‘Cycling On Prescription’: a gear change or a wrong turn?

I read with great interest the paper written by Heather Jones, which presents the need of ‘cycling on prescription’ to begin within the walls of the NHS in order to influence and benefit the wider population.¹

As a fourth year medical student in London, I am continuously travelling to different hospitals and GP practices across the city, mainly by bicycle. Through my own experience, I must agree with Heather Jones that the provision of cycle amenities at many of these NHS sites is poor. This poor infrastructure, such as limited (if any) access to safe bicycle storage and onsite showers, frequently deters me from cycling to these locations. Evidence shows that lack of safe parking is a major barrier to both cyclists and non-cyclists, conversely, non-cyclists state they will feel more enabled to begin cycling if further allocation of bike racks were placed at health centres.²

I am in agreement with Heather Jones that poor local cycling conditions may make clinicians wary to prescribe cycling. However, the ‘focused effort to promote cycling’ to NHS staff may fail to empower the wider population simply because it does not remedy the largest deterrent to cycling, which is fear of injury to oneself.² One of the main themes of the UK Government’s Gear Change policy is to ‘enable and protect people when they cycle’.³ Proposed Gear Change infrastructure interventions include the development of segregated cycle lanes, which have been proven to reduce the likelihood of cyclist injuries, whilst simultaneously producing a ‘safety in numbers’ phenomena.⁴ The Gear Change policy thus has the framework to remedy this large deterrent to cycling, thus hopefully increasing the adherence rate in those who are socially prescribed cycling.

Whilst it can be argued that promoting NHS staff to cycle will increase local cycling conditions, Gear Change aims to improve cycling infrastructure and promote cycling to the UK population as a whole. Through further offers of patient cycle training to mediate patient risk, peer support groups, and loaning of cycles, cycling on prescription may be ushered in as a staple in social prescribing.

References
1. Jones H. “Cycling On Prescription”: a gear change or a wrong turn? Br J Gen Pract 2020; 1;70(700):547.
2. Iwińska K, Blicharska M, Pierotti L, Tainio M, de Nazelle A. Cycling in Warsaw, Poland – Perceived enablers and barriers according to cyclists and non-cyclists. Transp Res Part A Policy Pract 2018; 1;113:291–301.
3. Department for Transport. Gear Change A bold vision for cycling and walking [Internet]. 2020 [cited 2020 Dec 2]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/904146/gear-change-a-bold-vision-for-cycling-and-walking.pdf 
4. Bhatia D, Richmond SA, Loo CKJ, Rothman L, Macarthur C, Howard A. Examining the impact of cycle lanes on cyclist-motor vehicle collisions in the city of Toronto. J Transp Heal 2016; 1;3(4):523–8.