Primary care attributes among public health service users and perceived discrimination based on sexual orientation in Brazilian municipalities: evidences from ELSI-Brazil.

The National Health Service (NHS) accounts for an estimated 4–5% of the UK’s greenhouse gas (GHG) emissions, making it a significant contributor to the country’s carbon footprint [, ]. In 2020, the NHS became the world’s first health system to commit to achieving net zero emissions by 2040 [, ]. This commitment, set out in the Greener NHS strategy [] and underpinned by the Health and Care Act 2022 [], provides a clear framework for decarbonising healthcare delivery. Primary care accounts for around 23% of NHS emissions through building energy use, prescribing (notably metered-dose inhalers), procurement, and staff and patient travel [, ]. The Royal College of General Practitioners (RCGP) has identified the climate emergency as a strategic priority [], and Integrated Care Boards (ICBs) have, since 2020, been required to publish “Green Plans” outlining local strategies for decarbonisation (e.g []). Patients have the potential to play a key role in decarbonising general practice. Their travel, medication use, and lifestyle behaviours account for a substantial proportion of practice-related emissions []. Many low-carbon actions – such as switching to lower-emission inhalers, opting for remote consultations, or returning unused medicines – depend directly on patients’ willingness and engagement. Evidence suggests that patients may be receptive to sustainability discussions when linked to personal health benefits, but less engaged when messaging feels politicised []. Understanding the factors that facilitate or hinder environmentally sustainable initiatives in this setting is therefore essential. Given its scale and reach, general practice has the potential to drive meaningful environmental change, provided this is pursued alongside delivery of high-quality patient-centred care [].