Environmentally Sustainable Primary Care: Systemic Barriers, Enablers and Stakeholder-Informed Solutions for a Net Zero NHS
Abstract
Introduction 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.
Related
- Pre-implementation barriers and facilitators to implementing a physical activity guideline for community-dwelling older adults with mild cognitive impairment: a qualitative stakeholder study
- Stakeholder perspectives on sustainable antenatal point-of-care ultrasound (APOCUS) implementation in rural Australia: a qualitative study of professional body submissions and clinician focus groups.
- Building sustainable IBD clinical research units: a practical toolbox emerging from a Belgian multi-stakeholder initiative.
- Collaborative Solutions to Identify Scheduling Barriers for Timely Post-Hospital Discharge Primary Care Follow-Up: A Quality Improvement Initiative
- Which barriers and solutions do (psycho-)medical providers perceive at the interface of acute care, rehabilitation and aftercare of patients with sepsis? An interdisciplinary online focus group study in Germany
BibTeX
@article{nunes2026environmentally,
title = {{Environmentally Sustainable Primary Care: Systemic Barriers, Enablers and Stakeholder-Informed Solutions for a Net Zero NHS}},
author = {Ana Raquel Nunes and Frederik Dahlmann and Helen Twohig and Olivia Geddes and Nicky Thomas and Jenny Earle and Jeremy Dale},
journal = {Health Services Insights},
year = {2026},
month = oct,
doi = {10.1177/11786329261488705},
url = {https://doi.org/10.1177/11786329261488705},
note = {CC BY},
}
RIS
TY - JOUR
TI - Environmentally Sustainable Primary Care: Systemic Barriers, Enablers and Stakeholder-Informed Solutions for a Net Zero NHS
AU - Ana Raquel Nunes
AU - Frederik Dahlmann
AU - Helen Twohig
AU - Olivia Geddes
AU - Nicky Thomas
AU - Jenny Earle
AU - Jeremy Dale
PY - 2026
DA - 2026/10/24
JO - Health Services Insights
DO - 10.1177/11786329261488705
UR - https://doi.org/10.1177/11786329261488705
AB - Introduction 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.
SN - 1178-6329
ER -