Q&A: What the October access changes mean for GP practices

Anna Colivicchi looks into the contentious contract changes coming into force next month and answers the most frequently asked questions about the new requirements

What changes around GP access will come into effect on 1 October?

The contract was changed last month to stipulate that practices ‘must take steps to ensure that all of the following means of contacting’ the practice ‘are available for patients throughout core hours’, including:

• by attending the practice’s premises; 
• by telephone; 
• and through the practice’s online consultation tool

This requirement appeared to go further than what initially announced in February, when practices were told they would be contractually required to keep their online consultation tool ‘open’ during core hours regardless of capacity.

Practices must also display the patient charter – a document setting out patient rights, including on access and registration – on their website no later than 1 October. This says that ‘the practice team will consider your request for an appointment or medical advice and tell you within one working day what will happen next’.

The charter also states that practices must be open from 8.00am to 6.30pm, Monday to Friday and that ‘throughout these hours’ patients are able to ‘visit the practice, call them, and go online using the practice’s website or the NHS App’.  

What does this mean for practices?

The BMA has pointed out that the changes were put in place to make it ‘an express requirement’ that all three of the specified modalities of contacting the practice – in person, telephone and online – are now ‘fully available to patients throughout core hours’ between 8.00 and 18.30. Previously, there was no reference in this section of the regulations to ‘throughout core hours’.

In practice, it means that practices must now contractually have an online consultation tool which must be accessible to patients throughout core hours to access routine and non-urgent enquiries. The BMA has advised that online consults for these queries should switch off at 18:30 but ‘may be reviewed the following working morning’ as they are routine and non-urgent, while urgent queries online need to be diverted to come via telephones or walk-in.

The requirements in terms of a patient attending the premises have not changed, as pointed out by the BMA, as practices must still provide ‘an appropriate response’ to a patient that attends the practice premises (this became a contract requirement in 2023/24).

In terms of phone lines remaining open throughout core hours, most practices already utilise cloud-based telephony, so this will already be compliant with the changes, as it ensures the patient can make contact by telephone throughout core hours.

The union also received confirmation in writing from NHS England that the timeframes within which practices must provide an appropriate response have not changed (a same day response if within core hours, or next working day if outside of them).

Why is the profession concerned about these changes?

GP leaders told Pulse that the changes could undermine practices’ ability to provide services flexibly and could destabilise practices, tying their hands to provide services ‘based on want rather than need’.

‘We have warned, repeatedly, that this will not solve the 8am scramble, merely make it electronic, and will lead to waiting lists as requests for routine appointments for trivial reasons increase,’ said BMA GPC member Dr Brian McGregor when the changes around online tools were first announced.

And the BMA has continued to raise concerns about it, highlighting that there is a risk of practices being accused of breaching their contracts if they run out of clinical capacity on a given day and they may need to temporarily switch off same-day online access in order to safely meet demand.

Although the GPC agreed to these changes when the contract was negotiated, it was on condition of securing ‘necessary safeguards’, which are still not in place. In a message to GPs last week, GPC chair Dr Katie Bramall said: ‘GPC England’s agreement to these changes to GP practice contracts was voted on in March in good faith, on condition of securing the “necessary safeguards” in advance of 1 October. At the time of writing, we do not believe those safeguards are in place.’

Dr Bramall also warned that NHS England’s wording in the patient charter, stating that practices should ‘consider requests for an appointment or medical advice and tell you within one working day what will happen next’, risked suggesting patients should receive medical advice within the time frame.

Doctors’ Association UK GP spokesperson Dr Steve Taylor pointed out that there are ‘huge problems’ with a rise in expectations from patients, without the resources to meet this. ‘For larger practices it will be possible to have someone monitoring requests, filtering the important, urgent from the non-urgent,’ he told Pulse. ‘For smaller practices this will place a huge burden on an already overstretched workforce.’

The BMA has also warned in its guidance that the requirements may force practices to establish waiting lists for routine care, which Dr Taylor also echoed. ‘As one friend put it, the GP is like the driver of a bus, full of passengers, arriving at a bus stop with a queue of people, asking the bus driver to accept extra passengers knowing it is unsafe, but if they refuse they are blamed for the lack of access,’ he said. ‘The bus company (Government) need to provide more buses (GPs), or at least manage expectations that they will need to wait. Some practices will inevitably create waiting lists, 111 & A&E will be used more and GPs will again be blamed.’

Do the changes mean that practices have to provide clinical advice ‘within one working day’?

No, NHS England has clarified to Pulse that practices are not required to provide clinical advice to all patients within one working day. However it has stressed that there does need to be active triage – with the patient needing to be told what will happen next – rather than just an automated acknowledgement message for the request.

