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Introduction Sodium–glucose cotransporter-2 (SGLT2) inhibitors improve outcomes in heart failure with reduced ejection fraction (HFrEF), irrespective of diabetic status. In September 2020, NICE guidance enabled initiation of SGLT2 inhibitors for HFrEF in primary care. However, evidence of community prescribing remains limited. This quality improvement project (QIP) evaluated dapagliflozin prescribing in primary care and identified barriers following the NICE guideline update.Methods A two-cycle QIP was conducted in a single GP practice within Camden Primary Care Network. Electronic health records were reviewed to identify patients coded with heart failure. Coding accuracy was verified by clinician review of echocardiography, electrocardiograms and cardiology correspondence. Patients with confirmed HFrEF were assessed for dapagliflozin suitability based on renal function, glycaemic control, diabetes subtype, prior adverse reactions, infection history, genitourinary anatomy, palliative care status and patient preference. Patients were classified as good (no contraindications), moderate (≤2 relative contraindications) or poor candidates (clinician-defined). Good and moderate candidates were counselled, provided written information and re-contacted after one week. Follow-up occurred at four weeks to assess renal function and at 2–3 months to assess symptoms, adherence and adverse effects.Results Forty-five patients were coded as HFrEF; 10 (22%) were inaccurately coded and reclassified following review. A further 20 patients were excluded due to significant contraindications or poor candidacy. Twenty-five patients were eligible and contacted, of whom 9 (36%) initiated dapagliflozin. Barriers to initiation included patient-level (polypharmacy concerns, fear of adverse effects, scepticism regarding multi-system benefit), clinician-level (prescribing confidence and perceived adverse-effect risk) and system-level factors (preference for secondary care input and follow-up constraints). Two patients discontinued dapagliflozin within two weeks due to urinary frequency and postural symptoms. Seven patients reported improved exercise tolerance, reduced fatigue and improved breathlessness at follow-up. No serious adverse events were observed.Conclusions Despite NICE guidance supporting primary care initiation of dapagliflozin for HFrEF, uptake was limited by inaccurate coding and multi-level barriers. Targeted patient identification and structured counselling facilitated initiation in a subset of eligible patients, with reported symptomatic benefit. These findings have informed development of a shared care pathway between Camden PCN and a specialist heart failure consultant at Barts Health NHS Trust to optimise guideline-directed medical therapy, reduce reliance on loop diuretics where appropriate and increase dapagliflozin uptake. A planned 12-month re-audit will assess sustainability of prescribing and impact on heart failure hospital admissions.