Access is one of the biggest issues in politics, and GPs are facing pressure on all sides. Cogora, the publishers of Healthcare Leader, have launched a major new report on Access which we feature in our latest report
‘As first steps to deliver the neighbourhood health service, we will restore GP access and ensure a far better experience of arranging care’, reads the Government’s 10-year plan, which has no less than five mentions of the ‘8am scramble’. Meanwhile, a Health Foundation and Ipsos MORI poll published last month found it is the public’s number one NHS priority. GP access is a major political imperative.
Yet ‘access’ is a nebulous term. Is it to do with the availability of appointments? And what kind of appointments – face to face, with a GP, on the day? And is it around waiting times? Or, is it about the ease of patients getting through to their practice?
The answer is, it is all of the above – and GP practices are expected to deliver on it all. And if they don’t get it right, they face pressure from commissioners, the media and patients.
Pressure from commissioners
Successive governments have vigorously pursued access policies. The Healthcare Improvement Studies Institute and the Health Foundation found more than 400 ideas and efforts to improve access to general practice in the UK in the past 40 years, including telehealth and total triage; Pharmacy First and self referrals; the additional roles reimbursement scheme (ARRS); extended hours; AI symptom checkers; and larger scale general practice, among many others.
Many of these, like the ARRS, are incentive schemes, designed to provide funding for practices but others become contractual requirements, enforcing practices to implement certain processes.
Yet much of the time, these mandates. around waiting times, extended access, improving ease of access, mode of consultation (remote or face to face) and all the other initiatives mean practices need to refocus their efforts away from what they feel will benefit their patients’ needs.
Peter Woodward, a practice manager in Cheedle, says patient feedback ‘consistently highlights two recurring frustrations: “you sit forever on the phone” and “you can’t see your GP”.’ But his award-winning practice struggles to address these issues, which matter most to their patients: ‘Rather than adopting a patient-centred strategy to address these areas, which directly affect the majority of our patients, practices are frequently drawn into a wide range of other important but competing priorities: neighbourhood integration, screening uptake, vaccination drives, outbreak response, locally commissioned services, ICB initiatives and public health campaigns. Each has merit, but the absence of an overarching framework to align these with core patient expectations risks leaving patients dissatisfied and staff demoralised.’
A case in point of these national demands is the contractual requirements set to be introduced in October 2025 that will oblige practices to keep their online access portals open from 8am to 6:30pm every day, make sure patients can walk in and keep phone lines open. While this is something that all practices would ideally want to offer, it will have implications for provision of care while their capacity remains as it is.
A GP in the Buckinghamshire, Berkshire and Oxfordshire ICB area says: ‘The 8am to 6:30pm online access is unsafe. We will have to block appointments to cover this safely, as people always put in clinically time-critical requests despite red flags warnings and pop-ups. A recent example was a mother asking about a 15-day-old baby with a sticky eye – buried in this was a comment that her baby was making grunting sounds with her breathing.’
Policies like this lead to practices changing their processes, and often in a way that doesn’t benefit direct patient care. As one GP in North West London puts it: ‘Patients just want phones answered and patches to be open all day. So we have hired an extra receptionist to achieve this metric.’
It is not only national policy that creates pressure for practices – there is local commissioner pressure too. Cogora’s surveys of 789 distinct practices (see methodology) reveals that the most common pressures involve telephone waiting times and appointment waiting times, with more than half of practices saying they had felt pressure on each. Pressure around face to face/remote and seeing the preferred healthcare professional is slightly lower.
As one GP from Cornwall put it: ‘We have felt clear pressure from local commissioners to improve several key areas of patient access and experience. This includes reducing overall wait times, shortening the time patients spend waiting on the phone, and increasing opportunities for patients to see their preferred clinician to support continuity of care.
‘There has also been a strong push to offer greater patient choice in the type of appointment – whether face to face, telephone or online – to better meet individual needs and preferences. While these aims are understandable and align with improving patient care, they add to the operational demands on already stretched services.’