The commissioner reiterated that expectations on response times have not changed – stressing that the contract already sets out that a patient should know on the same day how their issue will be managed by the practice, by arranging an appointment on another day, or signposting to an appropriate service. It clarified that automated messages without active triage do not meet the appropriate response requirements and that blanket diverts to other NHS settings would not be an appropriate response.

Do practices’ premises have to always remain open to the public during core hours?

In new advice this week, the BMA said that the new requirements do not actually mean practices have to remain open to the public throughout core hours – at least not in the sense of ‘open for patients to walk into the premises’. It pointed out that the requirements relate to patients’ ability to contact the practice and the practice’s duty to provide a response.

The advice said that therefore it would be sufficient for patients to be able to contact the practice by attending the premises, for example through a doorbell or buzzer for patients to leave a message or speak to a member of staff; or a phone number to call that would be monitored for emergencies, visible to patients at the premises. When asked by Pulse, NHS England did not dispute the BMA’s guidance on this.

Why has this caused an internal row within the GPC?

The changes have caused tensions within the GPC and among LMCs, as GP leaders expressed concerns that the changes had been ‘missed during the review of the draft regulation changes back in April 2025’.

Dr Bramall has acknowledged these concerns in a message to LMCs last week and said that the amended regulations were received by the BMA from the Department of Health and Social Care in April but that they were not shared with the relevant policy group. The BMA has sought legal advice on the changes, and a ‘significant event audit is underway’ which will be reviewed for discussion at a GPCE meeting later this week.

Following this message from Dr Bramall, a group of past and present GPC policy leads wrote to her to ‘get clarity on several concerns’ around the approval of the changes. The letter, seen by Pulse, requested that Dr Bramall acknowledges her ‘ultimate responsibility (as GPCE chair) for the error in ratifying the draft contract regulations’.

What does NHS England say about the changes?

When the contract variation was published last month, NHS England told Pulse that there was no difference between the substance of what practices were told in February and the amendment of the wording to the contract, and that the updated wording was merely to emphasise the obligation to remain open during core hours. 

NHSE has since reiterated to Pulse that since 2023/24, the contract has required that a patient making contact with the practice should know on the same day (or the following day if outside core hours) ‘how their presenting issue will be handled’. It added that this does not necessarily mean the practice ‘has to see or treat the patient on the same or next day’, rather the patient should know how their presenting issue ‘will be managed by the practice’, which could involve: arranging an appointment for the patient on another day; or signposting to another ‘appropriate service, such as Pharmacy First’.

In March, during a webinar on the contract changes, NHS England’s primary care director Dr Amanda Doyle received several questions from GPs about this change, which was branded ‘unsafe’ and potentially leading to staff ‘burnout’. In response, Dr Doyle clarified that practices will need to monitor requests during core hours but not necessarily deal with each one on the same day.

And earlier this month, NHS England’s group director for primary care Alex Morton acknowledged GPs’ concerns around the changes in a webinar, while she emphasised that the online tools should not be used for urgent requests and that practices should ‘flag’ to their ICBs if they are struggling. ‘I do really recognise that lots of people are very concerned about this,’ she said. ‘Some people have found that this has actually benefited their staff in terms of the workload, how they’re managing capacity and demand. My recommendation would absolutely be please flag where this is difficult for you. We’re working closely with [ICB] colleagues at the moment. We would really encourage you to make sure that on your websites, on your messaging to patients, you’re really clear that this is not for urgent appointments.’

What ‘safeguards’ does the BMA want?

The BMA wants NHS England and DHSC to publish ‘reasonable and pragmatic’ jointly agreed guidance before 1 October, which would enable practices to temporarily divert online patients to telephone and walk-in requests ‘only when they are at capacity’.

And to prevent urgent requests being submitted online, they also think that there needs to be a standardised approach across online consult providers of templates for requesting routine non-urgent appointments via a tick box set of questions for predetermined online consultation request and query types. In addition, a standardised operating protocol should be in place, which practices may follow when demand exceeds capacity, so they can temporarily switch from green to amber OPEL status.

The union said that following a meeting with NHSE and DHSC, the joint BMA and RCGP IT committee co-chairs will be writing to the Government with their conclusions ‘imminently’, but the committee ‘does not believe safeguards are in place’.

What next?

As revealed by Pulse last week, several LMCs are asking the GPC to return to a formal dispute with the Government over these changes and the lack of appropriate safeguards. The committee is meeting on Thursday (18 September) and it will debate next steps following these concerns.

Dr Bramall told GPs last week that any attempt by the Government to implement national contract changes ‘without the assurance of patient and staff safety’ will not be ‘acceptable’ to GPC England.

Health secretary Wes Streeting said he is open to talking to the BMA about the concerns, but also said GPs have to get with the 21st century. He defended the contract changes on online access, arguing they are achievable but some GPs just ‘don’t like’ them and have decided not to engage.