Dr Ellis is an avid campaigner in raising awareness of the climate emergency in healthcare, and how healthcare professionals can benefit the NHS, patients and the planet. Tamsin’s work as an associate at the Centre for Sustainable Healthcare led to her attending COP26 in 2021 as an official observer. Tamsin also co-chairs the national Greener Practice group, and has been featured in the British Medical Journal. She also appeared on the BBC Radio 4 programme Four Thought, where she discussed the link between health and the environment and finding ‘double wins’ which are good for both her patients and the environment.

When did you start to focus on greener practices?

I was partway through my GP training when I got involved. At the time there was a lot of media coverage on the climate emergency and I became concerned about the devastating consequences of a warming planet. At the same time I was also learning about the impact on health and healthcare, as well as how healthcare (as the largest public sector emitter) is contributing to the problem. I started to get involved in various organisations and it’s built up from there.

What kind of changes do you think need to be made to make healthcare more sustainable?

I think when people first think about the environment, they talk about recycling, but by the time something has gone in the bin, it’s almost too late. In sustainable healthcare we are focusing on prevention and reducing disease. As GPs we can be effective by having continuity of care and a person-centred approach where we know our patients.

If we reduce unnecessary testing, unnecessary referrals and improve overall community-based care, then we will reduce the amount of emissions in healthcare.

In terms of healthcare waste and plastics, I also believe that we need to rethink what we’re doing and why we’re doing it. For example, effective hand washing is appropriate and just as effective as wearing gloves when it comes to most of the things we are doing in GP. The pandemic meant that we are increasing unnecessary glove use.

In terms of the hotspot for emissions in primary care the highest by far is prescribing. So I’ve been working around overprescribing. People often visit the GP surgery and want to come away with a prescription; this may be appropriate but currently we are overprescribing. There is something around the quality of the conversations and consulting that you’re having and recognising that not everything can be fixed by a prescription and, if anything, can be harmful.

I also think there are elements of the climate movement that aren’t for individuals to fix; it’s up to the pharmaceutical companies to procure differently and for politicians to review policy. It’s a systemsbased level shift in how we procure goods and services that will change that.

What are the challenges in terms of trying to convince other doctors to bring in greener practices?

On the whole, I have found in primary care there is a huge amount of energy behind this. People really care and believe in it. What’s really helped us is that Greener NHS was set up in October 2020, which has mandated us to get to net zero.

The other thing we’re saying is a) this isn’t an additional role for GPs. This should be embedded into what we’re doing already and b) this is about making health care better for patients. This is about optimizing people’s conditions, and listening to patients and co-producing with patients. There are lots of the things we are trying to do that overlap with inequalities work such as reviewing people living in fuel poverty or areas with high air pollution. There are things that are win-win, and potentially money-saving as well. If you explore with people about sustainability and sustainable healthcare, once people understand, they’re normally keen to support.

On the other side the NHS is a huge organisation; it’s quite difficult and complex to understand all the funding streams and commissioning. I started a fellowship which has been really helpful to understand it better, but I think some people do think ‘we’ve been trying to do this for years’ or there is a degree of pushback when we are so pressured already.

How has Covid contributed to sustainable healthcare?

Doing remote consulting was very difficult, because when you’re learning to be a GP, a lot of that is risk management and it’s been really hard to risk manage over the phone. I’m happy that we’re going back to more face-to-face consulting, but on a sustainability level we’re asking for patient choice and to have a mixture of telephone/ video/face-to-face. I really like the fact that our text messaging services are much better or telemedicine for dermatology for example, is much better. This has helped patients and reduced paper waste.

On the other side, during Covid it’s been really difficult in general practice, and healthcare overall is under a huge amount of pressure. The demand has gone up, as have wait times. Plus the huge plastic waste from single use and masks, etc.

Where would you like to take things?

From a healthcare perspective, I often talk about things in terms of ‘bottom up, top down’. So from the bottom up, there are amazing GPs working in primary care, working on community gardens and community projects which have huge positive benefits.

The top-down stuff needs to be more from a policy level. I recently went to the Mayor of London’s Air Pollution Summit, where the big changes are getting made around air pollution. But in order for that to happen, you need the grassroots actions happening at the same time so that people believe in the changes and that the behaviour change is happening on the ground.

It’s about making informed choices. It might be that someone knowing about their asthma and inhalers, as well as the inhaler being more environmentally friendly, can improve care whilst reducing emissions.

As a doctor seeing patients, what would you say is the most important thing that we can do to improve our lives in an eco-friendly way?

The most important things are what the patient cares about and what may be beneficial to their health. There’s also evidence to suggest that a doctor having a conversation with patients about physical activity and getting out into green spaces does make a difference. For example, in a long-term condition review, patients are asked to make a goal for the next year. With a diabetic patient I used to ask, “How much do you want to bring your sugars down by?” Now I have a conversation where I ask what matters to them, I ask about their lives and how that impacts their diabetes. Actually encouraging the patient to think about their health as part of a wider picture of how their life is looking or what their quality of life is like. Their sugars will probably come down as a by-product because they’re getting active or improving relationships. So much of health is created outside of the consulting room.