Supporting the drive for net zero by decarbonising general practice - A longitudinal study protocol

The urgency to address climate change and reduce carbon emissions in healthcare, highlighted in the United Kingdom (UK) by the 'Delivering a 'Net Zero' National Health Service (NHS)' report, emphasises the need for healthcare organisations to adopt and integrate sustainability practices. General practice is recognised as a major source of greenhouse gas emissions, but evidence on achieving effective decarbonisation in general practice is limited, a knowledge gap that urgently needs further research. This study protocol sets out a subsequent study designed to examine the current approaches general practice uses for decarbonisation and to provide practical recommendations for facilitating, advancing, and sustaining these efforts, contributing to the goal of a net zero NHS.

A 30-month longitudinal case study will span three geographical sites in England and use a mixed methods study design. It will adopt a comprehensive approach, merging sociological (Normalisation Process Theory - NPT) and behavioural theories (Theoretical Domains Framework - TDF) to understand and address factors influencing decarbonisation efforts in general practice. NPT focuses on collective behaviours, emphasising relationships and interactions among professionals, patients, and stakeholders. TDF, with 14 domains simplifying behavioural change theories, concentrates on individual, social, and environmental factors. A systematic review will be conducted, and quantitative and qualitative data will be collected over a 12-month period from general practice, staff, patients, public, and key stakeholders' perspectives through surveys, interviews, and focus groups. Additionally, a non-clinical carbon calculator, alongside prescribing data, will be gathered to assess measurable changes in carbon emissions, informing a budget impact model for practice-specific and generic use.

A dynamic dissemination and impact strategy will be emplyed aimed at ensuring broad awareness, adoption, and accelerated uptake of decarbonisation measures. Outputs, including lay summaries, factsheets, policy briefs and academic presentations will be produced throughout the study and undergo regular review, targeting key audiences and ensuring alignment with regional and national goals.