From the quantitative results above, it was evident that the majority of journeys to the surgery were made by car or on foot. The focus groups and survey responses presented below were used to explore the reasons for this (for example, why were individuals not using public transport and/or walking instead of driving) and consider possible solutions for reducing the practice’s carbon footprint for patient travel.
For quotations, a number following a quotation, for example, No.10, refers to the survey number, and therefore a patient, N9, for example, is a non-clinical member of staff, and C4, for example, is a clinical staff member.
Travel mode choices
The results of the closed question in the survey are presented in Figure 3, which shows the percentages of free-text responses describing patients’ reasons for their choice of travel mode (car and walking).
Figure 3 Percentages of free-text responses for reasons for travel mode choices.
Using the car to travel to the surgery was justified through a number of differing reasons. Only one patient who completed the survey stated illness as the reason for coming by car. This is contrary perhaps to expectations. Clinical staff thought that this would be one of the main reasons why patients travelled in by car (and did not walk); for example, one member of staff stated that:
‘... I think ... they don’t walk because they are ill.’
(C5)
However, another staff member considered that cars might be used more habitually:
‘... Well I think they come by car because they live by the car and they can’t do without the car, personally. You know if you’ve got a car you just use it don’t you?’
(N6).
The main reason for driving (Figure 3) was that responders felt that it was quicker to drive than using alternative modes of transport. One individual stated that:
‘... I travelled from girlfriend’s house. I used car because 2-hour bus journey.’
(No. 104).
In this case, the difference in travel time would have been significant. Another patient stated that:
‘... [it] takes too long to travel otherwise.’
(No. 27)
Another person considered the car as a quicker and more convenient travel mode (at least occasionally), stating that:
‘[I] ... used car for convenience and time saving [today]. I usually walk.’
(No. 181)
If this patient had walked, the distance would be a total of 1.75 miles.
The quantitative results identified that, in the survey, on average, individuals overestimated the distance they had travelled by car. One patient stated they used their car because of the
‘... distance [I] have to travel’.
(No. 25)
For this individual, the GIS mapping indicated that it took 2.5 miles by car, but they estimated that their journey was 4 miles by car. Although 2.5 miles is quite a distance to walk, some patients did walk this distance and much further, as highlighted earlier in the quantitative results section.
Those who walked to the surgery similarly had a number of reasons for doing this (Figure 3). Walking was often chosen as a travel mode because patients lived conveniently close to the surgery or they were not time constrained, for example:
‘I walked because I live nearby.’
(No. 10)
‘I had time to walk.’
(No. 34)
Other reasons included walking for exercise and/or retaining mobility or walking because of financial considerations:
‘I walk to keep up my mobility.’
(No. 7)
‘... normally walks. No car and out of work.’
(No. 191)
Patients were also more likely to report a mode choice according to whatever mode was available or more convenient for themselves, for example:
‘... [I] always walk inward journey. Easier to return by bus.’
(No. 100)
‘... if my husband is around I come with him [by car] but normally I walk.’
(No. 59)
The National Travel Survey indicates that for the category ‘personal business’, which includes trips to the GP, on average those individuals walked 0.62 miles per trip for this purpose; that is, a distance of 0.31 miles both ways.9 If this distance is compared to the distances shown on Figure 1 of car journeys made within 2 miles of the surgery, then it is evident that a significant number of these journeys could potentially be made on foot.
In terms of other alternative travel mode options, ‘time issues’ and ‘cost’ were major reasons for not using public transport (Figure 3). The lack of alternative options typically related to a lack of, or a reduced, bus service, or a bus timetable and schedule not suitable for patients’ needs, for example:
‘... bus only runs hourly.’
(No. 193, used taxi)
Patients mostly reported private car or taxi as their main alternative to using buses. The location or distance to the nearest bus stop is also problematic for those patients with mobility difficulties:
‘... lack of bus service plus 1 mile to nearest bus stop and could not walk that far.’
(No. 42, used car).
Some patients used a bus if the timing fitted with their schedule, for example:
‘... getting bus home if one due ... Buses are only one every 30 minutes.’
(No. 65)
Some patients fitted their appointments around the bus schedule so that they could use their bus pass (time-restricted fare concessions), for example:
‘[I] don’t have a car. Have to book appointment after 9.30am for free travel.’
(No. 86)
