2025 in review: The widely misunderstood issue of GP access
Maya Dhillon argues that while politicians argued over appointment numbers, our white paper on general practice access revealed that what patients and practices truly need is continuity, capacity and trust
The second white paper released by Pulse’s publisher Cogora this year tackled the political football that is general practice access.
In the first year of a new Government, access remained an easy proxy for wider NHS performance, with parties trading various pledges and blows on appointment numbers as proof of competence. Ministers repeatedly framed the ‘access’ issue in terms of volume: How many appointments were delivered? How quickly patients could be seen? At the same time, the media peddled narratives of GPs being ‘unavailable’ or ‘closed’ – overlooking the reality of increasing workloads and record appointment numbers being delivered by a stretched workforce.
With attacks coming from both policymakers and the general public, we recognised this as one of the most pressing – but perhaps misunderstood – issues in general practice; making it the perfect subject to investigate for the next white paper. The report involved a survey of 2,000 primary care professionals; interviews with more than 100 general practice staff; and data analysis of more than 20 sets of NHS data on every practice in England. Access All Areas was launched at a fringe event of the Labour Party Conference in Liverpool, with attendees including MPs and primary care professional leaders.
The white paper exposed a widening gap between how access is discussed in policy circles vs. how it is actually experienced in practices. Our research found that:
- 70% of general practice staff said complaints had risen since the pandemic
- 31% of patient complaints related to access
- 55% of practice staff have faced verbal abuse due to access issues
The report also called for a shift in ministers’ attitudes towards access. While they consistently prioritise speed and quantity, almost half of GPs and practice managers viewed continuity of care as a bigger priority than waiting times, ease of contacting the practice, offering F2F and on-the-day appointments.
Despite record appointment numbers, patient satisfaction has lagged behind – meaning that whatever the solution is, it isn’t just as easy as magicking up more appointments with different members of staff. Patients want something more out of their appointments. Our findings showed that systemic pressures such as staffing shortages, administrative burdens, and rising patient complexity mean that quantity alone is not resulting equate to perceived accessibility. Practices are stretched, and staff are exhausted, with many reporting verbal abuse when patients perceive delays as a failure of care rather than a reflection of wider system pressures.
Some GP practices told us that they are considering radical measures to improve access, including cutting patient lists. Our survey showed that 58% of practices were happy with their list size (or could increase it) without any detriment to access – but 17% said they would have to cut their list size by 11 – 20% to provide appropriate levels of access; with 14% of respondents saying they would have to cut their list by more than 20%.
Politicians have always focused on access because it is an easy metric to gauge – surely more appointments means a healthier population? And so, though misguided, it does mean that there have been efforts made previously to increase capacity – each with mixed results. The additional roles reimbursement scheme (ARRS) added new staff to practices, but doctors warned that these non-GP roles ‘may not necessarily be of the same quality as one with a GP’. In 2013, extended-hours GP services were introduced to increase appointment availability, but practices report they do little for continuity of care and increase workload. Meanwhile, the Pharmacy First scheme has provided more minor-illness support, but GPs said patients are often simply ‘sent back to us for minor ailments’.
The final recommendations from the white paper focused on giving practices more flexibility to manage demand, prioritising continuity of care, and tailoring appointment systems to the needs of local populations. Ensuring that staff wellbeing is supported was highlighted as essential, since overstretched teams struggle to maintain quality.
Around the time the report was launched, health secretary Wes Streeting made a comment saying that he wanted to live in a world where booking a GP appointment was ‘as easy as booking a delivery, a taxi or a takeaway’. Pulse editor-in-chief and white paper author Jaimie Kaffash refuted that – while the takeaway comparison might make for a quotable headline, it woefully (and willingly?) misunderstands the point: takeaway shops have control over demand, GP practices do not; takeaway shops set their own pricing, GP practices are funded via an out-of-date formula; takeaway shops are easy to contact because they have the staff they need, GP practices are not because they do not.
Since the white paper’s publication, the changes requiring practices to have online consultation tools open during core hours have come into force. GPs have repeatedly warned that digital-first systems will erode clinical triage, obscure red flags and disadvantage groups who struggle to navigate online forms. We have reported accounts from GPs who are scared that serious conditions will be missed when access is reduced to written symptom lists and automated pathways. Our survey also showed that practices are collectively losing more than 200,000 appointments a week just implementing these changes – quite literally the opposite of what these changes were brought in to do.
Come 2026, general practice faces a fork in the road. If policymakers are to heed any of the warnings raised in Access All Areas, it is to start trusting GPs. Every practice knows their patients best and how to work in a way that serves them best. Against the current direction of travel, it is strengthening the partnership model which will allow for a sustained improvement in access. It might not be easy to achieve, but it will absolutely benefit patients in the long run.
Listen to our bonus podcast episode discussing the Access All Areas white paper here. For more coverage from the report – including analysis, first-person views and videos from the launch event debate, click here.
You can find all the data and the methodology in the full report. Click here to download the full report. GPs can download it for free.
Commercial partner of this white paper: General Practice Solutions
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READERS' COMMENTS [10]
Please note, only GPs are permitted to add comments to articles
Doing a locum yesterday. The staff are complaining. With the on line booking there is now a four fold increase in DNAs. Yesterday I had 30 slots and 3 DNAs.
Could you believe that there even appear to be DNAs for telephone triage appointments given out within last 0-2 days, as I tend to get the urgent patients rather than routine reviews (as a locum too).
How does on-line booking work to get patient to see correct staff member then? Even with Receptionist aid, a proportion of patients STILL book to see wrong staff member !
