GP practices to code ‘urgent’ appointments for ‘same day’ contract breach monitoring
GP practices will be expected to code which appointment requests are urgent to enable NHS England and ICBs to monitor whether they are meeting new contractual requirements.
From 1 April, as part of 2026/27 contract updates, GP practices will have to ‘deal with’ all clinically urgent patient requests on the same day.
NHS England is now developing a method of measuring how practices are performing against the requirement, its primary care director said in a webinar yesterday evening.
Dr Amanda Doyle said that practices will be expected to code appointment requests against the new requirement, and that practices will receive further guidance on how.
She also clarified that the requirement to ‘deal with’ all clinically urgent patients on the same day includes signposting to other ‘more appropriate’ services, and not only appointments.
And she added that ICBs had been given a ‘target’ of 90% being ‘dealt with’ on the same day across their area.
Dr Doyle said: ‘What we are putting into the contract is an expectation that patients who are clinically urgent should be seen or dealt with on the same day. It’s the practice who decides who’s urgent, in the same way that you do now.
‘If your reception team feel that patients need seeing that day or need dealing with urgently, then that’s how we will apply this.
‘We will send out information on how we measure and how we expect you to code what is urgent, but what we will actually do is use the GPAD codes that practices currently use to enable us to differentiate and measure that.’
Dr Doyle also added that she ‘strongly resisted’ including a definition in the contract of what is ‘clinically urgent’ as this is up to practices to determine.
She said: ‘I think you all know exactly what’s clinically urgent and what isn’t. And there’s lots of things that might be “soon” that aren’t “clinically urgent”.
‘I’m not asking practices to do anything that they’ve not already been doing. All of your receptionists are well-versed in who they need to get in the same day, who they need to put on as an extra at end of surgery, who they need to speak to somebody about. And I’d expect that to continue.’
GP leaders have told Pulse that there could be issues around defining an urgent request, as well as ambiguity around what will count as ‘dealt with’.
On how NHS England will define patients who have been ‘dealt with’, Dr Doyle said: ‘”Dealt with” means either seen or spoken to or passed on to somewhere more appropriate. We struggled with finding a word to use.
‘If we say everyone has to be seen, then that’s not right, because you can’t see them all, or you won’t need to see them all. “Dealt with”, is what we came up with as the most pragmatic answer.’
She said that she is ‘pretty confident’ that the requirement is already being delivered by ‘most practices’ and NHS England will only need to ‘demonstrate that is being delivered’.
She added: ‘It’s the sorts of things that we all know: children with very high fevers and rashes, or people who’ve become more breathless, or somebody’s become suddenly confused or suddenly more confused.
‘It’s those sorts of things that we’re all used to seeing as same day cases anyway, and I am pretty confident that for most practices this is being delivered, we just need to demonstrate that it is being delivered.’
While more guidance on this from NHS England remains outstanding, the Government has told the BMA in a closing letter following the contract consultation that practices who fail to reach the target will be contractually mandated to participate in a performance improvement process with their ICB.
Dr Doyle added: ‘The target we’ve actually given ICBs is that across the ICB that hits 90%, but from your point of view, we expect anyone who’s urgent [to be dealt with on the same day].
‘We don’t measure any of that at the moment, and so what we will be doing is deciding how we will measure it, and then telling you how we will measure it.’
She said that NHS England will probably look to measure this using a specific GPAD code, and that it won’t be using a completely different system.
She said: ‘It’ll probably be along the lines of asking you to reserve one of the GPAD codes, whether that’s a general consultation, acute, or something like that, to indicate where somebody is clinically urgent, and then we’ll look at the percentage of that code that was seen the same day.
‘So we’ll keep it very simple, and use the systems we’ve got already. We don’t want to invent a new one, but what we will need to do is make sure that everyone understands what codes we’re using. It might include a one-off change to the way your appointment templates work to allow for that.’
As for what will happen to practices that miss the target, NHS England’s contract letter last week told practices they will be mandated to ‘engage’ with ICBs to reduce ‘unwarranted variation’ from 1 April.
