Supporting the drive for net zero by decarbonising general practice – A longitudinal study protocol [version 1; peer review: awaiting peer review]

Raquel Nunes, Ana; Atherton, Helen; Dahlmann, Frederik; Eccles, Abi; Geddes, Olivia; Gregg, Michael; Jowett, Sue; Karaba, Florence; Nelson, Laura; Spencer, Rachel; Twohig, Helen; Dale, Jeremy

Abstract

Introduction
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 aims 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.

Methods and analysis
This 30-month longitudinal case study spans three geographical sites in England and uses a mixed methods study design. It adopts 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.

Dissemination
A dynamic dissemination and impact strategy is 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.

Plain Language Summary
The National Health Service (NHS) in the UK has set an ambitious goal to become a “net zero” healthcare system, meaning it aims to significantly reduce its carbon emissions. General practice, which includes GP surgeries and other local healthcare services, contributes a notable amount to these emissions. However, there is little information on how to successfully reduce these emissions in a sustainable way. This study seeks to explore how general practices are currently trying to cut their carbon footprint and will provide practical recommendations to help them do more and do it better.

The research will look at three areas in England and gather information over a year using a mix of surveys, interviews, and focus groups. These will involve healthcare staff, patients, the public, and other key individuals who are affected by or involved in these changes. Two different approaches will help guide the study, one focuses on how people work together and adapt to new ways of working, and the other looks at what motivates people to change their behaviour. The study will also measure the carbon emissions of practices using specific tools, such as a carbon calculator and data on medical prescribing, to see the impact of these efforts and estimate the costs.

The findings will be shared widely through various formats, including easy-to-read summaries, factsheets, and presentations. The goal is to ensure that everyone, from policymakers to the public, is aware of the work being done and can help make these changes happen faster and more effectively across the NHS.

Citation

Raquel Nunes, A., Atherton, H., Dahlmann, F., Eccles, A., Geddes, O., Gregg, M., Jowett, S., Karaba, F., Nelson, L., Spencer, R., Twohig, H., & Dale, J. (2024). Supporting the drive for net zero by decarbonising general practice – A longitudinal study protocol [version 1; peer review: awaiting peer review]. NIHR Open Research, 1-11. https://doi.org/10.3310/nihropenres.13833.1

• Journal Article Type: Article
• Acceptance Date: Jan 24, 2024
• Publication Date: Dec 24, 2024
• Deposit Date: Jan 8, 2025
• Journal: NIHR Open Research
• Print ISSN: 2633-4402
• Publisher: Taylor and Francis
• Peer Reviewed: Peer Reviewed
• Pages: 1-11
• DOI: https://doi.org/10.3310/nihropenres.13833.1
• Keywords: climate change; carbon footprint; primary care; general practice; longitudinal study; mixed method
• Public URL: https://keele-repository.worktribe.com/output/1022770