Impact of climate change and associated extreme weather events on primary care: A multi- perspective qualitative study in multimorbidity

Technical Summary: Impact of Climate Change and Associated Extreme Weather Events on Primary Care

Problem Statement
Multimorbidity, defined as the co-existence of two or more chronic physical and/or mental health conditions, is a growing global health challenge, particularly affecting older adults and those experiencing socioeconomic disadvantage. In England, primary care serves as the cornerstone for managing these complex conditions, yet the system is already under significant pressure from workforce shortages and financial constraints. While epidemiological evidence links temperature extremes to higher mortality and hospital admissions among people with multimorbidity, there is a critical gap in understanding how climate change and extreme weather events specifically interact with the complex care needs of this population within primary care settings. Existing literature largely focuses on single conditions (e.g., cardiovascular or respiratory disease) or acute outcomes like hospitalization, often overlooking the systemic resilience of primary care services and the lived experiences of patients, carers, and professionals in the context of climate adaptation.

Methodology
This study employed a qualitative research design utilizing semi-structured online interviews and focus groups to explore perceptions of climate change and extreme weather within the context of primary care in England.

• Participants: The study included 24 participants: 11 individuals living with multimorbidity (two of whom were also informal carers), 4 informal carers, 8 health professionals (including GPs, a pharmacist, a physiotherapist, a social worker, and a senior health coach), and 1 climate–health expert.
• Sampling: An iterative recruitment strategy was used, combining purposive sampling with snowball sampling via social media, university channels, and word-of-mouth. Participants represented diverse geographic regions, Index of Multiple Deprivation (IMD) deciles, and educational backgrounds.
• Data Collection: Data were collected between September 2024 and March 2025. Sessions lasted 25–90 minutes and were audio-recorded and transcribed verbatim. A co-developed topic guide covered impacts on health, effects on carers, implications for primary care services, and views on adaptation models.
• Analysis: Data were analyzed using Reflexive Thematic Analysis guided by Braun and Clarke's six-phase methodology. The approach was underpinned by a constructivist orientation, acknowledging the active role of researchers in theme generation. Four qualitative researchers and a public and patient involvement (PPI) contributor with lived experience of multimorbidity independently coded transcripts, with differences in coding treated as analytic richness rather than errors to be resolved.

Key Contributions and Results
The study identified four overarching themes regarding the intersection of climate change, extreme weather, and primary care for people with multimorbidity:

1. Perceptions of Relevance in England: Participants often perceived extreme weather as less relevant to England compared to other global regions, viewing the UK's temperate climate as protective. Consequently, extreme weather events were not seen as salient concerns in routine primary care activities. While public discourse often highlights heat, professionals and patients frequently identified extreme cold as the more immediate and significant health risk, particularly regarding increased workload and frailty.
2. Systemic Unpreparedness and Infrastructure Limitations: Primary care was described as overstretched and underprepared. Key issues included:
   • Infrastructure: Many facilities lack adequate climate control (e.g., air conditioning), with older buildings described as "glasshouses" during heatwaves.
   • Guidance: There is a distinct lack of clinical guidance or standard operating procedures (SOPs) for managing patients during weather extremes. Unlike winter flu seasons, there are no specific protocols for heat or flood events.
   • Capacity: Existing capacity constraints (long wait lists, funding shortages) are exacerbated by weather events, leading to further delays in appointments and referrals. Transport limitations for both staff and patients were cited as major barriers to service delivery.
3. Unequal Impacts on Patients, Carers, and Professionals: Extreme weather events were found to exacerbate chronic conditions (cardiovascular, respiratory, renal, musculoskeletal) and restrict mobility and social activity.
   • Health Impacts: Patients reported increased anxiety, fear of falls, and isolation due to weather conditions.
   • Carer and Staff Strain: Informal carers faced intensified stress and emotional fatigue. Healthcare professionals reported environmental challenges in workplaces (overheating) and operational disruptions (e.g., flooding preventing access to clinics).
   • Inequity: The impacts were unequally distributed, with socioeconomic deprivation intensifying vulnerability. Financial hardship prevented some from heating homes or accessing transport, while poor housing conditions (damp, cold) worsened respiratory and other conditions.
4. Pathways to Climate Resilience: Participants called for a multi-layered approach to adaptation:
   • Awareness and Education: Increased information for patients on self-management and safety during extreme weather.
   • Standardized Protocols: The need for specific contingency plans and SOPs for primary care practices, including welfare checks and medication continuity during power outages or floods.
   • Collaboration and Outreach: Strengthening cross-sector collaboration with community organizations, social care, and local authorities. This includes targeted outreach to vulnerable groups and the use of technology (e.g., telemedicine) to maintain contact.
   • Vulnerability Registers: The suggestion of creating prioritized lists of vulnerable individuals to ensure targeted support during extreme events.

Significance and Claims
The authors position this study as the first to examine the perceived impact of climate change and extreme weather events on multimorbidity specifically within the context of primary care in England. The study claims to highlight a system already under strain that faces additional, unaddressed risks from climate change.

The significance of the findings lies in the call for a cultural shift in primary care: moving beyond a sole focus on reducing healthcare carbon emissions (mitigation) to actively adapting services to protect health from climate risks (resilience). The paper argues that adaptation strategies must be equity-focused, integrated into routine care, and supported by infrastructure, guidance, and cross-sector collaboration. The authors emphasize that without these measures, climate-related disruptions risk widening existing health inequalities, particularly for those with multimorbidity who rely on sustained and coordinated primary care support. The study concludes that safeguarding the health of vulnerable populations requires recognizing climate change as a fundamental health systems challenge rather than an external environmental issue.