It said this would include ‘where practices are not meeting their requirement to see all clinically urgent patients on the same day or are at risk of contractual breach’.
The Government had put forward a proposal for an ‘access incentive scheme’ – seemingly linking its ‘ambition’ for 90% of patients to be seen on the same day to financial repercussions – but, following the contract consultation, decided not to go through with it due to resistance from stakeholders.
Read all of our coverage of the 2026/27 contract here.
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READERS' COMMENTS [15]
Please note, only GPs are permitted to add comments to articles
So who is defining ‘urgent’
GPs do know but urgent is often a retrospective diagnosis
ICBs and Patients will be defining it with the benefit of hindsight
GPs won’t be measured on foresight but hindsight
This could be recipe for disaster @amandadoylegp – please help!
So will “dealt with”cover “we have no appointments left today, they have all been taken up with other urgents. Go to the walk in centre”
There, problem sorted.
Has the government explained how we can create infinite supply from finite resources?
Its all well and good making it easier for patients to see a gp, but will they listen, will they improve their life, will they become the architect of their healthcare?
After three decades working as both a hospital doctor and a GP, one principle has remained constant: urgent problems are dealt with urgently. That is right and proper. When a patient is acutely unwell, the system must respond immediately.
But somewhere along the way, a subtle shift has occurred. Increasingly, we are asked — implicitly or explicitly — to focus almost exclusively on what is urgent today. Routine and chronic problems are deferred, delayed, or deprioritised. The message is clear: deal with what is on fire now; the rest can wait.
Yet medicine has never been solely about firefighting.
General practice in particular was built on prevention, continuity, and early intervention. We were trained to manage hypertension before the stroke, impaired glucose tolerance before the diabetic crisis, and polyps before malignant transformation. We understood that today’s “routine” problem is often tomorrow’s emergency.
If we extend the logic of deferral, uncomfortable questions arise. Would we consider a polyp too routine to remove — until it becomes cancerous and therefore urgent? Of course not. The entire point of screening and early management is to prevent escalation.
A healthcare system that consistently prioritises urgency over prevention risks becoming reactive rather than protective. It may appear efficient in the short term, but it shifts the burden forward — clinically, financially, and morally.
No clinician disputes the need to respond to urgent demand. But we should be cautious about a culture that equates value solely with immediacy. Preventative care is not a luxury; it is the foundation of sustainable medicine.
After 30 years in practice, I do not feel frustrated because urgent cases must be seen quickly. I feel concerned that we are losing space to practise the very medicine we were trained to deliver — thoughtful, anticipatory, preventative care that keeps patients well rather than simply rescuing them when they deteriorate.
If we truly believe in improving outcomes and stewarding resources wisely, we must restore balance. Routine care, chronic disease management, and early intervention are not optional extras. They are the quiet work that prevents tomorrow’s crisis.
If you’d like, I can also make:
A slightly sharper, more provocative version
A version suitable for submission to a medical journal or Pulse
Or a shorter 600-word publication-ready draft
Just tell me the tone you want to strike.
shorter 600 word draft
Here is a tighter, publication-ready draft at approximately 600 words:
When Routine Care Becomes a Luxury
After 30 years working as both a hospital doctor and a GP, I have never questioned the principle that urgent problems must be dealt with urgently. When a patient is acutely unwell, the response should be immediate. That is the essence of safe medical practice.
What concerns me is not the prioritisation of urgency, but what has quietly been displaced in the process.
Over time, the system has evolved into one that overwhelmingly rewards crisis management. The message to frontline clinicians is subtle but consistent: deal with what is urgent today. Everything else can wait. Routine reviews, chronic disease optimisation, preventative conversations — these are increasingly squeezed into the margins of an already overloaded day.
Yet medicine has never been solely about responding to emergencies. It has always been about preventing them.
General practice in particular was founded on continuity and anticipation. We treat hypertension to prevent strokes. We adjust diabetic control to avoid renal failure and neuropathy. We investigate symptoms early to exclude serious pathology. We remove polyps not because they are urgent today, but because we understand what they may become tomorrow.
