Anyone know any car-free GPs?

Hi Trevor,

I did a small project this summer to evaluate the possibilty of doing home visits on bike...

The Aim (Sustainable Action Planning: Plan)

The Aim was to determine whether cycling to home visits, rather than driving, was feasible and/or worthwhile.  The intention was:

• To cycle to work and undertake home visits on a bicycle over a three month period.
• Calculate the mileage of all visits and note which visits could not be made on a bicycle. 
• Evaluate the practicalities and carbon footprint of these visits, as well as the financial and health benefits; and
• Reflect on the outcome, assess the limitations for implementation and, if possible, identify solutions.

The Method (Sustainable Action Planning: Do)

Between 1 April and 1 July 2011 I undertook 35 home visits, 23 were done on a bicycle (66%).  I was unable to cycle to 12 of the visits either because of rain (one visit); or because I had too many visits on one day and/or they were deemed to be too far away to cycle (11 visits).  Home visits involved a total distance of 108.42 miles, with 59.42 miles undertaken by bicycle.

The differing amount of time taken to make visits by car or bicycle was not measured, but I did not feel that cycling to visits took much longer than driving.  In fact closer visits were often quicker by bicycle as I avoided traffic and parking problems.  Most visits were in close proximity to the practice.   Out of 35 home visits 37% of visits were less than 1 mile distance from the practice, 66% were less than 1.5 miles from practice.  I was caught in the rain on two occasions. 

Checking the benefits (Sustainable Action Planning: Check)

Probably few would dispute that driving less brings financial, environmental and social benefits.   In terms of scientific analysis, however, attempting to quantify the benefits of cycling to visits, other than the obvious financial benefit of saving petrol and car costs, is difficult to do and the value of any figures could be open to question.  This was an extremely small experiment, carried out in the spring/summer when cycling is more feasible, and extrapolating any long-term or wider results from such limited statistics should only be done with extreme caution.  For those who like figures, however, this section gives a rough indication of the benefits in statistical form. 

(a) Financial benefits

Financial benefits could be quantified using, for example, using Her Majesty's Revenue and Customs (HMRC) Approved Mileage Allowance Payments of 45p per mile.  Over the 3 month period: 

Cost of mileage if all 35 visits were made by car (108.42 miles x 45p)                                   =    £48.79

Cost of mileage when only 12 visits were made by car ((108.42 - 59.42 miles) x 45p)         =    £22.05

Saving (£48.79 - £22.05) = £26.75 So, in this instance, a saving of 45% on travel costs was made.

(b) Environmental benefits

Similarly the environmental benefits could be estimated in terms of carbon footprint using the RCGP Carbon Footprinter which is based on distance in kilometers:

Carbon footprint if all visits were done by car (108.42 miles i.e. 174.49 kilometers)   = 0.036 CO2e tonnes over 3 months

Carbon footprint when only 12 visits were made by car and the rest by bicycle (49miles i.e. 78.86 kilometers) = 0.016 CO2e tonnes over 3 months

So carbon saving = 0.036 – 0.016 = 0.02 CO2e tonnes over 3 months. This is the equivalent carbon footprint of spending four hours in a typical electric shower.  The carbon footprints estimated by the footprinter should be taken lightly, and you could argue that the cyclist may wish to shower after cycling!  

 (c) Health benefits

We all know exercise is beneficial for physical and mental health.  To measure the health benefits of cycling to visits we could estimate calories used.

59.42 miles were cycled to home visits over 3 months:

At an average speed of 12 mph, a 50 kg person burned 4159 calories cycling 59.42 miles

This is equivalent to about 16 chocolate bars (at 255 calories each)

It must surely be sufficient to say that there is no doubt that driving less to visits and cycling more brings financial, environmental and social benefit.  Whether it is feasible for many GPs however, is debatable.

 Reflecting on the changes (Sustainable Action Planning: Act)

 I found cycling to home visits possible, manageable and enjoyable. I like cycling; I like the fresh air and I like to feel I am playing my part in saving the environment.  From the patient's point of view, their doctor appearing on a bicycle was a novelty and sometimes raised a smile!  But I am aware that every GP and GP practice is different.  Sometimes time is short or distances are too great. 

 Individual GPs may be reluctant to cycle because of rain and cold weather, low fitness levels, practicalities of carrying the doctor’s bag, or perhaps getting sweaty on route and having to change.  There may also be concern regarding dangers of cycling on busy roads.

 In terms of practicalities there is the consideration of whether the GP should use their own bike or ‘practice bikes’.  Practice bikes are preferable as they would be kept at the practice all the time but this involves a cost and maintenance considerations.  There are difficulties getting bikes for GP practices through the NHS ‘cycle to work scheme’ as it is on a named person basis and is linked to a specific person’s pay. 

 I presented my findings to the practice and they were interested in the results.  I felt the experiment drew attention to the possibilities of cycling, and although not everyone was enthusiastic, some were willing to consider it.  Even if only a few chose to cycle occasionally, perhaps only on warm sunny days, everyone would benefit.

Hi Trevor,

I've been looking into the possibility of doing my GP visits on a motorbike, and have got as far as getting the bike, and organising getting the accessories to make this work (rack, top box, waterproof rucksack, helmet, portable heavy duty chain...) It works in theory, but about to see how things go in practice. I'm hoping that, being a little 125cc workhorse, it will be just right for a practice area with a plethora of hills & a mix of dense, tiny streets in town, and terraces clustering into the open country. Definitely less carbon emissions than the current vehicle.

Davina