ICBs have been told they should ensure GP practices implement contractual changes relating to access due to come into effect from this week.
NHS England chief executive officer Sir James Mackey wrote to ICBs reminding local commissioners that from 1 October GPs will need to keep online systems open for patient requests between 8am and 6.30pm for routine enquiries.
He highlighted that access to primary care is ‘an important part of managing system pressures’ ahead of winter, and that ICBs should ‘ensure practices are following these requirements’.
The letter added: ‘Patients need to be able to contact their GP practice by phone, online or by walking in, and for people to have an equitable experience across these access modes.
‘As part of dealing with the 8am scramble, from 1 October 2025 practices will be required to keep their online consultation tool open for the duration of core hours for non-urgent appointment requests, medication queries and admin requests.
‘ICBs should ensure practices are following these requirements.’
The warning to ICBs came ahead of the BMA this week giving the health secretary 48 hours to avoid dispute with GPs over the contractual changes.
Earlier this month, the BMA’s GP committee voted in favour of going back into dispute with the Government over the changes and has also demanded a deferral until the changes can be implemented safely, but this hasn’t been agreed to.
The GP committee has argued that because online systems cannot tell the difference between routine and urgent cases, serious problems could be missed if safeguards are not in place.
Now GP Committe chair Dr Katie Bramall said that the Government ‘has 48 hours to change course’ and ‘avoid this dispute’.
She reiterated that in February the Department of Health and Social Care (DHSC) and NHS England confirmed that ‘necessary safeguards’ would be in place before 1 October 2025 to ‘avoid urgent clinical requests being erroneously submitted online’ – but that these are currently not in place, and the Government has decided to press-on with the changes regardless.
She said: ‘We agreed to these changes on the condition that “necessary safeguards” would be put in place before Wednesday 1 October.
‘This was agreed – in writing – with Government, DHSC, and NHS England in February this year. Now almost eight months later, it is deeply disappointing to see promises broken. We have worked incredibly hard to rebuild the trust between our exhausted profession and the Government, but now what are England’s GPs and practice teams supposed to think?’
The BMA has previously warned that the policy will force GP practices to implement waiting lists for routine care.
Dr Bramall added: ‘The secretary of state knows that when these changes come into effect it will likely lead to the creation of hospital-style waiting lists in general practice, reduce face-to-face GP appointments – as we’ll be triaging a barrage of online requests, consequently putting patients at risk of harm as we try to find the urgent cases among the huge pile of unmet patient need that’s out there.
‘Mr Streeting needs to listen to us and understand how we believe GPs can deliver his ambitions safely.
‘General practice is the leader in NHS tech innovation, we do everything online from systems to prescriptions, referrals and appointments.We’re not resistant to change, but we will be when the safety of patients and practice staff is at risk. The Government has 48 hours to change course, avoid this dispute, and keep to their promises.’
In a letter to health minister Stephen Kinnock on 17 September, Dr Bramall listed some of the safeguards that would need to be put in place, including:
- removing any free text box to prevent patients submitting ‘urgent clinical requests erroneously’
- allowing patients to only select specific non-urgent requests or queries via tick-boxes
- directing patients to call the practice if their request or query is urgent
She said that without these safeguards the changes ‘become very problematic’ for practices in terms of ‘heightening’ the risk to patient and practice staff ‘due to overwhelm’.
The solution, she added, would be for NHS England to agree to a buffer period until April next year for practices to implement the changes with support from ICBs.
NHS England has confirmed to our sister publication Pulse that there is no such buffer period and the changes are coming in 1 October as planned.
A version of this article was first published by our sister title Pulse
