Factors influencing implementation of decarbonisation actions in general practice: longitudinal multi-centre case-study.

Background The National Health Service (NHS) aims to reach net zero by 2040. Although recognised as having a key role, little is known about how decarbonisation initiatives are implemented in general practice and how progress can be supported. Aim To explore the institutional, organisational and professional factors that influence implementation of decarbonisation actions in general practice over time. Design and setting Longitudinal qualitative case study in 12 general practices in England. Methods Practices developed a Green Action Plan (GAP) comprising 3-5 measurable actions to be implemented over 12 months. Qualitative data were collected through baseline workshops, 3-monthly follow‑up 'check-in' discussions and final focus groups. Topic guides were iteratively developed, informed by Normalisation Process Theory and the Theoretical Domains Framework, and Framework analysis was conducted Results The factors influencing decarbonisation are presented as five themes: systemic barriers; culture and communication; capacity and competing demands; 'making it work'; and behaviour, attitudes and feelings. Actions aligned with wider NHS priorities or offering time/financial efficiency were easier to embed, whereas those requiring individual behaviour change or reliant on external systems were more challenging. Lack of coordinated policy support and limited control over estates and infrastructure constrained progress. Conclusion At practice level, actions that integrate into routine work and provide efficiency gains are most feasible in enacting change. To support sustained change, directive national policies and coordinated system-level support are required. Individual behaviour change is challenging in an already pressured system, but a supportive culture and team collaboration can facilitate progress.