Patient perspectives on environmental sustainability in general practice in England: a qualitative interview study

Background Health systems are increasingly expected to reduce their environmental impact. In England, the National Health Service (NHS) has committed to achieving net zero greenhouse gas (GHG) emissions by 2040 for emissions under its direct control. General practice is critical to this ambition due to its high volume of patient contacts, prescribing-related emissions, and role in prevention. However, little is known about how patients understand and evaluate environmental initiatives in primary care. Methods This qualitative interview study, conducted as part of the GPNET-0 Study, explored patient perspectives on the rationale, implementation, and perceived consequences of environmental initiatives in general practice. Semi-structured interviews were conducted with purposively sampled patients through general practices and nearby community and faith organisations across three contrasting regions in England. Interviews were conducted via Microsoft Teams (video-conferencing) between December 2024 and May 2025. Data were analysed using framework analysis informed by Normalisation Process Theory (NPT) and Theoretical Domains Framework (TDF). Results Twenty-four participants took part, representing a range of ages, socioeconomic backgrounds, and health statuses. Four interrelated themes were identified: 1) patient care as the overriding priority; 2) limited visibility of environmental initiatives, weak communication, and unclear responsibility; 3) perceptions of limited impact of general practice-level action; 4) digitalisation and prevention as acceptable and credible approaches. While participants broadly supported environmentally responsible healthcare, this support was conditional on safeguarding quality, access, and equity. National leadership and adequate resourcing were viewed as prerequisites for meaningful local action. Conclusion Patients regard environmental initiatives in general practice as legitimate only when it is clearly aligned with patient-centred care and supported by transparent communication and system-level coordination. Embedding environmental initiatives within routine clinical priorities, rather than positioning it as an additional burden, appears critical for public acceptance. These findings underscore the need for whole-system approaches that protect trust, equity, and care quality while advancing environmental goals.