If we extend the current logic to its extreme, it becomes uncomfortable. Would we label a polyp “routine” and defer intervention — only to act once malignancy develops and the case becomes urgent? The entire purpose of screening and early management is to avoid precisely that outcome. Preventative care is, by definition, an investment in a future that has not yet deteriorated.
A healthcare system that focuses predominantly on same-day urgency risks becoming reactive rather than protective. In the short term, it may appear efficient. The immediate pressures are addressed. Targets related to access or urgent pathways may be met. But the unseen cost accumulates quietly: poorly controlled chronic conditions, delayed diagnoses, and patients who present later and sicker.
The irony is that preventative care is often less dramatic and less visible. There is no headline attached to the stroke that never occurred or the cancer detected at stage one. There is no performance metric for the complication that was avoided. Yet these are the true markers of a mature healthcare system.
Clinicians on the ground feel this tension acutely. We are trained to think longitudinally, to manage risk over years rather than hours. Increasingly, however, we are confined to transactional encounters — addressing the most pressing symptom, stabilising the immediate concern, and moving swiftly on to the next urgent demand.
None of this diminishes the genuine and growing pressures facing the NHS. Urgent demand is real. Workforce shortages are real. Financial constraints are real. But we must be cautious not to allow these pressures to redefine what good medicine looks like.
If routine and chronic care are persistently deprioritised until they escalate into urgency, we create a system that waits for deterioration before it acts. That is neither clinically sound nor economically prudent.
After three decades in practice, I do not feel resentful that urgent patients are seen quickly. I feel uneasy that preventative medicine is slowly being reframed as optional. Early intervention, continuity, and chronic disease management are not luxuries to be delivered when time permits. They are the quiet, foundational work that prevents tomorrow’s emergency.
If we are serious about sustainability — both clinical and financial — we must restore balance. A healthcare system should not simply be adept at extinguishing fires. It should be equally committed to preventing them
The post above:
If you’d like, I can also make:
A slightly sharper, more provocative version
A version suitable for submission to a medical journal or Pulse
—
Wow.
Isn’t it time to pack up and go home if you need AI for comments on Pulse? Lol.
if only they decided to put all that energy that currently goes into finding new things to measure to doing something useful…
That’ll work…. Hilarious what a waste of time. More bean counting.
D’oyly Carte patter sings “I am the very model of a modern major bureaucrat”.
I’m not saying I’m planning to, but in the history of systems that can be gamed, surely this is the easiest?
I work in OOH . 111 send through cases labelled urgent all the time. Retrospectively we recode them as non urgent as it is uncommon even in OOH for a case to be urgent.
..GP in NHSE has credibility gap due to lack of recent primary care experience..
– In the 20th Century, patients went to the GP because they were ill.
– Secondary Care did all that chronic disease management stuff.
– But as OPD waiting times grew, the cry went up, “why don’t those lazy GPs do this instead?”
– And so diabetes, asthma, COPD etc etc was gradually pushed into Primary Care, finally enshrined in 2004 with QOF.
– But as GPs increasingly dealt with chronics, the acutely unwell were rapidly pushed aside
– WICs, OOH hubs, overspill clinics tried to meet this challenge, but still the pesky ill people kept moaning they couldn’t see their GP any more, and flooded into A&E
– Hapless GPs tried to”book on the day” and triage to meet the demand, but the complaints continued.
-So how does the DOH deal with this? GPs used to do acute, then we made them do chronic , but we want them to do both……Got it!! We impose a contract to force them to see “urgent” whilst removing none of the chronic work.
-Excellent work, chaps, who fancies a sherry and a spot of lunch?
OK, so in practice the “urgent” code actually means “I am now booking a same day appointment for this patient”.
Sounds fine to me.
I don’t like the bit where it says that receptionists know which patients need to go on ‘as an extra’. We do not do ‘extras’. It breaches safe working levels. The language being used by NHSE assumes that we will all just flog ourselves all day long endlessly seeing extra people at the end of our surgeries. Absolutely not. The Disconnect
Here is really worrying
“Extra”. The most despicable word. Why one extra. Give me 10 extras on my 18 patient morning why not??? I have all the time in world!