In West Yorkshire we work hard to improve health and care services, and the ways in which deliver them.
In June 2024 Andy West and Dr Frank Swinton met to record a podcast ahead of Clean Air Day on 20 June to discuss a new E-Bike pilot scheme in West and South Yorkshire.
Frank Swinton, a consultant anaesthetist at Airedale Hospital, is the climate change lead at West Yorkshire ICB. Frank is also a trustee at Sustrans, the national active travel charity.
Andy West is a paramedic, currently seconded to the ICBs in South Yorkshire and West Yorkshire and working on sustainability and active travel to help reduce the disease burden on population health; improve local air quality and to encourage people – including clinicians - to be active and move more.
In this case study, we hear directly from Andy, and from his responses to questions about the E-bike pilot from Frank.
Planning a route…
Andy: “I lead a pilot programme in partnership with primary care GP surgeries in South Yorkshire and West Yorkshire where clinicians use ‘pool’ E-bikes, provided by local authorities, for business miles such as home visits, community services for patients, replacing short journeys traditionally carried out by car.
“My strategic vision was to have nurses and doctors out in the local community, riding bikes and promoting the benefits that come with cycling whilst helping their patients."
When developing this rolling pilot, Andy had to put himself in the saddles (sorry!) of the same nurses and doctors he was asking to trial E-Bikes to visit patients. Together, they had to consider issues including road safety, security, practicality of carrying equipment, specifications and the distances that could reasonably be covered.
The initial planning started in November 2023 by identifying Yorkshire GP surgeries in the area to participate and with local authorities to provide free E-Bike loans for the pilot.
Andy: “A key challenge was the idiosyncrasies of the ways in which E-Bikes are loaned out and the insurance, indemnities and conditions, which all need to be managed.
“It’s been a little like treacle, finding the right person in the right department to find the answers and permissions. This took more time than we thought.
“We knew primary care services are really busy and they have a real big footprint in terms of the areas they cover and the number of contacts they have with patients.”
Andy: “I was a paramedic for 20 years before this. The one thing that really struck in my first year in primary care was how close patients were to the surgery. For ambulances it’s not unusual to drive 20 or 30 miles to an emergency. In primary care I remember that my first patient was just 400 yards from the surgery! Patient number two was a mile away, and so on with the others. Previously, we would have driven to these appointments.”
Taking the saddle…
The pilot has nurses and doctors trialling E-bikes for 4-12 weeks free - with no cost to surgeries - to visit patients living close to surgeries and testing the benefits for individuals, patients and the community.
E-Bikes are supplied by local authorities for the pilot, which also provide cycling training and tuition. At the end of the trial Andy works with clinicians for their feedback and analysis.
Andy: “This pilot is also a powerful symbol of how people can change the ways we move around, with health care professionals leading by example.”
Active conversations …
Andy: “It was a great conversation starter when I arrived at a patient’s home by E-Bike, “Oh, hi. I'm Andy, the paramedic I've come by bike” … “Oh, that's interesting. I was expecting Doctor Jones and you know, he or she normally drives.” We would speak about the benefits of being active, not just of cycling, but walking. “Why would I want to drive when I can get some fresh air, I can reduce space on the road for other car users?
“We might have talked about chronic inflammation, respiratory health cleaning up the local air pollution - there was lots of opportunities to talk about lots of things depending on the patient and their condition.”
Conversations about cycling are an added benefit and they fall into two types. One is with patients where the clinician is not being prescriptive, rather than saying “you must” or “you should”, it is more about “this works for me.” Both sides speak about the benefits of walking or cycling, and that could potentially improve the quality of a patient’s life or reduce the disease burden on them, and the matter is left at that.
The other conversations were those with doctors and nurses themselves. These started as corridor conversations or in the staff rooms. “Why do you do it? How do you find it?” We talk about the barriers, the “you know what? It's “where?” “What if’s?” and “I see.”
Andy: “So you get to have the conversation and through a type of FOG theory - fear, obligation and guilt – this begins to influence others and get them to dip their toe in the water. The E-bike project is very much about giving doctors surgeries an opportunity to try taking on an E-bike as a pool bike for all to use as they need to.”
Having doctors and nurses using E-bikes to serve close patients living in close proximity is about leading by example, where behaviour change is at the core for both clinicians, and their patients.
Do the maths…
The numbers speak loudly when considering using E-bikes, rather than cars. There are 267 GP surgeries in Yorkshire (2024), with 1.4 million people. A one E-bike trip in each surgery daily would replace 69,687 car miles, and save £22,996 in fuel. This is in addition to the added costs for business insurance, MOT, servicing, Road Tax etc.
In reality clinicians do more than a daily one mile trip either by car or E-Bike, saving more NHS funds, freeing up more road space, reducing C02 emissions, improving air quality and demonstrating active travel benefits.
Looking at the benefits to individual health, the local community in terms of air quality, the money saved for a surgery or the NHS, this project is both viable and realistic.
“It’s all about the mindset and behaviour change which takes time, but has clear, and wide, benefits.” says Andy
Down the road…
In the analysis Andy works with participating clinicians to work out barriers and any positive actions that came out of the rolling pilot.
Andy: “The hope is the project rolls out further and that participating GP surgeries go on to make the decision whether to purchase an E-Bike for the surgery, rent one or even some sort of salary sacrifice to their staff members to use E-Bikes as an opportunity to change the way that they practice in terms of home visits and healthcare.”
In terms of future set-ups we see success in the local authorities having a single point of contact with GP surgeries, so the project grows in terms term of take-up and the area and numbers of patients covered.
Andy: “We might even look at the use of E-cargo bikes for the last mile in delivering medicines and services to patients or for specialist paramedics, specialist nurses to visit on a E-Cargo bike - this project has legs, errm, wheels!”
The next journey…
For more information about the South Yorkshire and West Yorkshire E-Bike pilot project in primary care, or if you would like your primary care service to participate, email Andy directly at: andy.