GP practices may be ‘forced’ to implement waiting lists for routine care to manage demand safely due to contractual changes coming into force next month, the BMA has warned.
As of 1 October, GP practices must keep their phone lines, premises and online tools open during core hours, in a development that appeared to come as a surprise to the union’s GP committee (GPC) and caused serious concern among the profession.
Now the GPC has released new guidance on the changes, including on different ways patients are expected to be able to contact their practice.
Practices need to start planning their workflow and triaging arrangements now, it has advised, to ensure that staff can continue to manage patient care safely and that staff wellbeing is not ‘adversely impacted’ from 1 October.
It said that the BMA said it has ‘repeatedly warned’ the Department of Health and Social Care (DHSC) and NHS England of the ‘significant anxiety’ that these contractual changes are creating ‘given the lack of necessary safeguards’.
And it also said that the GPC has ‘already seen potentially threatening messages’ from ICBs and commissioners from around the country advising practices that the contractual changes around online tools ‘will be enforced throughout core hours come what may’.
While the agreement within the contract stipulates that this new policy is ‘not intended to cover urgent requests’, the GPC raised concerns with NHS England and DHSC that there is no practical way to ensure this.
It advised that to continue to manage routine care ‘efficiently and safely’, practices may be forced to consider establishing waiting lists for certain routine services.
The guidance said: ‘You may be forced to consider implementing waiting lists for routine care to keep things safe.
‘As we have long recommended in our Safe Working Guidance handbook, in cases where practices receive considerable amounts of daily online consultation requests, and demand subsequently outstrips capacity, 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 care.
‘It is our strong view that Government changes to the contract will have the effect of forcing practices to create waiting lists in order to be able to manage online consultation requests until such time as practices are fully assured that no inappropriately submitted urgent online consultation requests can potentially be missed before the contractual period ends at 6.30pm.’
According to the document, the GPC has told DHSC and NHS England that the new requirements create ‘potential risks’ for practices being accused of breaching their contracts should there be days when they run out of clinical capacity and feel that keeping patient access to online consults open would be unsafe.
The GPC added: ‘DHSC and NHSE have provided little to no help or support as to what practices should do if they face clinical overwhelm due to e.g. seasonal pressures or widespread sickness amongst the practice team.
‘We have also repeatedly told DHSC and NHSE that even if the online software was closed, practices remain contactable, so patients still have access to their GP surgery for routine and urgent requests.’
The BMA has produced a standard operating procedure for online consultation requests and safe practice management to ensure ‘safe, effective, and equitable access’ to GP services via online consultation request, while maintaining clinical safety (see box).
This advice will ‘allow contractors to remain compliant with their revised contractual obligations from 1st October,’ the BMA has said.
An NHS England spokesperson said: ‘Since 2023, the GP contract has been clear that for patients who contact their practice in core hours, they should know on the day how their issue will be handled based on their clinical need.
‘The NHS has hired an extra 2,000 GPs further increasing access to primary care and making it easier for patients to be seen faster, since last summer.’
GP Standard Operating Procedure shared by the GPC
This SOP applies to all staff involved in patient access, triage, and appointment booking,
including practice managers; reception and administrative staff; clinical triage teams; and GPs and allied health professionals.
Online Consultation Request Pathways
Patient Options
Patients accessing the online consultation system will be presented with the following
options:
Urgent Help
Patients needing urgent help are directed to:
• Telephone or walk-in to the surgery
• NHS 111 online or call 111
• Local pharmacy or urgent treatment centre
Routine Requests
Patients can submit routine appointment requests unless they:
• Have a fever or suspected infection (including COVID-19)
• Are requesting for: Children under 16; Mental health concerns; Pregnancy-related issues; Frailty, learning disabilities, or additional needs. These patients must telephone the surgery.
Other Requests
• Repeat prescriptions
• Test results
• Certificates
• Online health advice (via NHS resources)
Appointment Categories
Patients can select from structured appointment types:
• Long-Term Conditions: Asthma, COPD, Diabetes, Hypertension, etc.
• Physiotherapy: Joint pain, sprains
• Medication Reviews & Vital Signs: BP diary, weight, pulse oximetry
• Vaccinations: Travel, childhood, adult (invitation required)
• Cervical Screening: Invitation required
• Women’s Health: Contraception, HRT, period delay, antenatal referral
• Health Checks: Well woman/man over 40, Learning Disability checks
Optional: Practices may enable free-text requests for additional flexibility; however, we advise that the online portal is set up in such a way that the patient cannot make a request for an urgent clinical intervention. This could be achieved with a series of tick boxes and no free text. Any free text option risks allowing patients to bypass safeguards.
Triage and Clinical Safety
Total Digital Triage
All patient requests are triaged before appointments are booked. Triage may be:
• Digital: via online consultation tools
• Telephone: by trained staff
• Face-to-face: if clinically indicated
Triage Principles
• Triage must be timely, appropriate, and patient-centred
• Non-clinical staff may perform care navigation; clinical triage is reserved for qualified staff
• Practices must offer remote and face-to-face consultations based on patient need.
Safe Capacity Management
GPC England Safe Practice Tool
When approaching safe capacity:
• Limit daily patient contacts per clinician to 25 (UEMO standard)
• Divert excess demand to: Urgent care centres; NHS 111; Pharmacies.
Actions When Capacity is Reached
• Do not keep online triage tools open beyond safe limits
• Use the OPEL Framework to assess and escalate operational pressures
• Communicate with commissioners and ICBs if unable to safely meet demand.
OPEL Escalation Protocol
OPEL Levels
• OPEL 1–2: Monitor and manage internally
• OPEL 3–4: Escalate to ICS/System Coordination Centre
• Use NHS England escalation algorithms and reporting templates.
Compliance and Monitoring
• Ensure all responses to patient contact (online, phone, walk-in) meet contractual obligations under GMS/PMS regulations
• Maintain records of triage decisions and capacity thresholds
• Regularly review SOP effectiveness and update in line with NHSE guidance.
Review and Governance
• SOP to be reviewed quarterly or upon significant policy change
• Practice manager responsible for implementation and compliance
• Staff training to be provided on triage, digital tools, and escalation protocols.
Source: BMA
Parts of this article were first published by our sister title Pulse
