Intended for healthcare professionals

Views And Reviews Primary Colour

Helen Salisbury: Let’s talk about sustainability

BMJ 2021; 373 doi: (Published 27 April 2021) Cite this as: BMJ 2021;373:n1082

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  1. Helen Salisbury, GP
  1. Oxford
  1. helen.salisbury{at}
    Follow Helen on Twitter: @HelenRSalisbury

The pandemic has hastened the development and use of technology in general practice, and many advances have had the effect of shrinking our ecological footprint. Now that nearly all of our prescriptions are issued electronically—sent with just a few keystrokes to any pharmacy in England—whole forests’ worth of paper have been saved. I can send text messages straight from patients’ notes, including invitations to book appointments, notifications of results, and links to online resources. Patients can also reply by text, including photos if needed, and the whole correspondence is directly filed into the medical record.

Saving natural resources has created time efficiencies, reducing the hours spent locating, accessing, and sharing information. These days, when I email a hospital colleague for advice, my question and their answer are automatically included in the patient record rather than needing to be scanned in or copied across—which is particularly helpful if I’m looking after another doctor’s patient.

This week, for the first time, I worked with a sign language interpreter by video link. I’ve been slow to warm to video consultations, as many of my patients can’t get the system to work, and if we do succeed the resulting pictures often remain too blurry to be helpful. On this occasion, however, the patient and I sat side by side, while the remote interpreter signed my questions and then translated her answers back to me. My previous experiences of in-person signers was always positive, but they were hard to organise for emergency appointments (which this one happened to be) and had come with higher environmental and actual costs in terms of travel and time.

A common definition of sustainable development is that it “meets the needs of the present without compromising the ability of future generations to meet their own needs.”1 The switch from paper to electronic communication is helping to save resources while using less time and labour. But in working out how to configure services as we come out of the pandemic (something that’s not guaranteed), we need to consider both how we respond to our patients’ needs in a safe and timely way and how we create a truly sustainable practice for our health service staff. The rapid tech innovations of the past year may have reduced the number of miles travelled and trees felled but, at every step, the increase in volume of work has outpaced any resulting time efficiencies. To be blunt, these improvements have not, so far, helped keep doctors in their jobs, and the GP workforce continues to shrink.2

Working 12 hours a day, while still feeling that you haven’t been able to do enough for your patients, is not sustainable. When the movement-activated lights go off because you’ve been sat still for so long at your desk, and when you keep having to log back into the system because your smartcard has timed out, the tech is trying to tell you to go home. But who’s going to check those results and do that urgent referral?



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