title: Carbon footprint of patient journeys through primary care: a mixed methods approach.
abstract: BACKGROUND
  The NHS has a target of cutting its carbon dioxide (CO2) emissions by 80% below 1990 levels by 2050. Travel comprises 17% of the NHS carbon footprint. This carbon footprint represents the total CO2 emissions caused directly or indirectly by the NHS. Patient journeys have previously been planned largely without regard to the environmental impact. The potential contribution of 'avoidable' journeys in primary care is significant.
  
  
  OBJECTIVE
  To investigate the carbon footprint of patients travelling to and from a general practice surgery, the issues involved, and potential solutions for reducing patient travel.
  
  
  METHODS
  A mixed methods study in a medium-sized practice in Yorkshire.
  
  
  METHODS
  During March 2012, 306 patients completed a travel survey. GIS maps of patients' travel (modes and distances) were produced. Two focus groups (12 clinical and 13 non-clinical staff) were recorded, transcribed, and analysed using a thematic framework approach.
  
  
  RESULTS
  The majority (61%) of patient journeys to and from the surgery were made by car or taxi; main reasons cited were 'convenience', 'time saving', and 'no alternative' for accessing the surgery. Using distances calculated via ArcGIS, the annual estimated CO2 equivalent carbon emissions for the practice totalled approximately 63 tonnes. Predominant themes from interviews related to issues with systems for booking appointments and repeat prescriptions; alternative travel modes; delivering health care; and solutions to reducing travel.
  
  
  CONCLUSIONS
  The modes and distances of patient travel can be accurately determined and allow appropriate carbon emission calculations for GP practices. Although challenging, there is scope for identifying potential solutions (for example, modifying administration systems and promoting walking) to reduce 'avoidable' journeys and cut carbon emissions while maintaining access to health care.
authors.affiliation: Bradford Institute for Health Research, Bradford Royal Infirmary (formerly Academic Unit of Primary Care, University of Leeds), UK. Elizabeth.Andrews@bthft.nhs.uk
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Andrews
authors.forename: David
authors.initials: D
authors.lastname: Pearson
authors.forename: Charlotte
authors.initials: C
authors.lastname: Kelly
authors.forename: Laura
authors.initials: L
authors.lastname: Stroud
authors.forename: Martin
authors.initials: M
authors.lastname: Rivas Perez
mesh_terms: D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D001334:Automobile Driving / Q000706:statistics & numerical data; D002245:Carbon Dioxide / Q000032:analysis*; D058572:Carbon Footprint / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D013222:State Medicine / Q000706:statistics & numerical data*; D014195:Travel / Q000706:statistics & numerical data*; D016138:Walking / Q000706:statistics & numerical data
chemical_list: D002245:Carbon Dioxide