Access is one of the biggest issues in politics, and practice managers are facing pressure on all sides. Cogora, the publisher of Management in Practice, has launched a major new report, which we will be serialising over the next few weeks. Jaimie Kaffash reports
Access to general practice is one of the biggest political talking points. The Government’s 10-year plan said it was going to ‘restore GP access and ensure a far better experience of arranging care’, and has no less than five mentions of the ‘8am scramble’. Meanwhile, a Health Foundation and Ipsos MORI poll published last month found it is the public’s number one NHS priority.
Yet ‘access’ is a nebulous term. Is it to do with the availability of appointments? And what kind of appointments – face to face, with a GP, on the day? And is it around waiting times? Or, is it about the ease of patients getting through to their practice? The answer is, it is all of the above – and GP practice managers are expected to deliver on it all.
They are facing pressure from all over, and, while patients are understandably frustrated, this often spills into abuse.
The patient-practice relationship
The patient-practice relationship has been deteriorating since the start of the pandemic and access is at the heart of it.
Our survey of 311 practices managers – conducted as part of Cogora’s surveys of GPs, practice nurses and pharmacists – found that complaints around access had risen since the start of Covid, with 27% of practice mangers saying they had increased significantly, and a further 26% saying they had slightly increased (see chart below). Applying a midpoint analysis, practice managers said that around 21% of complaints relate to access – which was much lower than what GPs and practice nurses reported.
When it comes to abuse, practice managers face far more than any other (see chart below). Wendy Foster, a practice manager in Frimley, Surrey, said: ‘We still do get abuse from some patients, verbal to punching the reception desk, albeit not daily occurrence. This is usually I want to be seen NOW and we tell them we’re not an emergency.’
Sarah Rhodes, a practice manager in Bradford, says patients’ ‘expectations have been raised’. She says: ‘Abuse from patients often arises when they do not receive what they expect, for example being advised self-care or the pharmacy scheme rather than a prescription, or being offered an appointment with another skilled member of the team such as a pharmacist or advanced practitioner instead of a GP. The media still presents general practice as being centred solely on doctors, which no longer reflects how we work. This raises patient expectations unrealistically, leaving frontline staff to deal with the frustration that follows, which is unfair.’
Mike Neville, a practice manager in Greater Manchester, says: ‘The abuse is both over the phone and in person with many patients taking their frustrations out on non-clinical teams through swearing in an inappropriate way to approaching staff members and shouting in an intimidating way.’ Abuse towards clinical staff is becoming more prevalent, he adds: ‘I have created a form for staff to fill in called the “Patient abuse incident reporting form” which formalises the abuse and an investigation arises. In the last three months I have issued both zero tolerance letters to patients as first and last warnings as well as removing two patients for their behaviour.’
A few respondents to all Cogora’s surveys cited the ‘Amazon’ or ‘Tesco’ culture as having an impact, with comments including: ‘They want instant Tesco style, open all ours care’; ‘Amazon Prime mentality means the patients just want everything now’; and ‘Patients today are increasingly influenced by the immediacy of modern services – such as on-demand streaming, next-day deliveries from Amazon and instant online customer support’.
However, there was sympathy for patients’ frustrations from many GPs and staff. One GP says: ‘Almost every patient rants. I tell them that the system is broken and I share their frustration. And then I try and move on to what they need. It’s terrible for patients.’
But this shouldn’t descend into abuse of staff, a GP in Cornwall says: ‘We have unfortunately faced abuse from patients due to access issues. This has included occasional incidents of physical abuse, multiple instances of verbal abuse, and increasing levels of online abuse directed at staff. While we understand the frustration patients may feel around access, such behaviour has a significant impact on the wellbeing and morale of the team.’
Media pressure
However, respondents to all Cogora’s surveys said that the most insidious abuse is from the media. In February 2021, at the height of the Covid pandemic, a Pulse study found that almost half of all articles (45%) about GPs had a negative slant. This was compared with around 19% in 2019. Furthermore, the number blaming GPs for access problems – for example, that practices were ‘refusing’ to see patients – increased from 12% to 20% over the two years. While it is true that face-to-face appointments did decrease during the pandemic, this was following advice from NHS England, and even encouragement from then health secretary Matt Hancock.
The media coverage has remained fairly consistent since. The Mail and the Telegraph have both launched tools using appointment data and patient satisfaction scores allowing readers to see how their practice compares. The Mail’s article was headlined: ‘The ultimate guide to all of England’s 6,000 GP practices – so is YOURS one of the worst? From how jammed their phone lines are to the competition for appointments, our search tool reveals all…’. Meanwhile, the Telegraph asked: ‘Are you waiting too long for a GP appointment? Use our tool to find out.’
A number of respondents to Cogora’s surveys referenced the effect of this media pressure on their morale. One practice manager in Norwich put the blame on the media for the perception of general practice: ‘The media are the main issue, telling patients stuff that is only half true, or is indeed entirely false.’ This was echoed by a GP respondent: ‘People do not wish to wait, they are fuelled by the media that GPs do nothing all day.’ One GP questioned the wording of our survey (see chart below), asking: ‘When you say “online abuse” do you mean from patients, or the constant low level abuse from the Daily Mail, the Telegraph, the BBC, etc? That’s pretty demoralising too.
