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London GP practices to receive air pollution warnings

London GP practices to receive air pollution warnings
By Emily Roberts and Rima Evans
25 March 2024

GP practices in London will be alerted to episodes of high air pollution to help them protect patients against the dangers of poor-quality air, under a scheme launched this month.

Air quality alerts will be sent via email to both GPs and emergency departments across London around 24 hours before an episode of high or very high air pollution is forecast.

GPs are being targeted so they can use the information to have ‘person-centred’ conversations with patients on how air pollution affects them and advise what steps they can take to reduce their risk of harm, such as reminding them to follow their asthma plan or to take their preventer inhaler.

The initiative has been developed by the London Air Quality and Health Programme Office, organisations from across London’s health and care system and the Mayor of London.

Alerts are triggered by forecasts from Imperial College London. It is anticipated there will be four to five a year.

Air pollution is the largest environmental risk to public health in the UK, GPs were warned in a letter sent about the new alert system from NHS England London.

‘London has the highest mortality burden attributable to air pollution of any English region and London’s most vulnerable citizens are disproportionately impacted’ the letter signed by Dr Chris Streather, medical director and chief clinical information officer and Professor Kevin Fenton, regional director of public health, both at NHS England London, said.

They added: ‘As health professionals, you have a powerful role to play in educating and protecting your patients against the negative effects of air pollution.

‘These new alerts will help to raise awareness of air pollution and the associated health effects among health professionals and equip you with the information you need to advise and support your patients and carers and to help reduce the burden of preventable harm’.

The importance of patient education from health professionals was highlighted following the inquest into the death of nine-year-old Londoner Ella Adoo-Kissi-Debrah, the first person to have air pollution listed as a cause of death.

A 2022 project by Global Action Plan involving GP practices in Islington, North London demonstrated the ‘crucial role GPs can play in supporting often hard-to-reach patients who are vulnerable to the effects of air pollution’.   

The project provided online teaching on the causes and health affects of air pollution to 17 healthcare practitioners working in practices across the borough. Results showed that half of all patients (52%) who received advice from their GP said that it made them want to understand more about air pollution and changed their behaviour

Dr Jo Sauvage, GP and chief medical officer of North Central London ICB, spoke about preventing illness from air pollution in a podcast released last month.

She said the ‘impact of air quality on the health of our residents has become very, very important,’ particularly after Ella Adoo-Kissi-Debrah’s death in 2013.

Dr Sauvage explained the air quality alerts sent to practices will inform GPs about certain days in the city when the air quality is severely impacted, describing these as ‘really helpful for me as a GP to understand what the air quality is like in the area where I work today’.

‘Receiving alerts can also remind me to talk to patients about the importance of air quality,’ she added. ‘Air quality is just like all the other factors that are linked with inequalities and so it is an important factor that we must advocate for change around.’

Speaking on the same podcast, Professor Fenton described air pollution as a ‘critical challenge’ for the city. He added: ‘Pollution, exacerbated by changing weather patterns, infiltrates our lungs, homes, and even our schools. And this translates to a rise in respiratory issues like asthma, COPD, and even lung cancer.

‘It impacts vulnerable groups like children, the elderly, and those with existing health conditions the most. We are seeing increased hospital admission, missed workdays, and a general decline in quality of health and life, all linked to the air we breathe.’

What information do the air quality alerts contain?

The new alerts provide GPs with clear guidance for conducting person-centred conversations with patients, preparing for future high air pollution episodes, and offering advice on reducing exposure to and contribution to air pollution.

An example of an alert is set out within the letter sent from NHS England London. For example, where a ‘probably high pollution’ warning is sent, it will highlight that exposure may induce symptoms such as wheezing, shortness of breath, exacerbations of asthma and COPD, and that these symptoms could appear within hours of exposure or several days later.

The notification will also include key clinical messages GPs should consider giving patients, one example being that ‘during high air pollution episodes, older people, and those with cardiac or respiratory conditions may need to reduce vigorous physical activity’, or that, where appropriate, patients should continue to follow their asthma /COPD plan.

Finally, it will outline advice to give patients on reducing their exposure and contribution to air pollution, such as walking, cycling and scooting more; avoiding busy roads; using public transport; and switching a car’s engine off when stationary.

A version of this story was first published on our sister title Management in Practice.

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