David Pencheon: Good general practice is sustainable general practice and vice versa

David Pencheon

Once again the RCGP’s Annual conference last week in Liverpool produced a wealth of stimulating and topical debates – from the ethics of whether doctors should take a lead in commissioning (why do we always feel the need to “take the lead?”), to what constitutes sustainable general practice. The groups considering the latter issue, chaired by Tim Ballard and Trevor Thompson, concluded that when done well general practice and primary care is, by its very nature, sustainable: keeping people healthy, independent, empowered, and out of hospital. However, these worthy aspirations don’t always inspire and direct individuals to more specific action. Of course, there is the usual list of ways in which we can do the day job in a more environmentally sensitive way: declutter, go even more paperless, measure and reduce energy consumption, more teleconsultations (did I hear correctly that one Cornish practice has exceeded 50% here?), better procurement, fewer and more integrated collection of specimens, visits on foot, by bike, on a (electric) scooter.

However, the group felt that if we really wanted to be truly sustainable, there should be a focus on the models of care for its population that really would keep people healthy, independent, empowered, and out of hospital. What was needed, the group felt, was a specific list of clinical and health related areas where significant action (or research if necessary) should be commissioned and/or implemented. What are the known knowns (or even the known unknowns) where systematic and exemplary action would have the most effect to immediate and long term patient care and population health? 

Five areas emerged, neatly summarised by Peter Cawston, a GP from Glasgow:

  1. Helping people eat better and move better (where some of the most significant co-benefits for health can be made. Over eating red processed meat is not good for immediate health or for longer term environmental survival and the use of fossil fuel to travel is good neither for our own health nor our children’s – as well as being dangerously carbon intensive).
  2. Enabling women to have control over their fertility (especially pertinent as we welcome the 7 billionth citizen to the planet).
  3. Targeting prescribing on those most likely to benefit (in particular moving from target driven medication lists to therapy tailored to the individual, with consequent improvements in safety and effectiveness as well as reductions in financial and environmental costs arising from the manufacture and use of drugs).
  4. Promoting a greater sense of belonging (helping people to connect more and consume less, building on the personal trusting relationships at the core of general practice).
  5. Helping people manage a better death (where the avoidance of death and promotion of longevity as signs of success need to be recalibrated to what is a much more humane and dignified approach to helping people manage their end of life, and end of life care).

David Pencheon is a UK trained public health doctor and is currently director of the NHS Sustainable Development Unit (England).