From 1 October 2025, to comply with new contractual requirements in the 25/26 contract, and to avoid the risk of receiving remedial or breach notices from ICBs, practices must:

• have an online consultation tool, which is available to registered patients throughout core hours (8am – 6.30pm), to allow them to make non urgent / routine appointments requests, medication queries and administrative requests. 

The necessary safeguards, which DHSC and NHSE committed to working with the BMA GP Committee (England) and others to implement before bringing in the contractual changes, had still not been put in place by 1 October 2025. GPC England is therefore now in dispute with DHSC and NHSE over these requirements, as well as changes related to GP Connect: Update Record and the lack of progress on GMS renewal and investment. Further details on the dispute can be found here. 

The below guidance aims to provide practices with practical advice on how to approach these new requirements while GPC England continues to seek the necessary safeguards.

• Online consultation requests – managing patient care safely
• Setting up your online consultations and appointment
• Choosing an online GP consultation platform

In addition, GPCE has also developed a number of resources to assist practices:

• Your practice charter – for your practice website
• FAQs for 1 October 2025 online consultations (reissued on 13 October 2025)
• Template Letter from GP practices to ICBs requesting support to manage care safely
• BMA branded template letter for GP practice notification to ICB of patient safety concerns related to online access
• GP online consultations poster (PDF)
• GP online consultations poster (word version)
• Downloadable graphics: graphic 1, graphic 2, graphic 3

Other relevant guidance

• Managing demand and capacity
• Waiting lists in general practice

Your online consultations and appointments

Under your contract, practices must provide appointments sufficient to meet the reasonable needs of your patients. Neither GMS nor PMS contracts specify a fixed number per practice registered list size, so this will be influenced by the practice population and how patients choose to use online consultation tools. However, use of online consultation tools must be done in a way that is safe for patients and practice staff. Signposting and triage are safe and effective ways of delivering care, although not all practices will wish to adopt a “total triage” model as it won’t necessarily be clinically suitable for their registered patient list.

Triage allows practices to:

• provide patient appointments more flexibly and utilise other members of the practice team (clinical or administrative)
• direct patients to the most appropriate provider of care, which may not be within the practice team and
• prioritise care based on patient need.

The October 2025/26 contractual changes outline that online consultation tools must be available throughout core practice hours (8.00am to 6.30pm) for patients to submit requests and queries. For urgent requests, patients should be advised to contact the practice via the telephone or walk into the surgery.

In practice, we know it can be challenging for patients to discern whether symptoms they have are ‘routine’ or ‘urgent’. One size will not fit all, so, as always, practices need to design their services in line with the reasonable needs of their patients and staff, whilst fulfilling their contractual obligations. 

The requirement for online consultations to be open for clinical and administrative requests and queries means that there needs to be necessary safeguards in place to mitigate against the accidental submission of urgent requests, or those requests that may have been believed to be initially routine but, after practice review, transpire to be urgent. It is also key that workload and patient demand is considered, as overwhelmed systems and practice staff risk burn out, mistakes and potential tragedy. 

Given the undifferentiated nature of those presenting in General Practice (and primary care as whole), the ability to differentiate between an urgent and routine clinical request or query requires an assessment and decision made on patient history and presentation. This involves clinical review and/or triage of the presenting complaint, and processes therefore need to be in place to ensure that this can be safely undertaken.

Choosing an online GP consultation platform

To help practices make an informed choice, read our checklist of safety, governance, legal and regulatory requirements when choosing an online consultation platform.

Online systems require significant assurances over security and governance to ensure their quality and safety, for both the patient and the clinician. Inadequate checks and poor quality products could make practices vulnerable and accountable, with the 
potential to cause harm to patients. Check your platform is safe.

Download our full guidance including a checklist for safety and quality assurance here

Online consultation tool functions

Online consultation tools enable a myriad of functions, including free text responses by patients describing their symptoms, concerns and expectations. There are a range of clinical and administrative actions that can be undertaken, including the use of online forms and questionnaires with tick box options.

We would recommend considering a range of online consultation tools providers, and familiarising yourself with the functionality that each provides in order to select the one that safely serves the needs of your patients and practice.

Key considerations

Routine/non-urgent versus urgent

It is not always straightforward nor possible to immediately delineate the difference between an urgent or routine request, as this can be dependent upon a range of factors including presentation, communication and mode of access.  Therefore, having robust and safe processes in place help to direct patients to the most appropriate service safely and minimise delay. 

