GP contract changes that dictate how patients are able to contact their practice have negatively impacted patient care and practice staff, an extensive new survey of over 1,300 practices published by the BMA today reveals. 

More than 1 in 5 practices in England responded and over 1,300 unique practice responses were recorded. Of these, the majority (73%) had to change their ways of working due to the contract change.

42% of practices have had to reduce face-to-face appointments - all reducing the time patients spend with their family doctor. 45% of these practices said they’ve had to redeploy staff to accommodate for the changes. Over half (55%) of these practices had seen a negative effect on patient care. Despite GPs warning of the risk of patient harm, 74% of these practices said they’d seen an increase in workload, 68% reported an increase in stress, and 54% said there was an increase in working hours.

On 1 October 2025, the Government introduced changes to how patients contact their GP practice via online platforms. In what it says was an attempt to ‘end the 8am scramble’, the Government imposed the requirement for all practices to provide continuous online, telephone and in-person access throughout core hours (8am – 6.30pm, Monday to Friday) without delivering the promised necessary safeguards to prevent urgent requests and queries being accidentally submitted online by patients. GPs have confirmed in these survey responses that urgent and emergency, requests have been submitted online, risking patient harm and staff stress / anxiety, which compounds the existing workforce pressures felt across GP practices in England.

The General Practitioners committee's current dispute with the Government includes this issue, after it failed to meaningfully engage with GPC England to deliver the necessary safeguards prior to 1 October 2025, as per GPC England’s conditions to agreeing the terms of the 2025/26 contract.

Relevant safeguards could include:

• ^{Engaging with IT software providers find IT solutions that work for patients and practitioners.}
• ^{Flexibilities in allowing practices to suspend online triage if and when they become overwhelmed on any given working day and safe care is threatened whilst telephones stay on and surgery reception desks remain open.}
• ^{Increasing practice resources and staffing capacity to manage online requests and queries beyond the end of the currently contracted core hours of 8am - 6.30pm}

GPC England has repeatedly said that patient access must be clinically safe. To ensure that happens, practices must retain the ability to manage their consultation systems safely, including when demand exceeds safe capacity, rather than being forced to prioritise convenience over patient need in a woefully under-resourced environment. Over half of practices implementing the change reported that there had been a negative effect on patient care, and 70% revealed that their practice had received requests that are medically inappropriate – mostly urgent requests coming through as routine/non-urgent, and an increase in requests that should not come to a GP practice at all.

Practices have shared their experiences with the BMA since the change came into effect on 1 October 2025: 

Urgent requests coming through as routine or admin requests

•  ^{"Patients submitting requests/queries for things that they need to go to A&E for at all hours of the day - you have to be vigilant to spot these requests and quickly divert them to A&E. If we are not manning the inbox constantly these will be missed."}
• ^{"Patients using this as an admin query when they should be calling 999 for a medical emergency e.g. hypotensive, tachycardic and breathless!"}
• ^{"Almost daily getting urgent requests through the online portal despite clear messaging that it should not be used for such and to telephone for on the day access instead."}

Respondents said that patients deliberately bypass the triaging systems/routing on the platforms, by marking an urgent query as non-urgent

• ^{"Urgent requests being initially declined by online software, only for the patient to then change the answers immediately on a new consultation to allow it to be submitted!!"}

Serious risk of patient harm 

• ^{"Patient submitting request at 6.20 with high fever and now bedbound being unable to move and breathless. Required an ambulance to take into hospital to treat for sepsis."}
• ^{"Use of sick note request forms requesting time off but also detailing significant deterioration in mental health requiring a consultation."}

Issues have specifically worsened because of the 1 October changes  

• ^{"Keeping online consultations open until closing time [6.30pm], regardless of whether the practice has reached capacity, increases the likelihood of urgent requests being submitted that may not be processed before the end of operating hours."}
• ^{"When practices were able to close their online platforms earlier in the day, any patient contacting the practice in the later afternoon would need to walk in or telephone the practice. Since, in that scenario, they are speaking to an actual person (two-way conversation), it is much more likely that urgent matters are picked up immediately and dealt with straight away."}

GP services are now easier to contact than other services, increasing the volume of requests 

• ^{"Due to online consultations being open during core hours, GP services are now easier to contact than ever before.  Respondents noticed more queries coming in about hospital matters – asking their practice to chase the hospital about results, or contacting their GP instead of attending A&E."}
• ^{"If the access is ‘too easy’, the volume of very minor things goes up - and that’s what we’ve seen."}
• ^{"When the volume of requests becomes unmanageable, triage becomes harder, and the risk increases that ‘false routine requests’ that are actually urgent are not picked up in time."}

BMA GP committee chair Dr Katie Bramall said:  

“Government is right that GP is the front door to the NHS, but they are wrong in refusing to understand how it works. To have over 1000 practices respond as quickly as they did, shows the impact of how badly government have chosen to embed these changes, with 6 in 10 remaining extremely unsupportive, and 2 in 10 somewhat unsupportive. Over 4 in 10 are having to reduce the number of GP appointments they can offer to their patients so they can manage/triage online requests and queries instead. If government had chosen to listen to us and work with us, we could have made this so much more of a success.  

“There is still ample opportunity for Wes Streeting to engage with us and help rebuild general practice, which would transform the NHS experience for the 1.5 million patients who use it every day. The public want more GPs delivering more appointments to fix the NHS. 

“We will continue to comply with the changes brought in on 1 October 2025 under protest, whilst exploring all options on how best to deliver transformative and safe change for general practice in England. Any action we take will be measured, informed, and undertaken only to defend GP partnerships and the safe, GP-led community-based care patients and their families rely upon.”

 

Notes to editors

Survey metrics

• Total unique responses: 1,341 (22% of practices in England)  
• Total registered patients represented by responding practices: 13,988,827 (22% of registered patients in England)  

Regional Breakdown: 

East of England - 178 
London – 147 
Midlands – 329 
North East and Yorkshire – 234 
North West – 154 
South East – 142 
South West – 155

•  Reponses were verified by practice ODS code; duplicate responses and those with an invalid ODS code were not included in the results.  
• https://www.bma.org.uk/gpcontract

The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.