ICBs told to ensure GP practices follow new access requirements from next week
ICBs have been told they should ensure GP practices implement contractual changes relating to access due to come into effect from next week.
NHS England chief executive officer Sir James Mackey wrote to ICBs reminding the local commissioners that from 1 October GPs will need to keep online systems open for patient requests between 8am and 6.30pm for routine enquiries.
He highlighted that access to primary care is ‘an important part of managing system pressures’ ahead of winter, and that ICBs should ‘ensure practices are following these requirements’.
The letter said: ‘Continuing our focus on access to primary care is an important part of managing system pressures. Patients need to be able to contact their GP practice by phone, online or by walking in, and for people to have an equitable experience across these access modes.
‘As part of dealing with the 8am scramble, from 1 October 2025 practices will be required to keep their online consultation tool open for the duration of core hours for non-urgent appointment requests, medication queries and admin requests.
‘ICBs should ensure practices are following these requirements.’
It comes after the BMA demanded that the Government pauses the contractual changes, until ‘significant concerns’ around patient safety are addressed. Pulse understands that at present no such deferral has been agreed.
The BMA is arguing that the online systems cannot differentiate between urgent and non-urgent queries and therefore serious issues risk being missed.
GPs have also warned 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’.
And this week GPC England deputy chair Dr David Wrigley said that there is a risk the policy will ‘cut back’ on access to face-to-face appointments.
He shared a message from a GP practice which said: ‘Opening the online form until 6:30pm rather than 4pm will result in us losing 25 routine GP appointments per week in order to ensure GPs have time to cover the inbox until 6:30pm. That’s over 1,000 appointments per year.’
The BMA claims it agreed to the changes on the condition that ‘appropriate safeguards’ would be in place. However, primary care minister Stephen Kinnock told the BMA in a letter in July that it would be up to practices to put in place the safeguards.
His letter, seen by Pulse this week, said: ‘I understand the concerns that have been raised about practices’ ability to respond adequately to urgent appointments requested online, particularly on the day.
‘During the 2025/26 GP contract consultation, it was agreed that practices will put necessary safeguards in place to avoid urgent clinical requests being erroneously submitted online.’
Pulse has asked the Department of Health and Social Care to clarify what safeguards these would be.
NHS England has previously said that practices should ‘make sure’ that on their websites and messaging to patients it is ‘really clear’ that online tools cannot be used for urgent requests.
GPCE chair Dr Katie Bramall said: ‘GPC England voted to accept the 2025/26 contract in good faith with three important caveats made crystal clear at the time: One: to secure the written agreement from the Secretary of State to negotiate and deliver a new substantive GP practice contract within this Parliament; two: to agree ‘necessary safeguards’ would be in place to prevent ‘erroneous’ urgent requests coming through online consultations; and three: to work collaboratively with GPC England and the JGPITC to secure the necessary safeguards within GP Connect Update Record (write access) ahead of 1 October 2025. We have seen comments from NHSE, DHSC and now Government “flip-flop” from initially claiming this is the responsibility of practices, to moving to blame online consult providers. The inescapable fact of their own abrogation of responsibility, is clear for all to see.
‘Nevertheless, we have not given up and GPCE has continued to work hard to seek such necessary safeguards with NHS England to no avail. It appears that civil servants have overpromised and under-delivered to their ministers. Wes Streeting’s speech to doctors at the BMA’s recent SRM gave the impression that he is deaf to our genuine concerns, branding us “laggards” despite general practice being at the very forefront of NHS IT innovation.
‘We have emphasised consistently from the start, that without the technical functionalities in place, these moves will do the opposite of “bringing back the family doctor”. They will reduce GP access and appointments, as GPs will be removed from scheduled surgeries to triaging online demand. This is unfair, unsafe, and unwarranted. Sadly, it looks like whilst patients can trust their GP, GPs can never trust politicians. We can only hope that the Government will wake up ahead of next Wednesday, and not choose to make such a catastrophic mistake with the profession.’
Last week the BMA announced that, following a GPC vote, English GPs will re-enter dispute with the Government – over the contract change as well as the 10-year plan for health.
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READERS' COMMENTS [10]
Please note, only GPs are permitted to add comments to articles
The only option I can see for practices to ensure safety in a system not designed for this and underresourced, is all clinicians are triaging all afternoon or day. We’ve been told by our online access providers they can’t provide a safe form with no free text.
If all the clinicians are busy triaging online requests they will have less time to do f2f. 5 or 10 minutes sorting out an online query is 5 to 10 minutes not available to actually see and examine a patient. Do the ICB’s have a plan to deal with the lack of access to GP’s. If patients complain give them the ICB’s phone number.
Very disappointing and will cause chaos in surgeries. We will need to change rotas and contracted hours to allow vetting of all requests received by 18:30 before the midnight cut off.
It also seems to cause inequality as any online request needs to be reviewed by a clinician on the same day. Telephone calls are not triaged by a clinician and nor are walk-ins to Reception.
The BMA better pull their finger out in the next couple of days as this is disastrous.
I fear the ICBs will be taking a heavy handed approach here with rapid threats to take away our contracts. That is what our “boss” Sir Jim clearly wants them to do. All very sad.
I published an article in the BJGP on “Access” 12 years ago. We studied and tested this within my small Practice working with our Patient Group . I concluded that a a system or 3 Triage options worked (1) Urgent same day appointments (2) Appointment within 3 days (semi-urgent) (3) Routine appointment within 7 days . I think this is a good system enabling some advance booking appointments whilst Triaging the Urgent ones.
Good luck policing this ICBs expecting some 6.25pm spot inspections – I know you have loads of staff and small areas so should be easy and sure all the ICB staff work until at least 6.30pm…
If ICB staff have all this spare time to ensure that each and every practice has their online consultation systems switched on for each moment in the 10.5 hour day. Then surely there is a failure of efficiency in ICBs or perhaps the spare time could be spent elsewhere in a more collaborative and holistic way by helping said practices with this workload and the hospitals with managing their waiting lists. Bring back the family doctor by threatening them and beating them to a pulp. Sir Jim sounds like a lovely bloke 😩
The public voted labour in so will get the service they deserve ( although I’m sure other parties would cause same mayhem ) Wes Streeting has no concept of how primary care works or the limitations on access when it is a free for all . The more access you create the more people will use it . You will never satiet the publics perceived need for health care
We as a collective body of general practice should reduce significantly access to patients so that we can triage and manage the online access system and watch what happens when we do this. Then ensure we have GPs/BMA reps who are on all forms of media explaining why access has deteriorated so significantly.
Lets then see who are the laggards, the overriding principal is safe practice.
Funding probems mean practices need gps but cant afford to employ them
Gps sitting unemployed
Underfunded practices as per BMA
Working to rule
safe limit to contacts 24 per day per staff member
but that creates access problems
keeping patches open all day
creates further access problems as someone now has to be triaging these
often patients will write a list of problems on one patches
General practice is having a slow car crash
and its not even winter yet
Someone mentioned GP’s will have a waiting list as per secondary care opd appointments
We can then like our secondary care colleagues
choose to provide private appointments on an expedited pathway
Cynically they need the nhs wait to promote their private incomes
What is happening?
Nigel Farage and reform and doge
any answers ?