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‘Practices have to get rid of the 8am rush’ to improve access, says NHS primary care director

by Beth Gault
23 November 2022

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GP practices need to find ways to prevent the morning ‘eight o’clock rush’ of calls from patients who struggle to get through to the surgery, the national director for primary care and community services, Dr Amanda Doyle OBE, has said.

Speaking at a webinar on ‘The Future of Primary Care: Winter and Primary Care Leadership’, Dr Doyle said patients not being able to get in touch with someone at their practice the first time and having to call repeatedly was ‘unacceptable.’

She said updated telephone systems with features that can better manage the volume of calls and improved digital access would help avoid the problem.

Dr Doyle said she could accept that practices were not able to deliver timely appointments because of the pressures of demand. But, she said, she ‘struggles with’ practices not being able to make ‘an offer’ to patients the first time they contact the practice.

This is the issue thing that people most complain about, she added.

‘I don’t get complaints like, “I contacted my surgery, and no one could see me for two weeks”. What we get are endless, enormous numbers of complaints, which say, “I couldn’t get in touch with my surgery, couldn’t get through on the phone, couldn’t get to speak to anybody, nobody got back to me, I had to keep trying again and again.”’

Dr Doyle said something had to be done urgently about patients’ ability to get in contact with general practice.

‘We absolutely have to get rid of this eight o’clock – or perceived eight o’clock rush – that we see in lots of places where everybody tries to ring in at the same time and can’t get through. People who do get through then tell us that they were asked to go somewhere else or call back tomorrow. I don’t think it’s acceptable,’ said Dr Doyle.

To improve the situation, she said new telephone systems need to be installed, as 65% of practices use old analogue systems that don’t have the ability to signpost people or feedback data to practices about who is calling and why.

There also needs to be greater prevent digital access for patients.

‘The more people that want to contact us digitally, the more the phone lines are free for those who can’t,’ said Dr Doyle.

Practices have to make it easier for patients to find the information they need to stop them from having to call in, she added. 

Reassessment of time

During the seminar, Dr Doyle also called for a reassessment of the job that GPs do, since being a funnel for patients to access ‘isn’t the best use of GP time’. Instead, primary care needs better integration of community services, such as pharmacies, nursing services, end of life care and social services.

‘Let’s look at how we can change modes of access for patients so they can access some of their services directly,’ said Dr Doyle.

‘And in the medium and longer term, we’ve got the Fuller stocktake that sets out a vision for what an integrated primary care service in the future might look like.’

However, she added, she didn’t underestimate the infrastructure work required to move to make that vision a reality and isn’t a solution for this winter, or even next.

‘It might be the solution for five- or 10 years’ time,’ she said.


Meanwhile, to cope with patient demand, Dr Doyle recommended a number of suggestions to help with recruitment to increase capacity. These included creating a bank of reception and admin staff who could come into the practice and already be familiar with its systems, in order to cover staff absence.

She also called for alternatives to the partnership model for GP practices that are struggling to recruit partners or are having to hand back contracts.

‘I don’t think it’s the end of the partnership model,’ said Dr Doyle. ‘It works really well in lots of places around the country.

‘But I think we need a range of alternatives that can go alongside that for when practices are struggling.’