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GP ‘eight o’clock rush’ is ‘not acceptable’, says NHS England director

GP ‘eight o’clock rush’ is ‘not acceptable’, says NHS England director

GP practices need to find ways to prevent the morning ‘eight o’clock rush’ of calls from patients who struggle to get through to the surgery, NHS England’s primary care director has said.

Speaking at a webinar for GPs at the end of last month, Dr Amanda Doyle said patients not being able to get in touch with someone at their practice the first time and having to call repeatedly was ‘unacceptable.’

She said updated telephone systems with features that can better manage the volume of calls and improved digital access would help avoid the problem.

Dr Doyle said she could accept that practices were not able to deliver timely appointments because of the pressures of demand. But, she said, she ‘struggles with’ practices not being able to make ‘an offer’ to patients the first time they contact the practice.

This is the issue that people most complain about, she added.

‘I don’t get complaints like, “I contacted my surgery, and no one could see me for two weeks”.

‘What we get are endless, enormous numbers of complaints, which say, “I couldn’t get in touch with my surgery, couldn’t get through on the phone, couldn’t get to speak to anybody, nobody got back to me, I had to keep trying again and again.”’

Dr Doyle said something had to be done urgently about patients’ ability to get in contact with general practice.

‘We absolutely have to get rid of this eight o’clock – or perceived eight o’clock rush – that we see in lots of places where everybody tries to ring in at the same time and can’t get through.

‘People who do get through then tell us that they were asked to go somewhere else or call back tomorrow. I don’t think it’s acceptable,’ said Dr Doyle.

To improve the situation, she said new telephone systems need to be installed, as 65% of practices use old analogue systems that don’t have the ability to signpost people or feedback data to practices about who is calling and why.

There also needs to be greater focus on improving digital access for patients.

‘The more people that want to contact us digitally, the more the phone lines are free for those who can’t,’ said Dr Doyle.

Practices have to make it easier for patients to find the information they need to stop them from having to call in, she added. 

During the webinar, Dr Doyle also called for a reassessment of the job that GPs do, since being a funnel for patients to access ‘isn’t the best use of GP time’. Instead, primary care needs better integration of community services, such as pharmacies, nursing services, end-of-life care and social services.

‘Let’s look at how we can change modes of access for patients so they can access some of their services directly,’ said Dr Doyle.

‘And in the medium and longer term, we’ve got the Fuller stocktake that sets out a vision for what an integrated primary care service in the future might look like.’

However, she added, she didn’t underestimate the infrastructure work required to move to make that vision a reality and isn’t a solution for this winter, or even next.

‘It might be the solution for five- or 10 years’ time,’ she said.

Meanwhile, to cope with patient demand, Dr Doyle recommended a number of suggestions to help with recruitment to increase capacity. These included creating a bank of reception and admin staff who could come into the practice and already be familiar with its systems, in order to cover staff absences.

She also called for alternatives to the partnership model for GP practices that are struggling to recruit partners or are having to hand back contracts.

‘I don’t think it’s the end of the partnership model,’ said Dr Doyle. ‘It works really well in lots of places around the country.

‘But I think we need a range of alternatives that can go alongside that for when practices are struggling.’

A version of this article was first published by Pulse’s sister title Management in Practice



Please note, only GPs are permitted to add comments to articles

Douglas Callow 6 December, 2022 5:25 pm


Andrew Jackson 6 December, 2022 5:27 pm

This kind of article from our political leadership just shows how little they understand the front line and why the 8 o’clock rush happens.

neo 99 6 December, 2022 5:29 pm

Highlight the issues but no solutions as expected from NHSE leadership. What kind of “offer” can practices make to patients when they first contact when they have no capacity? Phone lines need staff to answer calls and most practice already have digital phone lines. Digital access is also not a solution. There is still a clinical decision maker responding to digital queries which often takes longer than seeing a patient as the information provided is often inadequate and needs clarifying. A digital back and forth ding dong is neither efficient or satisfactory for the patient or the clinical decision make. At the end of the day, for an efficient quality service you need the right amount of staff and time to deal with the bums on seats demand but can’t see that happening. The whipping continues.

Pradeep Bahalkar 6 December, 2022 6:23 pm

If my practice start offering appointment for every patient who wants appointment and books one which is next available. We will be booked for next 4-6 weeks immediately. Will Dr Doyle be happy then. As every patient who called got appt on the first contact. they were not asked to call back tomorrow or they were not asked to go to Walk in centre or extended access clinic.
First solve the problem of capacity then talk about access.

Pradeep Bahalkar 6 December, 2022 6:26 pm

If patients had to pay 3-5 pounds for appointment this problem of having to wait for 2 weeks to see GP will get solved overnight
. Does anybody has got guts to bring on charges?

Simon Braybrook 6 December, 2022 11:33 pm

I know. How about we offer 12-24 appointments at 8am
Then 12-24 more at 10am.
Then 12-24 more at 12 etc.
Then we wouldn’t have an 8am rush! Just a series of smaller rushes throughout the day!

That would fix it.

Unless … the problem isn’t the rush, but the fact that there’s too much demand and not enough doctors to cope with it.

