Sustainability Q&A 

The risk to public health arising from the climate crisis is clear.

Sustainability in healthcare is a priority and we recognise the connection, relevance, and impact on human health and the practice of individual medical professionals. That is why in Good medical practice 2024 we set a specific duty that medical professionals should choose sustainable solutions. 

In this resource, we answer questions on how this could apply, suggest ways to practise sustainably and signpost to organisations that show how this is being done.

1. What is sustainable healthcare?  

The International  Association for Health Professionals Education (AMEE) sets out: “Sustainable healthcare: focuses on the improvement of health and better delivery of healthcare, rather than late intervention in disease, with resulting benefits to patients and to the environment on which human health depends, thus serving to provide high-quality healthcare now without compromising the ability to meet the health needs of the future.”

In line with this, the Centre for Sustainable Healthcare has identified four key principles which underpin sustainable clinical practice.

• Prevention of ill health.
• Patient empowerment.
• Lean Pathways / service delivery.
• Low carbon alternatives.

2. What does the duty in Good medical practice on sustainability say?

15. You should choose sustainable solutions when you’re able to, provided these don’t compromise care standards. You should consider supporting initiatives to reduce the environmental impact of healthcare.

3. Why has sustainability been included in Good medical practice ?

In our guidance, we have always been clear that it is the responsibility of all doctors, whatever their role or position in the place that they work, to manage and use resources effectively.

However, during the consultation for Good medical practice, there was also a call from medical professionals and other bodies, to give more attention to the impact on public health arising from climate and ecological breakdown. 

This was in addition to the evidence from the Department of  Health and Social care that health services globally account for 4.6% of global greenhouse emissions which if counted as a single country, would make health care collectively the fifth largest world emitter.  An example of this is that in the UK, NHS England sets out that the health and care system in England  is responsible for between 4-5% of the country’s carbon emissions. 

There was also mounting evidence set out by multiple reports, including reports from the 26th meeting Conference of the Parties to the UN Climate Change Conferences (COP26), Intergovernmental Panel on Climate Change (IPCC) and the Lancet Countdown. Priority was also given to health impacts of climate change at COP28.

The duty in Good medical practice recognises that medical professionals have a responsibility to consider the environmental impact of healthcare practice in the course of their work.

4. What do you mean by sustainable healthcare?

We mean choosing to practice in a way that delivers high quality care to patients whilst reducing the impact on the environment, so that you are able to meet the healthcare needs of patients now and in the future. 

5. Isn't this an issue for organisations not individuals to tackle?

There will be areas of sustainable healthcare which organisations will lead. However, professionals can, and have, been able to drive and influence sustainable solutions to impact change. 

The new Good medical practice duty recognises that medical professionals have an ethical responsibility to consider the environmental impact of healthcare practice in the context of their work.

6. Does this duty apply to my personal life?

No. This duty is about the use of sustainable solutions in a professional context.

7. Will I be asked for evidence of this in my appraisal?

All of the applicable principles in the professional standards for your practice will be relevant at appraisal.

During your annual appraisals, you can use supporting information to demonstrate that you have managed or contributed to improving and/or delivering sustainable healthcare. Information about anything you’ve done to support these  principles could contribute to demonstrating working in line with the sustainability duty. You can find good practice examples in question 10.

8. What if there is conflict between sustainability and my duty to make the patient my first concern?

The aim of sustainable healthcare is to provide high value care for patients whilst reducing the impact on the environment. This means that it should be possible to improve the quality of care for patients by practicing sustainably. 

That is why we set out in the professional standards  that you should choose sustainable solutions only where these do not compromise care standards. Our expectation is that the medical professionals we regulate, provide the best care possible, while using the resources available responsibly.

9. If I have difficulty practising in line with this duty, will the GMC take action against me?

Good medical practice is a framework of professional standards to guide doctors when they’re caring for patients and working with colleagues. The new duty recognises that individual doctors aren’t always in a position to make the final decision about sustainable options. We reflect this in the standards by using ‘should’ when describing duties that some doctors may not be able to comply with because of factors outside of their control. We also use ‘should’ for duties that may not apply to every doctor or every situation.

We only take action in the small number of cases where an investigation indicates a doctor’s fitness to practise may be impaired, to the point that patient safety, or public confidence in the profession, may be at risk. We will always consider the individual circumstances and take any relevant factors into account. You can read more about how we do this, and the types of concerns we investigate, on our Fitness to practice web pages. 

10. What can I do to practise sustainably?

There may be sustainability guidance for your speciality, usually available via your royal college or faculty website. There may also be local or national speciality based sustainability groups and networks you can join. 

You may find it useful to look at previous sustainable health projects that have involved or been initiated by clinicians. The Centre for Sustainable Healthcare has a growing number of case studies, which set out the methods, results, barriers, and conclusions, from these projects.  
These include:

• An Emergency Medicine Consultant and Matron. They set out to reduce unnecessary cannulation in the Emergency Department.  

Reducing Unnecessary Cannulation in the Emergency Department report.

• A FY2 doctor, ST6 general surgery registrar, three consultants, a senior sister and a clinical procurement specialist. They worked on reducing the carbon footprint of laparoscopic appendicectomies using a Sustainability in Quality Improvement approach, instigating lasting behavioural change in the surgical department.

Reducing the carbon footprint of laparoscopic appendicectomy report.

• A clinical lead, personal assistant to the service manager and consultant lead, administrators, nurses, pharmacy and medical team. They looked to reduce the frequency of face-to-face appointments and phlebotomy testing for a defined ‘very stable’ section of the county HIV patient cohort. 

A Novel Care Pathway for Stable HIV Patients report.