The conclusion of whether a request is routine or urgent is based on clinical judgment and thus requires a process to be applied. It also needs careful consideration of how the patient is contacting the practice in terms of time and location. 

The process for online requests needs to be carefully designed for the patient to navigate and be safely signposted to other modes of access or services when appropriate.

Free text online submissions

Routine / non urgent online consultation requests do not need to have free text enabled. Online requests or queries that have free text need an active clinical assessment and/or triage on the day they are received to ensure safe care.

This means all online free text submissions must be considered urgent until proven otherwise.

For those practices who wish to use it, we recommend that free text is only enabled when active clinical capacity is available to review these submissions

The availability of this option may vary according to the online software provider and therefore may be a key criterion for you when choosing an online consultation tool. Once this ability to review has been exhausted, online consultation requests or queries need to be tightly defined, i.e. via check box options, to enable patients to safely submit requests that can only be classed as routine / non-urgent. 

On-screen messaging should remind patients that online consultation tools are not for urgent requests or queries. If they believe their issue to be urgent, they must either telephone the practice or use NHS 111, which ‘helps people get the right advice and treatment when they urgently need it’. For medical emergencies, the on-screen messaging on online consultation tools should advise that they attend A&E or call 999, which is where they will receive the best and most appropriate clinical care.

Online consultation form functionality to ensure routine / non-urgent requests or queries only

Practices should consider using tightly defined online consultation tool forms or questionnaires that help to navigate the patient to the right service and ensure that the request is truly routine / non-urgent. These would require either tick box or yes/no answers. These would not be for undifferentiated presentations, which need to be considered urgent until clinically reviewed and judged to be routine. Ideally, these forms/questionnaires should not have free text enabled to avoid accidental submission of urgent requests or queries by patients.

Examples of predefined questions include (tick box / yes/no only): 

• Contraceptive review (no free text for blood pressure)
• Long term condition with no changes in symptoms annual review
• Medication review – predefined conditions
• Routine monitoring blood test
• Cervical smears

As stated above, online consultation forms need to clearly advise patients, via on-screen messaging, on how they should seek urgent or emergency help.

Download our ‘setting up online consultations and appointments’ guidance

Managing patient care safely

As GPCE has long recommended in its Safe working guidance in cases where practices receive considerable amounts of daily online consultation requests, and demand subsequently outstrips capacity on any given day, this may naturally lead to waiting lists for routine care in some cases. Especially if patients wish to see the same GP each time in order to maintain continuity of their care. 

Our safe working guidance resources on workflow and triage will help your practice manage both same day and routine care phone calls, walk-ins and online consultation requests. However, to help you keep care safe for patients and staff, you will need to consider how the practice’s management of routine care may need to change. 

Until such time as practices are fully assured that no urgent online consultation requests or queries can be accidentally submitted, leading to the risk of something urgent being missed after the contractual period ends at 6.30pm, the Government’s failure to provide necessary safeguards alongside changes to the contract will have the effect of forcing at least some practices to create or extend waiting lists for routine services just to safely manage online consultation requests on the day. To continue to manage care efficiently and safely, your practice may therefore need to carefully consider establishing waiting lists for certain routine / non-urgent services.

Download our 'Safe working guidance'.

See also our guidance on managing demand and capacity and waiting lists in general practice.

Impact of online consultation changes - survey results

A BMA survey of more than 1,300 GP practices in England has exposed significant concerns about the Government’s new online requirements introduced on 1 October 2025. 73% of responding practices said they had to change how they work because of the contract change, and many reported negative effects on both patients and staff. 

Key findings include: 

• Reduced patient access:

  42% of these practices had to reduce face-to-face appointments – reducing the time patients spend with their family doctor

• Pressure on staff

  45% of these practices said they’ve had to redeploy staff to manage the changes, while 74% reported an increase in workload, 68% reported a rise in stress and 54% said there was an increase in working hours. 

• Negative impact on care:

  Over half (55%) of these practices had seen a negative impact on patient care. One practice explained that, “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.”

• Safety concerns:

  70% of these practices received medically inappropriate online requests, including urgent requests coming through as routine/non-urgent. A practice shared that “patients using this as an admin query when they should be calling 999 for a medical emergency e.g. hypotensive, tachycardic and breathless!” Another practice told us that they are “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.” This presents a significant risk to patient safety. 

Video: GPs express their concerns about the Government’s new online access requirements introduced on 1 October 2025