General practice in a ‘Fit for the Future’, net zero NHS

Ana Raquel Nunes is an Associate Professor at the Warwick Medical School with a keen interest in healthcare and sustainability-related issues. She is currently the Principal Investigator on the GPNET-0 Study – an NIHR funded study on the ‘Implementation of decarbonisation actions in General Practice to help achieve a net zero NHS. A mixed methods study of institutional, organisational, professional, and patient factors’.

The UK’s Government’s Fit for the Future: 10 Year Health Plan for England¹ is an ambitions and far-reaching blueprint for reforming the National Health Service (NHS). Among its core commitments is the transformation of the NHS into a sustainable, prevention-oriented, community-based service. Notably, the plan reaffirms the NHS’s commitment to achieving net zero emissions by 2040 for directly controlled emissions and by 2045 for those it can influence, in line with the Delivering a ‘net zero’ National Health Service report.² These climate targets, while critical, must not remain theoretical commitments. They require operational clarity and translational implementation, especially in primary care, where the majority of patient contacts occur,³ and were preventative, low-carbon care can be delivered at scale.⁴

The Plan’s language on climate resilience, environmental sustainability, and healthcare transformation is both timely and essential.¹ However, there remains a critical gap between strategic ambitions and granular, systemic actions needed to embed sustainability and climate adaptation into everyday healthcare delivery. We should explore how the Plan’s key proposals interface with the wider goals of healthcare sustainability and climate resilience.

First, the Plan’s shift from hospital to community is foundational.¹ The proposed Neighbourhood Health Centres are envisioned as accessible, integrated ‘one-stop shops’, reflecting a promising move towards a health system that is geographically embedded, locally accountable, and prevention-focused. Such decentralisation is not only clinically sound, it is environmentally prudent. General practice, when sufficiently resourced and empowered, can reduce avoidable hospital admissions, associated emissions from transport, diagnostics, pharmaceuticals, and energy-intensive hospital infrastructure. Yet, the Plan lacks detail on how these community settings will be required or enabled to meet sustainability targets. Without integrating carbon accountability, procurement reform, and low-carbon clinical pathways into the design and operation of these centres, the decarbonisation opportunity could be lost.

Second, the Plan’s emphasis on prevention aligns with salutogenic principles long advocated in public health.⁵ Its call to transform the NHS from a ‘sickness service’ to a ‘prevention service’ is a radical by necessary reframing. The inclusion of genomics, digital screening, anti-obesity policies, and tobacco control legislation as levers of early intervention is commendable. Still, prevention must be conceived not only in biomedical terms⁶ but also in environmental ones.⁷ Decarbonising care is itself a form of prevention, mitigating the upstream health impacts of climate change and air pollution while reducing health service-related emissions that drive those very harms.⁸

In this context, the Plan’s recognition of the NHS’s role in addressing climate change is welcome. However, its operationalisation remains overly centralised and technocratic. For example, while the document¹ mentions solar energy partnerships and renewable energy initiatives across the NHS estate, these are largely framed as capital investments, rather than as a comprehensive framework for localised, carbon-conscious service delivery. General practices, often small and heterogeneous in scale, require specific tools, resources, and governance models to meaningfully contribute to net zero ambitions.⁹ Sustainability is not only an engineering challenge, it is a transformation challenge, requiring cultural change, clinical leadership, and system redesign¹⁰.

Moreover, the Plan references the need to ‘increase resilience to climate risks’ across all NHS bodies but fails to provide a substantial model for what climate resilience in healthcare actually entails.¹ In primary care, resilience must be understood not only as the capacity to withstand shocks such as heatwaves or flooding, but also to adapt services, protect vulnerable populations, and ensure continuity of care under volatile environmental conditions. This calls for risk-informed infrastructure design, heat-health action plans, digital service continuity, and inter-sectoral preparedness strategies, none of which are developed in the current policy paper.

This omission is particularly striking given that climate change is already manifesting as a public health emergency.^11,12 Primary care is on the front line of responding to heat-related illness, air pollution-related exacerbations of chronic disease, mental health impacts from climate anxiety, and the emergence of vector-borne diseases. Yet the Plan is silent on the operational protocols, training frameworks, or surveillance systems needed to support healthcare workforce in navigating this new risk landscape.¹ Equally concerning is the underdeveloped articulation of sustainability within clinical governance.

A further risk lies in workforce implications. There is insufficient attention to developing a climate-competent workforce. Training in sustainable healthcare, carbon-informed clinical decision-making, and climate risk assessment is essential but notably absent from the proposed new staff standards. The NHS needs not just more staff, but staff equipped to deliver care that is both clinically effective and environmentally sustainable.

The Fit for the Future Plan sets out a compelling vision for a reformed NHS, one that is community-focused, digitally advance, and prevention-led.¹ It acknowledges the imperative of net zero and resilience to climate risks, yet it stops short of embedding sustainability and climate adaptation as integral to care design and delivery, particularly in primary care. For the NHS to be truly ‘fit for the future’, its plans must not only be radical in ambition but operational in clarity, climate-literate in governance, and just in implementation. The future health of populations and the planet demands nothing less.

References:

1. UK Government. Fit for the Future: 10 Year Health Plan for England. NHS, 2025 https://assets.publishing.service.gov.uk/media/6866387fe6557c544c74db7a/fit-for-the-future-10-year-health-plan-for-england.pdf (accessed 03 Jul 2025).
2. NHS England. Delivering a ‘net zero’ National Health Service. 2020. https://www.england.nhs.uk/greenernhs/publication/delivering-a-netzero-national-health-service/ (accessed 03 Jul 2025).
3. Hoddinott S. Delivering a general practice estate that is fit for purpose. 2024. https://www.instituteforgovernment.org.uk/sites/default/files/2024-06/Delivering-general-practice-estate-fit-for-purpose.pdf (accessed 03 Jul 2025).
4. Nunes AR, Karaba F, Geddes O, et. al. Implementation of decarbonisation actions in general practice: a systematic review and narrative synthesis. BMJ Open. 2025;15(7):e091404.
5. Mittelmark MB, Bauer GF, Vaandrager L, et al. The Handbook of Salutogenesis. 2nd Edition, Springer Open; 2022 (eBook). https://doi.org/10.1007/978-3-030-79515-3
6. Nunes AR. Medicalisation of public health: a narrative review. Public Health, 2025;246:105827.
7. Nunes AR, Dale J. Global trends in sustainable health care research: a bibliometric analysis. Future Healthc J. 2025; 12:100251.
8. Nunes AR and Dale J. Primary care’s preparedness for extreme weather events. Br J Gen Pract. 2024 Jun; 74(733): 274-6
9. Geddes O, Twohig H, Dahlmann F et al. Readiness to reduce general practice-associated carbon emissions in England: a cross-sectional survey of clinical and non-clinical staff views. BMJ Open. In press.
10. Nunes AR, Atherton H, Dahlmann F et al. From theory to practice: using the Normalization Process Theory and Theoretical Domains Framework to understand implementation of decarbonization in general practice. Fam Pract. 2025: 42(3): cmaf050.
11. Romanello M, Walawender M, Hsu S-C, et al. The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action. Lancet. 2024;404(10465):1847-1896.
12. Intergovernmental Panel on Climate Change; Pörtner HO, Roberts DC, Tignor MMB, et al, editors. Climate change 2022: impacts, adaptation and vulnerability. Cambridge and New York: Cambridge University Press; 2022. www.ipcc.ch/report/sixth-assessment-report-working-group-ii/ (accessed 3 Jul 2025).

Featured Photo by Aniket Bhattacharya on Unsplash