Greener Leader Blog Series: Many small steps create big change. By Dr Frances Cundill

Ultimately, I want to leave the world in a better place for my children and future generations, and for them to live happy and healthy lives. Whilst the climate news stories can feel disheartening at times, I believe that a brighter future is still possible, and, if anything, it has made me more determined to do what I can to ensure this brighter future can happen.

As a salaried GP from South Yorkshire my passion for environmental sustainability developed from my increasingly awareness of how many of our current actions, as humans, are damaging our planet’s health and, in turn, our own health. As healthcare professionals this is something we have a responsibility to pay close attention to.

So, in 2020 I took this passion from my personal life, into my work life. I joined Greener Practice, a UK wide network of primary care professionals working together to makeshift primary care into the space of meaningful environmental sustainability. This network enabled me to attend regular meetings, engage in discussions on far ranging topics, from how to communicate effectively on climate change, to how we can work with local public health teams to drive a positive future for our communities, and I began to talk to colleagues about changes we could make in our workplace. Sure enough, I took on the role of chair of the South Yorkshire group when the current chair moved onto a national directors’ role within the network. I felt honoured to be asked and through the group have met, and had conversations with, some truly inspiring individuals who have further enhanced my own commitment to this cause. The Greener Practice network has grown exponentially over the few years it has been in existence, it was started by two GPs in Sheffield having a conversation and is now a national community producing information, guidance, and support. This growth motivates and inspires me as there are so many individuals coming together to focus on making changes to reduce our impact on the planet. It is this inspiration that I want to convey to others to bring them along in this movement for change.

My role in Greener Practice led to new leadership opportunities including obtaining an aspiring leader’s fellowship through my local training hub. This has highlighted to me how sometimes doors open doors, and we never know what opportunities lie around the corner. This fellowship provided me with something which feels rare in General Practice, time. Time away from my clinical work to read, think and question. Reflective leadership is crucial if we want to lead meaningful change, and the opportunity to have a dedicated day a week to work on my passion has been invaluable. I appreciate that I am fortunate to have this time, that many colleagues do not feel they have. However, the beauty of sustainability is that it needn’t be an ‘add on’ or an extra chore to complete; it should and can be a core part of primary care. Most importantly, it can bring joy back into General Practice, as we remember our purpose as healthcare professional – to create health and to ‘first do no harm’. Everything we do, every bit of advice we give, every medication we prescribe has an impact on the planet, and we need to be working together to not only minimise that impact as much as possible, but to find ways to generate health and happiness for our communities.

So, what have I done, you might be pondering?

I have given talks, shared resources and, most importantly, listened and learnt from others, a crucial aspect of humble leadership. More specifically, I have been working on our city-wide Primary Care Network vision document and the citywide education events, to support getting environmental sustainability incorporated into both. The purpose is to normalise sustainability into all that we do. I recognise the conflict of needing the dedicated time to work on this, to make it an easy part of everyone’s everyday practice, and my fellowship time has allowed me to do this.

I have learned to focus on sharing resources and examples of what has already been done; support and stories of success breed more energy for more success. For example, in Primary Care, inhaler prescribing contributes to 3% of the total NHS carbon footprint, so sharing the excellent high quality low carbon asthma guide and working with prescribers on better asthma care has been a crucial part of sharing knowledge and building the confidence required for change. Other areas include supporting practices to promote active travel and healthy lifestyles, de-prescribing and social prescribing. These are all good for our patient’s health, good for planetary health and, for those financially minded, good for the bank balance – people, planet, profit – the “triple bottom line”.

Is it hard or lonely?

It can be a lonely and, at times, demoralising place trying to convince others to engage in the green agenda. It is essential as the climate crisis is a healthcare crisis, so we, as healthcare professionals, are left with little choice but to act and mobilise others in this space. I believe every little helps, so even if only two people come to the talks I give, if only one person in a practice feels they can put a poster up or make a change, then that is a win for me, and for all of us, because every journey requires many thousands of small steps to get there.

Why does it even matter?

We know that climate change is having a direct impact on our patient’s health. The NHS contributes 21 million tonnes of carbon per year (approximately 4-5% of the UK’s total carbon footprint) and employs around 1.26 million people so by making changes in our professional lives, together we can make a huge impact. The NHS is aiming to be the worlds’ first net zero national health service, but it won’t get there without every employee doing what they can. It seems to me that what feels like inertia towards making the changes needed may be due to lack of information, confidence, and awareness of what can done, alongside a lack of dedicated time to work on this.

My fellowship has taught me about different leadership styles and models, it has taught me about process mapping and communicating messages but most of all it has brought me a sense of optimism in terms of what leadership can offer in this crisis. I have met and spoken to many individuals who are passionate green champions and strong advocates for us all. I hope to educate, inspire, and support people to make the changes, even just small changes, needed to make our planet a better place to live, now and for future generations. If any of this has sparked an interest, please join our Greener Practice community who are making lots of small steps to create big change.


Photo of Frances Cundill

Dr Frances Cundill

Frances Cundill is a salaried GP in Sheffield and chair of the South Yorkshire Greener Practice Group. She is currently undertaking an aspiring leaders fellowship with South Yorkshire Primary Care workforce training hub.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none

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