GPs may have to put patients on waiting lists due to contract changes, says BMA

GP practices may be ‘forced’ to implement waiting lists for routine care to manage demand safely due to contractual changes coming into force next month, the BMA has warned.

As of 1 October, GP practices must keep their phone lines, premises and online tools open during core hours, in a development that appeared to come as a surprise to the union’s GP committee and caused serious concern among the profession, with several LMCs asking for a return to formal dispute due to the new requirements.

Now the GPC has released new guidance on the changes, including advice specifically on online consultations being available throughout core hours and on different ways patients are expected to be able to contact their practice.

It said that the BMA has ‘repeatedly warned’ the Department of Health and Social Care and NHS England of the ‘significant anxiety’ that these contractual changes are creating ‘given the lack of necessary safeguards’.

And it also said that the GPC has ‘already seen potentially threatening messages’ from ICBs and commissioners from around the country advising practices that the contractual changes around online tools ‘will be enforced throughout core hours come what may’.

While the agreement within the contract stipulates that this new policy is ‘not intended to cover urgent requests’, the GPC raised concerns with NHSE and DHSC that there is no practical way to ensure this.

It advised that to continue to manage routine care ‘efficiently and safely’, practices may be forced to consider establishing waiting lists for certain routine services.

The guidance said: ‘You may be forced to consider implementing waiting lists for routine care to keep things safe.

‘As we have long recommended in our Safe Working Guidance handbook, in cases where practices receive considerable amounts of daily online consultation requests, and demand subsequently outstrips capacity, this may naturally lead to waiting lists for routine care in some cases – especially if patients wish to see the same GP each time in order to maintain continuity of care.

‘It is our strong view that Government changes to the contract will have the effect of forcing practices to create waiting lists in order to be able to manage online consultation requests until such time as practices are fully assured that no inappropriately submitted urgent online consultation requests can potentially be missed before the contractual period ends at 6.30pm.’

According to the document, the GPC has told DHSC and NHS England that the new requirements create ‘potential risks’ for practices being accused of breaching their contracts should there be days when they run out of clinical capacity and feel that keeping patient access to online consults open would be unsafe.

It comes after health secretary Wes Streeting defended the changes on online access yesterday, arguing they are achievable but some GPs just ‘don’t like’ them and have decided not to engage.

The GPC added: ‘DHSC and NHSE have provided little to no help or support as to what practices should do if they face clinical overwhelm due to e.g. seasonal pressures or widespread sickness amongst the practice team.

‘We have also repeatedly told DHSC and NHSE that even if the online software was closed, practices remain contactable, so patients still have access to their GP surgery for routine and urgent requests.’

It has produced a standard operating procedure for online consultation requests (see box) to ensure ‘safe, effective, and equitable access’ to GP services via online consultation request, while maintaining clinical safety.

Online consults for routine and non-urgent queries should switch off at 18:30 but ‘may be reviewed the following working morning’ and urgent queries online need to be diverted to come via telephones or walk-in, the guidance clarified.

With regards to providing telephone access throughout core hours, the vast majority of practices already utilise cloud-based telephony, the GPC added, ensuring the patient can make contact by telephone throughout core hours ‘in a way that complies with the amended regulation’.

On the requirement to keep premises open during core hours, the BMA also clarified that this does not change current requirements.  

The guidance said: ‘The requirements in terms of a patient attending the premises have not changed; practices must still provide an appropriate response to a patient that attends the practice premises, and practices can still do this through a sub-contracting arrangement.’

It clarified that if a practice was closed during core hours ‘for any reason’, it would be sufficient to comply with patients being able to contact their practice throughout core hours ‘by attending the contractor’s premises’, to provide a door bell or buzzer for patients to press to either leave a message or speak to a member of staff.

It added: ‘Alternatively, a practice could provide a phone number to call that would be monitored for emergencies, visible to patients at the premises.

‘In that situation the patient would not need to be admitted into the practice, or to be seen immediately unless it was clinically necessary to deal with an emergency.

‘A practice should therefore have a means of detecting when it is an emergency when a patient attends at the practice when the practice is closed.’

An NHS England spokesperson said: ‘Since 2023, the GP contract has been clear that for patients who contact their practice in core hours, they should know on the day how their issue will be handled based on their clinical need. 

‘The NHS has hired an extra 2,000 GPs further increasing access to primary care and making it easier for patients to be seen faster, since last summer.’

Pulse has contacted DHSC for comment.

GPs told Pulse the chances were tying their hands to treat patients based on ‘want’ rather than having flexibility to treat them based on need and the issue has also sparked a row among GP leaders.

Last week, in a letter to LMC officers, GPCE chair Dr Katie Bramall acknowledged concerns that the changes had been ‘missed during the review of the draft regulation changes back in April 2025’ and she announced that a ‘significant event audit is underway’ which will be reviewed for discussion at the 18 September GPCE meeting.