Does the drive to a net-zero NHS affect General Practice access for our vulnerable patients? A systematised narrative review

Introduction

The National Health Service (NHS) aims to achieve net-zero emissions by 2045. Telehealth is a potential low-carbon alternative within general practice which might help to achieve this. Despite environmental benefits, concerns remain regarding the impact on vulnerable groups who may face digital exclusion. This systematised narrative review examines how telehealth, as part of decarbonisation efforts, influences access to general practice among vulnerable populations.

Methods

A systematic search of Medline, Embase and Scopus was conducted using PRISMA guidelines. Eligibility criteria were informed by the PICO framework. Data extraction was completed independently by two reviewers, and methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Due to heterogeneity, a structured narrative synthesis was undertaken using a thematic approach and conceptual models. Descriptive statistics were used to analyse the quantitative data. No ethical approval was required for this work. Only published, publicly available data was used.

Results

Five studies from Portugal, Australia, Sweden, the Netherlands, and a UK-China collaboration were included. Most used mixed methods design and examined synchronous telehealth interventions. Reported benefits include reduced travel-related emissions and improved convenience for patients and clinicians. However, significant barriers were identified for vulnerable groups, including those with low digital literacy, poor technology access and older adults. In one study, uptake among older adults was low, and concerns were raised regarding suitability for patients with complex health needs. Carbon impacts were measured in one study; 0.1kgCO₂e for teleconsultations compared with 0.3kgCO2e for in-person home visits. Younger users in particular viewed telehealth as environmentally responsible.

Conclusion

Telehealth provides environmental and practical advantages aligned with NHS net-zero ambitions, but its expansion risks widening health inequalities if digital barriers persist. Strengthening digital inclusion, improving access to resources, and conducting more comprehensive research on the impacts of telehealth on minority groups are essential to ensuring equal access within general practice.