David Jarvis 7 December, 2022 8:43 am

The only rate limiting step in a free all you can eat buffet is the queue. If you don’t want a queue you need to add a different rate limiting step. Or if you believe in the free market the money has to follow the demand so that meeting the demand with extra staff is matched by the required resources. Pay per appt by somebody? But that isn’t going to fly because they know they couldn’t afford it.

Sam Tapsell 7 December, 2022 12:32 pm

I also cannot see a mechanism to match demand and supply except by payment for an appointment.
What else would encourage a new GP to work in an area short of GPs?
What else would encourage existing GPs to work longer, later, or into weekends? Maybe pension / tax changes could help a bit.
I also have lots of concerns about payment for care, health inequalities etc, but other countries seem to make it work.
A poor family in an area without GPs is not well served at the moment.

ANTHONY Roberts 7 December, 2022 2:10 pm

It is not rocket science.
I suspect Dr. Doyle has not spent time in a GP surgery.
It there are only 8 workstations available and 8 members of staff to handle the incoming phone calls then only 8 can be dealt with at any 1 time. If there are more calls then they have to wait.
You can have any sort of clever telephone system but if demand is greater than it can respond too then a queue will develop. No diktat from any NHS manager is going to solve it.

Decorum Est 7 December, 2022 2:46 pm

England’s primary care director Dr Amanda Doyle said ……

Patrufini Duffy 7 December, 2022 5:16 pm

A public nobody put in a complaint after getting a next day appointment for her child. Yes within 24 hours. The issue was “conjunctivitis”. The child was seen next day. The child was normal. The eye was normal. She wanted a same day for “that”.
Normal. Nothing was given for normal.
And complained.
Made in UK.

Andrew Pountney 7 December, 2022 9:44 pm

Dear Dr Doyle. As a front-line GP I ‘don’t get’ why NHSE and government think it is ok to publicly release ‘time from appointment booked to being seen’ data and push the invalid narrative of this being a ‘waiting time’; misrepresenting practices who do exactly as you are asking as poorly performing with longer ‘waiting times’ vs practices who just don’t pre-book and so patients never enter those figures. Such data is damaging and will only potentially worsen the 8am rush if practices are forced to respond to avoid unfair criticism. Maybe therefore get your own house in order before casting aspersions?

Anonymous 8 December, 2022 12:47 am

Playing devil’s advocate, have you ever tried calling your own practice to get an appointment?

Appointments are gone within the first hour if not sooner.

The problem is often with lines getting overwhelmed in the first 15 minutes and calls dropped automatically.

1.Upgrade your phone systems for them to keep all calls in a queue, not drop the calls because there is a lot of them.
2.Ask all your admin and reception staff to only answers calls in the first hour.
3 Allocate appointments according to in-house agreements with any overflow redirected elsewhere (econsult, 111, local hub etc) .

Simply being told by a receptionist at 0810 to ‘try again tomorow’ is just not good enough in this day and age. It’s all about more efficient triage.

Sam G 8 December, 2022 1:55 pm

But an 84 female on floor for 18 hours with broken hip is acceptable?

Patrufini Duffy 8 December, 2022 4:46 pm

Like kids in a sweetie shop. Find more sweets. Or give them a piece of your own. To those selfish kids that shouted and already came yesterday, and those others that threw their sweets on the floor last week – treat them all like angels, they can do no wrong.

Patrufini Duffy 8 December, 2022 11:44 pm

The last time I checked in the real world, of less cover-up and more truth, most patients calling a hospital are hung up on after switchboard, met with an answerphone or receptionist that works Monday and Thursday only and doesn’t cover that team anyway, and so let’s wish for the best. Let’s not even start if a GP calls a hospital. So wow, a GP rush at 8am? – because chemists open at 9am, physiotherapy is shut, IAPT is shut, GUM is closed, they’re bored of waiting 8 hours in A+E for chest pain and hospital receptionists start at sometime. 8am gimmicks, to bailout the fortress, and entire system that does no wrong. Comedy. I’m sure you can ask dentist receptionists to help out with GP issues no? – ofcourse not, just let GPs take their dental calls too.

Albert Barcellos 10 December, 2022 8:54 am

Even the best systems e.g office of public guardian keep you waiting 2 hours and you could be the 72nd person in queue …I was. Hung up after 2 hours. Same with other bodies like council.

Carpe Vinum 13 December, 2022 11:06 am

How’s about addressing the other side of the coin which tries to tackle the fact that the GP surgery has become the de facto first-point-of-call for everything from social problems to delayed hospital outpatient appointments to any number of fatuous queries. If anything we have become too accessible. It’s Parkinson’s Law gone crazy and the answer is much like the A&E endless debate – yes, you can increase capacity endlessly but at some point we need to have an honest conversation about preventing inappropriate use/abuse of the system

Centreground Centreground 13 December, 2022 11:13 am

New shiny telephones with lots more data and graphs to look at should sort this GP/workforce crisis -no problem.
When the the 8am rush becomes an 8am, 11am and 3pm rush what should we change next ?
Maybe extra front doors so easier to get into the surgery for patients??