Background Extreme weather events (EWEs) can significantly impact on mortality and morbidity in the UK. How EWE guidance is disseminated and applied across health and social care systems, at the local, operational level, is not well understood. Methods This exploratory study develops tools and resources to assist local stakeholders to cascade national 'all weather' EWE guidance across local systems. These resources are also used to evaluate the local interpretation and implementation of this advice and guidance within three local authority areas. In total, five discussion group meetings were held and 45 practitioners took part in the study. A thematic analysis was conducted. Results The main themes emerging from the analysis related to awareness of PHE guidance for EWE preparedness, data sharing feasibility, community engagement, specific conditions in remote rural areas and capacity of frontline staff. Conclusions The relative difficulty in finding where the study 'best fits' on local stakeholders' agendas suggests that year-round and preparedness planning for EWEs may not have been considered a high priority in participating areas. This study adds to the relatively limited evidence internationally concerning the practical implementation at local level of national adaptation advice and guidance and potential barriers to achieving this.