Dr Rebecca Lewis, a GP in the Black Country, says her local framework asks for a certain number of appointments per 1,000 patients per week, and this has recently increased. ‘These can be appointments with anyone in the practice – not just doctors – so the targets are easy to hit, but one has to ask why we need them? If we were free to decide who needed and would benefit from our time the most, within reason, I am sure primary care would offer enough access (of the right kind) to the patients who need it most.
‘The issue with all this is there has to be targets and that way they can be measured. But you cannot make the medicine fit the money, and trying to do so leads to moral distress and burnout, and makes people walk away from the jobs they trained long and hard for. This ultimately punishes the patients when practices close, cannot recruit or have very high list sizes with poor continuity and high staff turnover.’
Media pressure
This pressure also comes from the media. In February 2021, at the height of the Covid pandemic, a study by sister title Pulse found that almost half of all articles (45%) about GPs had a negative slant. This was compared with around 19% in 2019. Furthermore, the number blaming GPs for access problems – for example, that practices were ‘refusing’ to see patients – increased from 12% to 20% over the two years. While it is true that face-to-face appointments did decrease during the pandemic, this was following advice from NHS England, and even encouragement from then health secretary Matt Hancock.
The media coverage has remained fairly consistent since. The Mail and the Telegraph have both launched tools using appointment data and patient satisfaction scores allowing readers to see how their practice compares. The Mail’s article was headlined: ‘The ultimate guide to all of England’s 6,000 GP practices – so is YOURS one of the worst? From how jammed their phone lines are to the competition for appointments, our search tool reveals all…’. Meanwhile, the Telegraph asked: ‘Are you waiting too long for a GP appointment? Use our tool to find out.’
A number of respondents to Cogora’s surveys referenced the effect of this media pressure on their morale. One practice manager in Norwich put the blame on the media for the perception of general practice: ‘The media are the main issue, telling patients stuff that is only half true, or is indeed entirely false.’ This was echoed by a GP respondent: ‘People do not wish to wait, they are fuelled by the media that GPs do nothing all day.’ One GP questioned the wording of our survey (see chart below), asking: ‘When you say “online abuse” do you mean from patients, or the constant low level abuse from the Daily Mail, the Telegraph, the BBC, etc? That’s pretty demoralising too.
One GP in south Wales said the media coverage was worse than individual complaints: ‘Personally, I think the abuse I take to heart is about primary care/GPs in general in the news/social media and not directly at me.’
It is also common to see local news sites ranking the ‘best’ and ‘worst’ GP practices in their region based on appointment data and patient satisfaction. A practice manager in Blackpool said: ‘We’re not supposed to be booking more than two weeks ahead or we are negatively highlighted by the local press. Sometimes patients need a follow-up in 3/4/5 weeks’ time and so these patients are battling with everyone else trying to get an appointment, but with their chosen GP, as it’s a follow-up.’
The patient-practice relationship
Regardless of the media’s role in dissatisfaction with GP access, the patient-practice relationship has been deteriorating since the start of the pandemic.
Our survey results found that complaints around access had risen since the start of Covid, with 37% of 790 GP partners saying they had increased significantly, and a further 37% saying they had slightly increased. Applying a midpoint analysis, respondents said that around 31% of complaints relate to access.
Meanwhile, half of the 1.074 GPs say they receive verbal abuse around access ‘often’ or ‘occasionally’. One locum GP in Cornwall said: ‘In my experience, since the post-pandemic era, patients have been increasingly abusive, demanding and entitled towards GPs and other practice staff. Language and attitudes which would have been a rarity before 2020 are now almost a daily occurrence. I have been sworn at multiple times a day, usually when I do not give a patient what they want or discuss waiting times with them. It has led me to increasingly pursue private medicine, and I suspect I will leave the NHS entirely in the near future as a result of the workload pressures, under-resourcing and patient behaviours and attitudes.’
These complaints can even carry a legal threat. As one GP puts it: ‘It is common for lawyers to slip an access criticism in there in addition, especially for weaker claims!’
