Engaging patients in the decarbonisation of primary care: findings from a cross-sectional survey in England

OBJECTIVES: Primary care accounts for almost a quarter of the National Health Service (NHS) carbon footprint. While general practices are expected to contribute to NHS decarbonisation efforts, little is known about how patients perceive these activities. METHODS: A cross-sectional survey was conducted as part of the General Practice Net Zero (GPNET-0) study across twelve general practices in three Integrated Care Boards (ICBs) in England. Adult patients who had recently attended their general practice completed an online or paper survey assessing: awareness of climate change and health, perceptions of general practice responsibility for reducing emissions, willingness to engage in sustainability-aligned behaviours if suggested by practice staff; and perceived barriers to action. Quantitative data were analysed descriptively overall and by ICB. RESULTS: A total of 252 patients responded (response rate 12%). Only 6.4% agreed that their general practice has a key role in reducing greenhouse gas (GHG) emissions, and 5.0% felt their general practices should take greater action. Most (82.0%) disagreed that the government should do more to incentivise practice-level decarbonisation. Few respondents felt well informed about climate change (14.0%) or its health impacts (1%). Awareness of practice-level actions such as electronic communication and medicine-return schemes was moderate, but these were rarely recognised as decarbonisation measures. Around one in four reported willingness to engage in a medication review or increase active travel if suggested by practice staff. Concerns that environmental actions might compromise the quality of their care were common (72%). CONCLUSIONS: Decarbonisation is not currently a core expectation that patients hold for general practice. Limited awareness and engagement highlight the need to frame sustainability as supporting, rather than competing with, care quality. Embedding decarbonisation within routine service improvement may be more acceptable than positioning it as a separate priority.