Environmentally Sustainable Primary Care: Systemic Barriers, Enablers and Stakeholder-Informed Solutions for a Net Zero NHS
Ana Raquel Nunes, Frederik Dahlmann, Helen Twohig, Olivia Geddes, Nicky Thomas, Jenny Earle, Jeremy DaleIntroduction
Climate change poses a major threat to health and health systems. General practices in England urgently require context-sensitive strategies to become environmentally sustainable in line with the United Kingdom’s (UK) National Health Service (NHS) net zero 2040 goal.
Objective
To explore systemic barriers, enablers, and feasible solutions for decarbonising general practice in England through stakeholder engagement and knowledge mobilisation, using a systems thinking approach.
Design
We conducted a qualitative knowledge mobilisation workshop involving 15 stakeholders, including general practitioners, commissioners, policymakers, and public contributors. The workshop was structured to uncover multi-level insights and elicit and synthesise stakeholder perspectives on context-sensitive strategies for environmentally sustainable primary care.
Methods
Workshop data included audio recordings, rapporteur summaries, and observational notes across three decarbonisation domains and thematic discussion groups: travel, estates and operations, and procurement and supply chains. Framework analysis guided the synthesis across five levels of systemic intervention: structural elements, feedback and delays, system structure, goals, and paradigm.
Results
Participants identified accountability gaps, policy fragmentation, and perceived tensions between sustainability and care delivery as systemic barriers. Key enablers included leadership engagement, peer learning platforms, integrated urban-health planning, and co-benefit framing. Feasible solutions ranged from emissions tracking tools to paradigm-level redefinitions of general practice’s purpose. Cross-cutting insights emphasised the need to embed equity, scenario planning, and patient voice into all stages of system change.
Conclusions
Decarbonisation of general practice cannot be achieved through technical interventions alone. A systems thinking lens reveals that meaningful and equitable progress requires change at deeper structural and normative levels. The stakeholder-generated recommendations from this study outline one strategic roadmap for the NHS general practice to operationalise net zero ambitions while reinforcing the values of high-quality, community-centred care. These findings reflect stakeholder perceptions elicited in a single workshop, rather than an empirical systems analysis, and should be interpreted accordingly.