When will this tale be possible? Towards the end of the working day, I jump on a train that takes me smoothly well in excess of 100 mph to another large town in England in less than 45 minutes (It took 90 minutes before 2009). I get picked up by a GP in an electric car. We drive to a hotel where my host drops me by the entrance whilst she plugs the car into the hotel’s free charging point.

Inside, after a light supper, which is locally and sustainably sourced, we meet and hear from GPs and practice managers about all the general practices across the county competing to be the most sustainable practice. They focus on actions where financial, social, and environmental sustainability overlap. They talk about low energy, better waste management, and active travel to the practice for patients and staff. They talk with the leaders of the local commissioning teams about how better models of care involving prevention, staff  engagement, and patient empowerment are cutting costs and improving the experience for everyone. They talk of how they provide a working environment and working practices where staff can emulate at work what they are doing at home. Local council members interrupt presentations to remind colleagues of the help with sustainable transport plans for staff, patients, and deliveries. Experts on improving air quality calculate the lives saved from reducing air pollution from diesel vehicles. Guests from local academic units and from local government in the nearby counties participate hoping to implement the best ideas with their local health system. Saplings of oak (but not ash) are given as prizes for those who have engaged and delivered measurable improvements most positively. At the end of the meeting, as we thank the hotel for charging the car, we see from the video screen behind reception exactly how food and energy are sourced, which externally validated low carbon standards have been met, and how procurement and waste are managed in the hotel. When does this tale take place? It took place earlier yesterday evening. The future has aready arrived—it’s just unevenly distributed.

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