All-day online consultations will only cause ‘temporary’ GP demand spike, says BMA

The requirement for GP practices to keep online consultation tools open all day will likely cause a ‘temporary spike’ rather than a ‘sustained increase’ in demand, the BMA has suggested.

As part of the 2025/26 GP contract, practices will be obliged from 1 October to keep their e-consult software open to patients ‘for the duration of core hours for non-urgent appointment requests, medication queries and admin requests’. 

The BMA’s GP Committee England has put out guidance on this new contractual requirement which said IT leads are working with NHS England and system suppliers to ‘ensure practices receive as much support as possible’. 

It also suggested that the Government should ‘shoulder the burden of communicating changes’ to patients, or provide resource to practices to do so.

The guidance recognised concerns from GPs about this ‘potentially opening the floodgates’ for patient queries, noting that the committee had made the Government ‘fully aware of this issue’ during contract negotiations. 

At a webinar on this year’s contract in April, the BMA said online access for patients to request consultations was the ‘most contentious’ requirement for GPs, and highlighted concerns about ‘the impact on GPs’ mental health’ and workload.

In the new guidance shared last week, the committee said ‘practices should do nothing’ until system suppliers are compliant, but that ‘many practices’ may need to make preparations sooner than 1 October ‘given the high degree of variation in how e-consults are utilised by the profession’. 

‘At the very least, the change will require practices to establish rules governing what requests patients can make and how those requests should be dealt with,’ the committee told practices. 

On demand, the guidance said: ‘In theory it should not lead to a sustained increase in demand as patients who would have accessed services over the phone or in-person will now instead do so online. 

‘We do know though that some patients submit multiple requests online and this is an area we wish to address with NHSE.  

‘It may be that there is a temporary spike while some patients attempt to engage by both traditional and novel means as the new systems are settling in. 

‘Having said that, there is no way to totally predict what impact it will have on patients’ interactions with practices and we continue to advise practices to follow our safe working guidance to ensure working days are manageable.’

The committee also said that even though NHS England’s new contractual requirement is ‘not intended to cover urgent requests’, in reality ‘there is no practical way to ensure this’.

In order to address concerns about clinical liability, the GPCE is therefore ‘working with e-consult suppliers to create safeguards’.

More guidance is expected from the GPCE ‘in the coming months’.

In March, NHS England attempted to allay concerns raised by GPs about the move to mandate practices to keep online consultation tools open from 8am to 6:30pm.

During a webinar on the contract, NHS England fielded several questions from GPs who branded the requirement ‘unsafe’ for patients and said it could lead to staff ‘burnout’.

Primary care director Dr Amanda Doyle clarified that practices will need to monitor requests during core hours but not necessarily deal with each one on the same day.

She also said this requirement was ‘something ministers were absolutely set on’ during the 2025/26 contract negotiations.

The contract changes, including almost £800m being invested into the global sum, were agreed with the BMA’s GP Committee earlier this year.