The end of the ‘8am scramble’?

Improving access to general practice has long been a central concern for policymakers and making it easier to get a GP appointment is currently the public’s top priority for the NHS. Improvements in patient satisfaction seen in this year’s general practice patient survey suggest some progress is being made. However, challenges remain. 1 in 3 patients remain dissatisfied with access and continuity of care, a cornerstone of high-quality general practice, is declining.

From October 2025, the 2025/26 GP contract and a new general practice patient charter – ‘You and Your General Practice’ – set out expectations that patients must be able to contact their practice via phone, online or in person during core hours (Monday to Friday, 8am to 6.30pm). Patients must be informed of the outcome of their query within 1 working day, and practices may no longer ask patients to call back the next day. Together, the intention is to improve access, reduce inequities and restore trust in the NHS’s ‘front door’. The changes form part of an additional £889m investment in general practice under the 2025/26 contract – the largest in over a decade. 

But will it work? Do these plans really spell the end of the ‘8am scramble’?

A symptom of systemic strain

The 8am scramble for same-day GP appointments, typically via congested phone lines, has become symbolic of wider NHS pressures. It is a result of GP practices capping appointments subject to staffing levels and closing online consultations after a self-set time or quota – often based on first-come-first-served systems and limited triage. These approaches have too often failed to meet patient needs. 

The causes are partly due to constrained capacity: GP numbers have declined relative to population growth since 2015. There has been a fivefold rise in other direct patient care roles, such as pharmacists, care coordinators and social prescribers (largely through the Additional Roles Reimbursement Scheme), but this has not translated into a proportional increase in appointments per capita, nor necessarily into the type of appointments patients feel they want.

But the causes of the 8am scramble also reflect broader system failures, including missed elective and A&E targets, symptomatic of a decade of underinvestment. This strain is also compounded by the COVID-19 pandemic, increasing complexity of medical care, and the demands of a growing, ageing population. 

What is changing with the GP contract?

Changes to the GP contract and the new patient charter require practices to stop asking patients to ‘call back tomorrow’. From next month, practices must not close online consultations during core hours for ‘non-urgent appointment requests, medication queries and administrative requests’, although the exact wording of this is still being debated between the BMA and DHSC. These changes build on requirements introduced in the 2023/24 GP contract.

The charter also outlines patient responsibilities, encouraging the use of the NHS App, 111 and community pharmacy when appropriate. It sets out patients’ rights to register with a GP practice and how to raise concerns. Practices will be required to share a link to the charter on their website.

Risks and realities

While the charter is ambitious, it lacks enforceability. Beyond complaining, which patients often find hard to do, there is no clear mechanism to hold GP practices to account. Patients are advised to contact Healthwatch, but the government announced its proposed closure in June. Integrated Care Boards (ICBs) are expected to help with implementation, but recent cutbacks limit their capacity to provide oversight or hands-on support. 

There is also a risk of confusion and unrealistic expectations. To safeguard against urgent requests being delayed via online systems, the contract and charter suggest that ‘urgent’ queries may still require phone or in-person contact. But patients may not be able to distinguish between what is and is not medically urgent. Meanwhile, the government has promised that ‘people who need one will be able to get a same-day GP appointment’ and ‘a guaranteed online appointment in 24 hours’ as part of their 10-year health plan. This may understandably be interpreted as a consultation with a GP, rather than being informed of what will happen next after an online query – which the contract and charter currently suggest. 

What is needed to fulfil these promises?

Practical support, clear accountability and sustained investment will be essential to convert the charter’s ambition into reality. Many practices are already making progress through the Modern General Practice model, supported through Capacity and Access Support and Improvement payments and the General Practice Improvement Programme. These initiatives help practices redesign access, improve triage and adopt digital tools like cloud-based telephony and online consultation platforms. Services such as Pharmacy First, the NHS App and 111 aim to divert pressure away from GP practices. But the impact of these initiatives on quality of care and patient satisfaction still needs to be better understood. 

Digital access must be inclusive and safe. Practices need to be assured that online consultation tools can reliably flag urgent queries, and that any artificial intelligence-based triage systems both meet regulatory standards and don’t worsen health inequalities. At the same time, practices must be adequately staffed to meet rising demand. ICBs must be equipped to identify and address unwarranted variation in access between practices and across patient groups.

Volume and speed of access are not the only things that matter. Quality and continuity of care, especially for patients with complex needs, must be protected. Practices will need to consider how best to balance access and continuity of care with the staff they employ. Meanwhile, policymakers must focus their attention on stemming the loss of GPs from NHS general practice, as well as examining to what degree the changing skill mix in general practice is improving patient access and continuity of care.

Patients also have a role to play – engaging with digital tools and alternative services, such as community pharmacy, where appropriate. But they need clarity about what to expect from general practice. With the proposed Healthwatch closure, patients will want to know how ICBs and the proposed DHSC Patient Experience Directorate will ensure their voices are heard. 

October is fast approaching. The changes to the contract and new charter are a step forward, but without clear expectations and ongoing investment into general practice, these changes risk fueling further dissatisfaction, on all sides.