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Sunday 25 September 2016
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A green and pleasant plan for reducing your carbon footprint

Premises & Facilities

Simon Carvell
MB ChB MRCGP

GP Partner

Simon qualified from Birmingham University in 1994 and has been a Member of the Royal College of General Practitioners since 1999. He is currently a GP partner working in the West Midlands, and is an honorary lecturer at the University of Birmingham

For a change, you're about to read an article from a GP who's not harping on about extended hours, practice-based commissioning or the NHS Spine in the changing climate of primary care.

No, these are my thoughts on how we in primary care can reduce our contribution to climate change, our "carbon footprint".

Primary care may not have the output of China or one of the many other emerging economies, but nonetheless we have a responsibility to do our bit to reduce carbon emissions and, in doing so, perhaps make our practice more efficient and sustainable.

"Good housekeeping"
The Carbon Trust – a government-funded independent company helping businesses and the public sector to cut carbon emissions (see Resources) – suggests that it may be possible to save up to 5–10% of a healthcare building's total energy costs by common sense and good housekeeping.

Heating
One degree of overheating could increase your practice's heating bill by 8–10%. As heating costs represent the largest proportion of energy use in primary care, it's important to get it right.

Understanding the need to regulate temperatures in a primary care building means one needs a guide as to what the temperature should be. Different areas in the practice may benefit from different ambient temperatures.

In a recent survey in our practice, a major complaint from patients was that the waiting room was too hot. In fact, the ambient room temperature in circulation space should be lower (ambient room temperature 19–24 degrees) than in clinical areas. A regularly serviced boiler can save up to 10% on annual heating costs (though to be frank, I've no idea when our practice's boiler was last serviced!).

Lighting
Significant energy savings can be made in the way we light our buildings. In general, we are being encouraged to upgrade our standard tungsten bulbs to the energy-saving equivalents. These may be more expensive initially, but lifespan and energy consumption represent significant value in offsetting against that initial cost.

There is also psychological value to swapping the old fluorescent lighting systems with the newer high-frequency tubes: there's less mind-blowing hum and flicker, not to mention an increased
energy value.

It's a common misnomer with fluorescent tubes that turning the bulb on and off uses more energy than just leaving it on. How often is your practice's exterior light left on during the day? Depending on your own energy, a lighting monitor could be nominated at the practice to check that redundant lighting is switched off during daylight hours.

Paper
A small office produces 2.5 tonnes of wastepaper per year. In primary care, we have a responsibility to address the huge volume of wastepaper that we generate. Using recycled paper is therefore one answer – a phone call to your local authority will soon inform your practice of local service provision (some authorities don't have the facilities to recycle paper, therefore won't pick it up).

However, there are understandable medicolegal implications of recycling paper in primary care. Some paper has sensitive patient data recorded on it. This paper has to be shredded. Unfortunately, not all shredded paper can be recycled as this can affect the quality of the recycled paper.

Some paper use, however, can be avoided in the first place. Operate a "think before you print" policy. Can the information be transmitted electronically? Each day, thousands of unsolicited faxes are received across primary care. It is possible to register online with a fax preference service to eliminate these (see Resources).

We should use recycled paper in practice toilets and when cleaning our buildings – eg, toilet rolls and kitchen towels. Allied to paper, consider purchasing furniture from approved organisations that promote sustainability (eg, the Forest Stewardship Council – see Resources).

A frightening waste of energy can result from overuse of the practice photocopier/s. A photocopier left on overnight wastes enough energy to make 5,300 A4 copies. So switch it off with the lights!

General measures
Many energy suppliers have green or renewable energy options. It is worth checking with price comparison websites.

New builds – an opportunity for sustainability in general practice?
When a practice is based in a converted Victorian/Georgian house, there are some limitations to what you can achieve in improving the efficiency and sustainability of the basic fabric of a building. But if your practice is on the move, sustainability must be the key when planning and developing.

Basic rules should probably be adhered to with new builds:

  • Avoid being overly specific in the design and layout of new premises. Buildings designed today must have a lifespan of more than 50 years. When liaising with architects, one should aim for simplicity in design. Overly specific buildings can ultimately prove inflexible and incur potential costs if changes are required.
  • Maximise the use of natural resources. When planning a new build, consider the orientation of the building to maximise the daylight and ventilation, rather than seeking mod cons, such as air conditioning, to overcome
  • such issues.
  • Think of the long term. Low-quality initial construction is a false economy and will become a burden to a future partnership. But at the same time, the components of a new build should also be replaceable.

New green buildings in general should not be too deep or too high. Sunlight penetrates up to 7 m into a building, so it makes little sense to build a cave! Few practices will require seven storeys, and conventional green wisdom suggests buildings with a maximum of 4–6 storeys are more energy efficient.

In discussion during development, general requirements for energy conservation should be made, with thoughts of natural ventilation, high levels of insulation and optimal use of daylight.

How ethical one wants to become during development is debatable. Whether you can muster the energy to insist upon specifying locally sourced construction materials is a decision for the individual partnership. However, basic principles might be agreed with contractors, when there's an option.

Although it may not be desirable/achievable – and may even be just too idealistic – to specify the bricks with which a new build is constructed, the fitting out of the interior offers an opportunity for sustainability – eg, water conservation. While compost toilets may not be feasible in a primary care building, dual flush toilets, spray taps and waterless urinals are.

As well as the new build, the surroundings provide opportunity for energy conservation. Planting trees and shrubs in the local environment can have a greater effect than merely breaking up the 250 car park spaces that surround the practice building. But bear in mind that tree and shrub planting could inadvertently block light in the summer and winter, rather than provide shade and wind deflection in areas where it's needed.

Land is scarce, but when selling a new project to investors – whether it's the local primary care trust or others – consider brownfield sites and access and, in the best traditions of our new green world, don't forget those bike racks!

Resources

British Medical Association
(contains useful information on climate change and the implications on the wider development of medical services)
www.bma.org.uk

Carbon Trust
www.carbontrust.co.uk

Facsimile Preference Service
www.fpsonline.org.uk

Forest Stewardship Council
www.fsc-uk.org

Royal Institute of British Architects
(supplies useful information on sustainable development)
www.architecture.com

Scottish Environment Protection Agency
(provides tips and help with environmental issues)
www.sepa.org.uk