NHSE primary care director Dr Amanda Doyle: Patients deserve consistent online access
NHS England’s national director for primary care and former GP partner Dr Amanda Doyle argues that the changes to online access are essential for general practice to keep pace
I know that some GPs have concerns about some of the changes to the contract that kicked in on 1 October. So let me tackle these concerns head on.
First, I know change is hard, but I want everyone to know that everything we are doing is based on what patients tell us they want and crucially what will also work for GPs.
Colleagues and I spend a lot of our time listening to GPs and as you know, I am a GP by background, so it should come as no surprise that the input of family doctors is critical to our plans.
That’s why we know how challenging it has been in the last two years as the operating model for general practice has completely shifted and we recognise that practices will often need support to make the change effectively.
It’s important though that general practice keeps pace with the shift to online access that people want, and which they see in every other aspect of their lives. Like it or not, we simply can’t afford to be left behind.
We made the contract changes to ensure that those contacting online received the same access and experience as those who phone up or walk in.
Inconsistent or variable switch-on of online consultation systems makes that impossible. Patients deserve better than that.
So, in 24/25 we signalled the change by financially incentivising having online systems switched on throughout core hours. 85% of PCNs told us that all their practices had achieved this and claimed the funding. The fact is not one of these PCNs reported safety concerns.
Therefore, for 25/26, we consulted the BMA’s General Practitioners Committee (GPCE) on making this a core contractual requirement, accepting a delay until 1 October so practices had the first half of the financial year to get ready.
The GPCE agreed the proposal, and the wider contract – and we have shared the various communications which confirm this. Therefore, none of this should come as a bolt from the blue.
We hope that by offering consistent online access throughout contract hours we will continue to see the channel shift to digital access that has already emerged, and that phone line access will be increasingly freed up for those who can’t, or don’t want to, use online consultation requests.
The added benefit of all this is that practices can actually better control their patient flow. Practices who have already made this change, and those who have gone further and offer online access 24/7, tell us it makes their work easier to manage and increases patient satisfaction.
Transparency matters and we are closely monitoring the numbers and profile through the day of online contacts both before and after 1st October and will publish this alongside the telephony and appointments data shortly.
This is important to help us quantify the real demand upon general practice – the first step in ensuring we have enough supply to meet that demand.
But from personal experience as a GP partner, I know that amount of change is going to be more difficult for some practices to implement than others, and it is understandable that many GPs feel anxious about how this affects their work and their patients – but you aren’t on your own.
We want to support you to make the change and anyone struggling to do so should contact their ICB to discuss the support available.
The signs so far are positive. In August, for the first time, the ONS reported more people choosing to contact their surgery online than by phone, with people reporting that contacting online was significantly easier.
GPs are some of the best NHS innovators and the work you’ve all done over the last few years is paying off. We’ve seen patient satisfaction with access to GP increase by almost 15% in little over a year, without compromising continuity. In fact, 67.5% of patients in the most recent ONS survey said they were able to see or speak to their preferred healthcare professional.
Alongside this, we’ve turned round more than ten years of declining GP numbers and since April 2024 we’ve seen significant, steady increases in the number of GPs in the workforce. The shoots of recovery are there – we now need to encourage the growth.
I am determined to keep listening to your concerns and to work to address them as consultation for the 2026/27 GMS contract begins in the coming weeks.
We will consult with GPCE as we usually do but also talk to a range of other groups so that we hear from a wider group of primary care stakeholders, including patients.
Finally, thank you for all the hard work you and your teams are doing to continue to serve patients, improve access and prepare for the winter ahead.
Dr Amanda Doyle is NHS England’s national director for primary care and community services
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READERS' COMMENTS [22]
Please note, only GPs are permitted to add comments to articles
Amanda, with the greatest respect, is it really right that patients now submit multiple triages on a daily basis for the same thing or for completely trivial issues. These changes over the last 2 years have just resulted in an absolute explosion of worried well demand which will result in almost no improvement in health of the population. If patients attach no value to the service they are receiving, which they don’t, then there is no effort whatsoever to self manage and self care. We have essentially encouraged a belief that the NHS will sort it out for them,
Ease of access and consistency is important but Healthcare is a finite resource and demand is currently exploding and to be honest it is being led by people who need it less, that is the issue. If the demand was need led I would have less concerns but it absolutely isn’t.
Patients deserve to be seen within 18 weeks and cancer treatment to start within 62.
They deserve to be seen quickly in AE, but the system is so stretched that these targets are impossible. While hospital targets are being taken away, they are flogging the GP horse and insisting on same day targets.
They can’t improve waiting lists, can’t improve hospital care but they can batter GPs and that’s what they are doing
Patients deserve to have better NHS England and government leaders who also carry the support of the professions.
Sadly the GPC agreed this , not sure what mandate they felt they had for that but we are now where we are!
The real problem is requiring a same day response , which means a one minute response at 1829!
That should be 24 hours at least as this is for non urgent requests.
in every other walk of life you get a chatbot with digital access , is that what patients want Amanda?
This will just increase demand to a service already swamped and with an ever reducing share of the NHS budget.