And it seems to be too difficult a concept to master that, if there aere more patients trying to contact surgery at 8:05 am, each of them will have more difficulty getting through on the phone. The answer is to reduce numbers trying to contact surgery. Since we are not supposed to snuff them out, perhaps we could start by instructing our colleagues elsewhere to NOT tell patient to go see GP for something THEY can (or, on some occasions, ‘must’) give the patient while they are seeing them.
It might be that some patients wish, that more could be done at primary care level. There’s a misunderstanding describing how most stuff is referred to A&E or a Consultant. Eyes-down consultations are another misunderstanding.
A small charge to see a GP would significantly improve access.
GPs would be incentivised to see Patients, and Patients would be incentivised to think twice before booking an appointment.
Most of the Developed World operate healthcare systems that require patients to contribute, and without dead bodies piling up in the streets, and without the delays and obstructionism that characterises the NHS.
Yet again we doctors know what’s best-so more of us, charge patients and demand behavioural changes. Maybe instead we should think about a team approach here..Let’s start at what patients need and do first. They want quick reliable access to a computer (mostly younger) or person( mostly older) and are happy to be have their concerns/ queries sorted by whoever is best to do it- computer or person ( that’s any professional including our most precious ones, receptionists!). Doctors are part time more now(partly stress, partly life choices)so more doctors must reflect that and is very expensive for NHS and those managing primary care budgets. Solutions must be team based and embrace staff for the long term training them all to help and rewarding those that do so to keep them. Bottom line is doctors must manage patients and be ready to add their skills when needed but not see all patients.
SM banging on his own drum as usual, totally oblivious to the irony of accusing everyone else of behaving as if they “know what’s best” whilst telling us all what we should be doing. Nothing to see here except self interest…
Nah not self interest just a common sense scouser who wants the NHS to be as good as possible within the resources available. It would be great if you can come up with your options to improve the NHS JM rather than just personal attacks- I thought this was a professional forum to explore the opinions of GPs and creative respectful debate…maybe I am old fashioned.
General practice in England is delivering more appointments than ever recorded. NHS England reported 383.3 million appointments delivered in the 12 months to June 2025, up from 375.7 million the year before.¹ NHS Digital’s monthly publication shows the new baseline clearly: June 2025 recorded 31.4 million appointments, and monthly totals now routinely sit above 30 million.²
These figures are often presented as proof that access is improving. But activity is not the same as capacity … and volume is not the same as value. Rising appointment numbers can just as easily reflect an overwhelmed system repeatedly absorbing unmet need, shifting work from elsewhere in the NHS, and the growing complexity of an ageing population.
Independent analysis supports the scale of this shift. The Nuffield Trust estimates that in 2019 there were on average 25.2 million appointments per month, illustrating how far workload has risen in only a few years.³ The Institute for Government’s performance tracker notes that appointments per patient increased between 2019 and 2024, while much of the growth in activity has been delivered by non-GP staff groups.⁴ This is not a criticism of multidisciplinary teams … it is a reality check: substitution does not erase supervision, risk, continuity needs, or the clinical responsibility that still lands with GPs.
And yet the system continues to make increasingly absolutist promises … most notably the rhetorical commitment that “the GP will address your concerns on the day you call.” That might be achievable for a subset of problems some of the time, but it is not a credible universal offer when demand rises year on year and the workforce is not expanding in real time to match.
Workforce data reinforce the mismatch between expectations and capacity. NHS Digital’s General Practice Workforce statistics (September 2025 snapshot) describe the size and composition of the workforce, but do not support the idea of a workforce expanding at the same pace as activity.⁵ More concerning still, a repeat cross-sectional study in The BMJ found the proportion of GMC-licensed GPs not working in NHS general practice increased from 27% (13,492) in 2015 to 34% (19,922) in 2024, a striking signal that retention, participation, and deployable capacity are central problems, not just recruitment.⁶
At organisational level, the system is also thinning out. An analysis reported in BMJ Open and summarised by the BMJ Group describes a decade-long picture in which the number of practices has fallen while average list size has increased markedly.⁷ Fewer practices holding larger lists reduces slack, shrinks continuity options, and makes “same day for all” promises even less deliverable.
In that context, ever-higher appointment totals can become a trap: they create an impression of limitless elasticity, encouraging policymakers to announce new access guarantees without funding the staff and infrastructure required to deliver them safely. The result is predictable: frustrated patients, demoralised teams, and a widening gap between what is promised publicly and what is achievable clinically.
General practice is not failing because it is seeing too few patients. It is failing because we keep asking how many more appointments can be produced, rather than asking what resources, workforce stability, and clinical time are required to deliver care that is safe, relational, and sustainable.
References
NHS England. Millions more GP appointments delivered in record year. NHS England website. 2025 Jul 31.
NHS Digital. Appointments in General Practice, June 2025. Statistical publication. 2025 Jul 31.
Nuffield Trust. Access to GP appointments and services. Nuffield Trust website. Updated 2025 Dec 18.
Institute for Government. General practice across England: appointments and satisfaction (Performance Tracker). Institute for Government website. 2025 Apr 21.
NHS Digital. General Practice Workforce, 30 September 2025. Statistical publication. 2025 Oct 23.
Pettigrew LM, Bharmal AV, Akl S, et al. Trends in the shortfall of English NHS general practice doctors: repeat cross sectional study. BMJ. 2025;390:bmj-2024-083978. doi:10.1136/bmj-2024-083978.
BMJ Group. Number of general practices shrinking but patient lists ballooning in England. BMJ Group website. 2024 Sep 4.
Thank you for highlighting and trying to explain this problem “Pulse”. However, I fear that the politicians still fail to understand the difference between “access” and “capacity”.
‘Deliver care that is safe, relatable and sustainable’: what a fantastic summary of our situation Anuj!… if our leaders read your comments they might think about how we can do that ahead. We need to reconsider delivery of care embracing your statement with a willingness to build teams around patients and populations….or we can ignore reality until too late.