It is also common to see local news sites ranking the ‘best’ and ‘worst’ GP practices in their region based on appointment data and patient satisfaction. A practice manager in Blackpool said: ‘We’re not supposed to be booking more than two weeks ahead or we are negatively highlighted by the local press. Sometimes patients need a follow-up in 3/4/5 weeks’ time and so these patients are battling with everyone else trying to get an appointment, but with their chosen GP, as it’s a follow-up.’
Pressure from commissioners
If there is pressure from patients and the media, then ministers will surely follow. Successive governments have vigorously pursued access policies. The Healthcare Improvement Studies Institute and the Health Foundation found more than 400 ideas and efforts to improve access to general practice in the UK in the past 40 years,including telehealth and total triage; Pharmacy First and self referrals; the additional roles reimbursement scheme; extended hours; AI symptom checkers; and larger scale general practice, among many others.
Many of these, like the ARRS, are incentive schemes, designed to provide funding for practices but others become contractual requirements, enforcing practices to implement certain processes.
Yet much of the time, these mandates. around waiting times, extended access, improving ease of access, mode of consultation (remote or face to face) and all the other initiatives mean practices need to refocus their efforts away from what they feel will benefit their patients’ needs.
Peter Woodward, a practice manager in Cheadle, says patient feedback ‘consistently highlights two recurring frustrations: “you sit forever on the phone” and “you can’t see your GP”.’ But his award-winning practice struggles to address these issues, which matter most to their patients: ‘Rather than adopting a patient-centred strategy to address these areas, which directly affect the majority of our patients, practices are frequently drawn into a wide range of other important but competing priorities: neighbourhood integration, screening uptake, vaccination drives, outbreak response, locally commissioned services, ICB initiatives and public health campaigns. Each has merit, but the absence of an overarching framework to align these with core patient expectations risks leaving patients dissatisfied and staff demoralised.’
A case in point of these national demands is the contractual requirements set to be introduced in October 2025 that will oblige practices to keep their online access portals open from 8am to 6:30pm every day, make sure patients can walk in and keep phone lines open. While this is something that all practices would ideally want to offer, it will have implications for provision of care while their capacity remains as it is.
A GP in the Buckinghamshire, Berkshire and Oxfordshire ICB area says: ‘The 8am to 6:30pm online access is unsafe. We will have to block appointments to cover this safely, as people always put in clinically time-critical requests despite red flags warnings and pop-ups. A recent example was a mother asking about a 15-day-old baby with a sticky eye – buried in this was a comment that her baby was making grunting sounds with her breathing.’
With this pressure from all angles, it might come as a bit of a surprise that appointment numbers are up across the board – even if patient satisfaction decreases, as we shall see in the next part of the series.
More about the survey methodology
The Management in Practice and Pulse surveys were open between 2 July and 21 July 2025, collating responses using the SurveyMonkey tool. The survey was advertised to readers of via our websites and email newsletters, with a prize draw for a £1,000 voucher as an incentive to complete the survey. The survey was unweighted, and we do not claim this to be scientific – only a snapshot of the primary care staff populations.
Where we say ‘distinct’ practices, GP partners and practice manager respondents were asked to input their practice code, their practice name and their post code. Where this wasn’t clear, we correlated this information with official data. Where this still wasn’t clear, we searched practice websites. All those without the required information after this research were removed. For duplicate practice codes – more than one respondent from a single practice – we remove duplicates in the following order: Those who provided fuller information (ie, fewer blank answers and ‘don’t knows’) were prioritised; After this, GP partners were prioritised over practice managers; After this, those who answered first were prioritised.
This left a remaining 797 ‘distinct’ practices, represented by 471 GP partners and 326 practice managers.
Pressure from commissioners: Survey of 789 distinct practices across the UK (see methodology). Respondents were asked; ‘Have you felt pressure from local commissioners (ie, ICBs, health boards or trusts) to improve the following: Time patients spend waiting on the phone for the practice to answer; Waiting times for appointments; Patients being able to choose form of consultation (ie, face-to-face, remote, home visit); Patients seeing their usual/preferred healthcare professional.’
Patient complaints: Survey of 1,417 general practice staff across the UK (311 practice managers, 790 GP partners, 281 practice nurses and 35 practice pharmacists), after ‘Don’t knows’ were removed. Respondents were asked: ‘Roughly what percentage of in-house complaints relate to access issues? 0%; 10%; 20%; 30%; 40%; 50%; 60%; 70%; 80%; 90%; 100%; Don’t know.’ To work out the average, we applied a midpoint analysis.
They were then asked: ‘Has this percentage increased or decreased since before the Covid pandemic in 2020?’ Significantly increased; Slightly increased; About the same; Slightly decreased; Significantly decreased; I wasn’t working pre-2020; Don’t know.’ Again, ‘Don’t knows’ and ‘I wasn’t working pre-2020’ were removed from the analysis.
Faced abuse: Survey of 1,947 general practice across the UK (350 practice managers, 1,054 GPs, 475 practice nurses and 68 practice pharmacists). We asked: ‘Have you ever faced abuse from patients due to access issues? Physical abuse; Verbal abuse; Online/social media abuse.’ The answers were: ‘Yes, often; Yes, occasionally; Once or twice; No; Don’t know.’
You can find all the data and the methodology in the full report, which can be downloaded here.
Commercial partner of this white paper: General Practice Solutions