Lord Darzi said funding increases to primary care should be hard wired in , it’s the government’s report so make that happen !
I don’t buy Doyle’s breathless sales push – it smells of the vested interests of Big Tech.
For sure, online access in the future – but not while general practice is being ventilated in ITU. Nor before appropriate Funding, and staffing is in place. And certainly not before legal guarantees that the sovereign online data will not be used for (Palantir’s) LLM training and algorithm design.
Disingenuous factually inadequate nonsense ignoring finite capacity, safety whilst encouraging the infantilisation of the computer savvy healthy at the expense of those that actually ‘deserve’ GP access
“Practices who have turned it on 24/7 say it makes their work easier to manage and improves patient satisfaction”
We are contracted 8-630. Please tell me this isn’t actually happening.
Turncoat
it also creates- IMO- alot of duplication- we message patients back with an appointment and they don’t respond so then we have to call them to avoid wasting the appointment (which wouldn’t be necessary if they booked it with reception in the first place) also we seem to be like some kind of instant messenger with patients responding asking for an appointment 10 minutes later or after working hours which is usually impossible. when you speak with someone at the desk or on the phone – the issue is usually sorted out by competent staff within minutes – but the online stuff just creates more running around/duplication/waiting for responses from patients blah blah…it seems to create MORE inefficiency not make it better! ghastly!
Patients deserve what they’re willing to pay for as net taxpayers
For most of our patients this is – less than 0
For the mean number of our patients this is about £160 a year
So, not a lot.
Dear Amanda
I actually agree with the thrust of what you say
BUT the insistance on ‘core hours’ is a bad mistake
If you just rolled it back and made it 08.00 – 17.00 I think most of the noise would go away
Please consider
At the moment, with all due respect, you just come over as supercilious and inflexible
Kind regards
Bruce Allan
Yes, we (patients) do.
So bring back 24 hour access to our own familiar, local GP, within our own local town, 24 hours a day !
It might cost you a bit more Amanda, but why not, eh?
Do tell us, Amanda, if everything worked so well in 24/25 and you spent so much time and care getting an agreement with GPCE in February 25 why did you find it necessary to shift the goalposts by imposing mandatory contractual variations in July 25?
We have been let down and gaslit by NHSE too many times before to retain any faith or trust in this organisation, and by inference, with all due respect, yourself.
You cannot manage infinite demand with a finite and inadequately resourced service. GP’s and their teams are going to collapse and give up. Then what is left of the NHS is going to be in an even worse mess
All is for the best in this best of all possible #NHS worlds!
How very patronising “change is hard”.., does she realise how much general practice has changed since the time when “she was once a GP”. Change is not the problem here. GPs embracing technology is not the problem here. The problem is the age old issue of human behaviour – give them unlimited access to something for free and they’ll take and take and take until there’s nothing more….
Change is hard and hence why some GPs/ doctors jump ship to continually failing quangos such as NHS England or alternatively the DHSC .
I think regarding action and dispute with government
I think mass resignations signing pre date etc pointless because they don’t do anything and Streeting happy to call GPs bluff. Already done that with this move to stop negotiating with BMA or GPs at all. But withdrawing from pcn des is powerful. As that doesn’t breach contract and will utterly block their planned fuller Darzi polyclinic nhs neighbourhood plan as they hope to implement that through PCNs. Pcn is the size of neighbourhood centres which I think they want to be the acute GP part with nurse practitioners and one GP overlooking and gauge out that part of the GP contract to separate it. Then hoping for ‘entrepreneurial’ GPs/PCNs to jump on board with finanacial incentives and divide and conquer done. The fact they will sign up the public to pay tens to hundreds of billions for the neighbourhood centres by PFI we don’t need is no concern to them as the private companies benefiting from this under Blair (80 billion from the last PFI) doesn’t matter. Tax payer pays and Streeting will be long gone into his long term role for a US multinational take your pick of Pharma, private health,etc.
I would collectively ditch pcn des. Doesn’t even matter if some don’t any amount will cause chaos and any other contractually compliant changes eg all shared care ended, literally anything on that BMA list that GPs do that we are not contracted for. But mainly pcn des, because it is central to their 10 year toxic plan and blocks that
I am fed up with these so called ‘GPs’ telling others how to do the job. They are so far removed from reality it is ridiculous. I doubt she has had to work a GP session in many many years. Likely took that non-patient facing role for reasons we all know. They then have the audacity to tell us how to do our job. Patronising Duck.
Dear Amanda
If you really wish to understand (and I sincerely hope you do), I challenge you to spend a day shadowing my clinical triage day on a Monday.
Then you will get a measure of the capacity/demand mismatch this policy has created.
And YOU and your government friends will go down in history as the party who created GP waiting lists in the order of 6-8 weeks.
Another useful lapdog for the politicians.
This is a shameless gaslighting piece reminiscent of of a Soviet Commissar congratulating us on tractor production.
We need the GPC to abandon the NHS ship
OK, so ‘consistent’ means the same at any time, any location.
Only way to achieve that is if we all switch our online access systems completely off, all the time, and patients will get consistent zero access. fine if you say so.