A few survey respondents cited the ‘Amazon’ or ‘Tesco’ culture, with comments including: ‘They want instant Tesco style, open all ours care’; ‘Amazon Prime mentality means the patients just want everything now’; and ‘Patients today are increasingly influenced by the immediacy of modern services – such as on-demand streaming, next-day deliveries from Amazon and instant online customer support’.
One Ayrshire GP partner says: ‘Patients “want” to have same day access to GPs, but, when they do, most of them demonstrably have no need to do so, and their actions are delaying the care of those who need it. I don’t mind speaking to them – I’m very fond of my patients and want the best for them – but I do mind when it degrades the care that I can offer the people who need it.’
However, there was sympathy for patients’ frustrations from many GPs and staff. In terms of on-the-day care, one GP in the north east of England says ‘people have a way of knowing when something can wait and when it can’t’, with another adding that ‘most on the day appointments turn out to be urgent/semi-urgent/important like suspected cancer etc’.
There was also an acknowledgement that general practice staff and patients share frustrations. One says: ‘Almost every patient rants. I tell them that the system is broken and I share their frustration. And then I try and move on to what they need. It’s terrible for patients.’
But this shouldn’t descend into abuse of staff, a GP in Cornwall says: ‘We have unfortunately faced abuse from patients due to access issues. This has included occasional incidents of physical abuse, multiple instances of verbal abuse, and increasing levels of online abuse directed at staff. While we understand the frustration patients may feel around access, such behaviour has a significant impact on the wellbeing and morale of the team.’
One of the interesting aspects of this is that this deterioration in the practice/patient relationship is coming at a time when appointment numbers are rising across the board – but patient satisfaction is not reflecting this, as we will see in the second part of this series.
Survey methodology
The surveys by sister brands, Pulse and Management in Practice, were open between 2 July and 21 July 2025, collating responses using the SurveyMonkey tool. The survey was advertised to readers of via our websites and email newsletters, with a prize draw for a £1,000 voucher as an incentive to complete the survey. The survey was unweighted, and we do not claim this to be scientific – only a snapshot of the primary care staff populations.
Where we say ‘distinct’ practices, GP partners and practice manager respondents were asked to input their practice code, their practice name and their post code. Where this wasn’t clear, we correlated this information with official data. Where this still wasn’t clear, we searched practice websites. All those without the required information after this research were removed. For duplicate practice codes – more than one respondent from a single practice – we remove duplicates in the following order: Those who provided fuller information (ie, fewer blank answers and ‘don’t knows’) were prioritised; After this, GP partners were prioritised over practice managers; After this, those who answered first were prioritised.
This left a remaining 797 ‘distinct’ practices, represented by 471 GP partners and 326 practice managers.
Pressure from commissioners: Survey of 789 distinct practices across the UK (see methodology). Respondents were asked; ‘Have you felt pressure from local commissioners (ie, ICBs, health boards or trusts) to improve the following: Time patients spend waiting on the phone for the practice to answer; Waiting times for appointments; Patients being able to choose form of consultation (ie, face-to-face, remote, home visit); Patients seeing their usual/preferred healthcare professional.’
Patient complaints: Survey of 790 GP partners after ‘Don’t knows’ were removed. Respondents were asked: ‘Roughly what percentage of in-house complaints relate to access issues? 0%; 10%; 20%; 30%; 40%; 50%; 60%; 70%; 80%; 90%; 100%; Don’t know.’ To work out the average, we applied a midpoint analysis.
They were then asked: ‘Has this percentage increased or decreased since before the Covid pandemic in 2020?’ Significantly increased; Slightly increased; About the same; Slightly decreased; Significantly decreased; I wasn’t working pre-2020; Don’t know.’ Again, ‘Don’t knows’ and ‘I wasn’t working pre-2020’ were removed from the analysis.
Faced abuse: Survey of 1,054 GPs. We asked: ‘Have you ever faced abuse from patients due to access issues? Physical abuse; Verbal abuse; Online/social media abuse.’ The answers were: ‘Yes, often; Yes, occasionally; Once or twice; No; Don’t know.’
You can find all the data and the methodology in the full report. Click here to download the full report.
Commercial partner of this white paper: General Practice Solutions
