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The letter by Freund, et al,1 in the August issue of the BJGP raises the fascinating issue of assessing the potential environmental impact of developments in health services. Given the amount of concern currently evinced by CO2 emissions in the global warming debate, it seems plausible that researchers may now need to consider the environmental impact when developing and evaluating complex healthcare interventions.2
We have recently completed a randomised controlled trial of GP led integrated follow up for people with cutaneous malignant melanoma.3 As our main analyses proceed, we believe that we can provide some heartening data to boost the green credentials of primary care.
In the 12 months prior to the study (and assuming that the median mode of transport was a Toyota Avensis 4-door saloon with CDX trim)4 we estimate that our intervention group generated a mean of 58 kg of CO2 in attending hospital follow up). During the 12 months of the study, participants generated a mean of 19 kg of CO2, attending their own GP for melanoma follow up. We further believe that this 39 kg reduction in follow up related CO2 emissions is conservative, since several participants may have exercised the healthy option, left their Avensis in the garage, and walked to their GP surgery.
Furthermore, we estimate that there are approximately 4000 people in Scotland and 48 000 people in the whole UK currently receiving follow up for melanoma.5,6 Extrapolating our data, we believe that if proven to be otherwise effective, UK-wide GP-led follow up for melanoma would result in annual reduction in CO2 emissions of 1872 tonnes. We stop short of suggesting that primary care can save the planet, but in common with one leading supermarket chain, would suggest that ‘every little helps.’