Plant-based/vegetarian diet
• Eat seasonal vegetables (healthier, cheaper, fresher and tastier)
• Meat eaters, have a meat-free day during the week
• Take pack lunch from home
• Use herbs grown in your own garden
• Consume local and seasonal products

Active travel/exercise

• Walking, cycling or using public transport
• Carpooling
• Electric vehicle
• Enjoy local parks
• Stop smoking

Women:

• Long-acting reversible contraception reduces monthly bleeds
• Consider bamboo-based rather than cotton-based sanitary products (more sustainable)
• Menstruation – consider reusable pads/menstrual cups where safe and appropriate

Holiday/Travel:

• Enjoy green spaces in the local environment
• Use public transport
• Avoid or fly less in a year
• Carry reusable bags/bottles when travelling

Energy:

• Switch off lights when not in use
• Change light bulbs to LED
• Switch off electronic appliances when not in use
• Boil only the water that you need
• Cover the pot while cooking (saves energy/cooks faster)
• Washing machine/dishwasher starts only when fully loaded
• Install solar panels
• Draft proof your home (saves money and energy)
• Encourage digital communication whenever possible/appropriate. But also consider when an email or text is unnecessary (perhaps add a message to this effect to your e-signature)

Waste:

• Use reusable water bottles, cups and bags
• Avoid using single-use plastics
• Recycle items (e.g. clothes/shoes/papers)
• Reduce food waste
• Compost waste
• Think before you print
• Print on both sides of the paper
• Use non-confidential printouts as rough paper

Medicines:

• Inhalers (advice about optimal usage and disposal)
• Return used/unwanted/expired medications to the pharmacist
• Do not flush medicines down the toilet

Career/Activities:

• Think how one could reduce carbon footprint in their chosen career
• Plant trees (e.g. Plant-for-the-Planet initiative allows people to sponsor tree-planting around the world)
• Form local groups or joining existing initiatives
• Small projects in the community e.g. supporting a local school in educational intiatives
• Gardening in communal areas
• Newsletter sharing ideas and achievements

As trusted primary care leaders, GPs have ample opportunities to communicate, empower and engage with our community in reversing the effects of climate change of the past. Simple repeatable messages are most effective. Understanding our unique patient population and having positive conversations while offering pragmatic practical advice tailored to the person’s needs is the way forward in energising our society.

References:

1. ‘Quality of care in General Practice, Independent Inquiry report, chapter two’. The King’s Fund, 2011; 24 March: https://www.kingsfund.org.uk/sites/default/files/field/field_related_document/gp-inquiry-report-evolving-role-nature-2mar11.pdf
2. ‘NHS five year forward view – Primary Care’: https://www.england.nhs.uk/five-year-forward-view/next-steps-on-the-nhs-five-year-forward-view/primary-care/
3. ‘One in 10 GPs see twice as many patients as safe limit, survey finds’. The Guardian, 2019; 8 May: https://www.theguardian.com/society/2019/may/08/gps-doctors-seeing-twice-as-many-patients-as-safe-limit-study
4. ‘A vision for primary health care in the 21st century’. WHO, 2018; 10 Dec: https://www.who.int/docs/default-source/primary-health/vision.pdf
5. Cohen, Deborah J et al. Identifying teachable moments for health behaviour counselling in primary care. Patient education and counselling vol. 85,2 (2011): e8-15. doi:10.1016/j.pec.2010.11.009
6. Ipsos Veracity Index 2020; 26 Nov: https://www.ipsos.com/en-uk/ipsos-mori-veracity-index-2020-trust-in-professions
7. Petersen, Thomas. “spiral of silence”. Encyclopedia Britannica, 2019; 2 Jan. https://www.britannica.com/topic/spiral-of-silence (Accessed 24 June 2022).

Featured image: Clouds over the rock pools, Sidmouth UK, by Andrew Papanikitas 2021