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Background Formalised clinical pathways have become popular approaches to translate evidence into clinical recommendations, tailored for the local healthcare setting. In recent years, the HealthPathways platform has been used to implement a range of clinical and referral pathways in New Zealand and Australia. Despite widespread adoption, little is known of factors influencing the sustained use of HealthPathways in Australian general practice. Methods This qualitative study, conducted in three Melbourne Primary Health Network catchments, applied normalisation process theory to explore HealthPathways implementation. We conducted semi-structured interviews with 43 participants, including general practitioners (GPs), practice nurses, practice managers, Primary Health Network staff and key regional informants. Analysis combined inductive and deductive approaches. Results The findings suggest that although HealthPathways holds promise for enhancing clinical practice, its adoption and impact are currently limited due to low awareness and varied integration across Primary Health Network catchments. Recent medical graduates found it useful for helping patients access appropriate care. Adoption was influenced by peer recommendations and time constraints, although established GPs resisted change. Targeted education, effective promotion and improved monitoring systems were identified as crucial to facilitate wider and more effective use of HealthPathways, ultimately contributing to better patient care and streamlined clinical processes. Conclusion Although HealthPathways’ relative normalisation is evident, challenges in integration persist, requiring targeted strategies. Comprehensive promotion to GPs, standardisation across Australia and enhancing technical interoperability between digital interfaces is essential. Strong partnerships and feedback mechanisms can optimise HealthPathways’ impact on patient care, supporting the objectives of the Australian National Primary Health Care 10-year plan.