Nine million requests a month: are GP online consultations actually getting people seen?

On 1 October last year every GP practice in England was required to keep its online consultation form open from 8am to 6.30pm, Monday to Friday, so that patients could ask for a routine appointment, a repeat prescription or a sick note without joining the 8am phone queue. From 1 April this year the requirement was tightened: practices may not cap the number of online requests or switch the system off, must see anyone with a clinically urgent need the same day, and must give everyone else an update by the end of the next working day. Ministers call this fixing the front door of the NHS. The British Medical Association calls it unlimited demand without the staff to meet it, and has been in formal dispute with the government for almost a year.⁷¹¹¹⁶

Both sides quote numbers at each other. NHS England counts submissions; the BMA counts hours. Neither answers the question a patient asks, which is whether filling in a form gets you seen faster, or at all, than it did before. This piece puts the official data sets side by side, the request counts, the appointment counts, the workforce figures and three different patient surveys, to work out what has actually changed.

The demand: nearly three times as many requests

NHS England publishes a monthly count of what patients submit through online consultation systems. In July 2024, before the government's push, practices received 3.4 million submissions. By July 2025 it was 5.9 million. In October 2025, the first month of the all-day rule, it jumped to 8.3 million, of which 5.5 million were clinical and the rest admin or prescriptions. It has not fallen back: 8.6 million in February, 9.8 million in June, 9.5 million in July. August's published figure of 7.3 million is incomplete because five suppliers, including eConsult and Rapid Health, failed to return full data, which NHS England flags on the release. Around 6,100 practices, almost all of England, now take part in the collection.¹²⁷⁸

Some of that is new demand and some is old demand that has changed lane. NHS England's own release for October noted that practices also took 31 million phone calls that month, so online is still a minority of contacts. But the GP Patient Survey, which asked 654,714 people this spring how they last contacted their practice, found 30.8% did so online, up from 22.4% a year earlier and 16.8% the year before. The form is now how nearly a third of patients get in, and the 8am rush has visibly eased in practices that use it heavily: one analysis of 4,300 practices with both online and telephony data found that 25% of the day's calls arrived between 8am and 10am at high-online practices, against 35% at low-online ones.⁸¹⁹²⁴

The supply: more appointments, fewer of them with a doctor

Practices are doing more. General practice delivered 377 million appointments in 2024-25, a quarter more than in 2019, and NHS England now describes 1.4 million a day. August 2026, a quiet month, recorded 29.8 million; May recorded 33.8 million. The problem is who delivers them and how. In May, 44.5% of appointments were with a GP and 60.2% were face to face. The face-to-face share was 69.8% in March 2023 and has fallen steadily since. Fully qualified GP numbers only climbed back above their 2015 level last year, and because the population has grown there are 44.9 of them per 100,000 patients against 50.2 a decade ago, with deprived areas having a quarter fewer per head than affluent ones. NHS England's August workforce return shows the number still rising, by 757 fully qualified permanent GPs in a year, but from a base that took ten years to recover.³⁴⁵⁶

That mix matters to patients more than the total. A University of Manchester study of 5,278 practices, published in the British Journal of General Practice last year, found that the volume of appointments most strongly associated with patient satisfaction was face-to-face appointments with a GP, which made up fewer than three in ten of all appointments in its data; each extra ten such appointments per 1,000 patients a month was associated with a one-point rise in satisfaction. The authors concluded that access initiatives should prioritise expanding face-to-face GP appointments, which is roughly the opposite of what has happened.²⁵

So do people get seen?

Here the official data is thinner than the volume of policy built on it. NHS England counts submissions but does not publish what happened to them: how many became an appointment, how many a prescription, how many a message telling the patient to call 111. What it does publish is timing. In August 2026 there were 5.7 million appointments the practice classed as clinically urgent, of which 77.8% happened the day they were booked. Of the rest, the routine requests that the online form was designed for, 57.2% were dealt with within seven days and 76.0% within 14. In May, 45% of all appointments were same-day and 81.7% were within two weeks. Those are respectable figures, and they are not obviously better than the same months a year earlier.³⁴

The Office for National Statistics asks patients directly. In its Health Insight Survey last summer, 73% of adults who had contacted their practice in the previous four weeks called the experience good. Among those who had wanted an urgent appointment, 53.8% got one the same day, 9.7% the next day, 18.6% later than that, and 13.9% were given something else, such as a pharmacy referral or advice. People wanting an urgent appointment mostly still phoned, 55.6% of them, while people wanting a prescription mostly used an app, 42.9%. The same survey's latest analysis, published this month, finds the gaps are social rather than technical: people with no qualifications were 23% more likely than graduates to say contacting their practice was difficult, and social renters 46% to 51% more likely than outright owners.²¹²²

The GP Patient Survey, run by Ipsos for NHS England, is the most positive of the three sources and the one ministers quote. Every access measure has improved for two years running, and people who used the NHS App to get in touch were the most satisfied group, 75.7% rating the contact good. But the survey measures the experience of contacting, not the outcome of the contact. Healthwatch England's reading of the same results was that "access still lags behind the quality of care patients receive", and that 13% of people with communication needs said their practice never helped them, up from 11%.¹⁹²⁰

The most useful attempt to link the online door to what comes out of it is an independent analysis by Anne Marie Cunningham, a GP and data analyst, who grouped 6,000 practices by how many online submissions they receive per 1,000 patients and compared NHS appointment, workforce and survey data across the groups. Practices in the top third, taking more than 8.5 submissions per 1,000 patients a day, delivered about 25 appointments per 1,000 patients daily against 23 in the bottom third, a modest gain that excludes the unrecorded work of reading and triaging the forms. Their morning peak of total demand, calls plus forms, was 40% higher than at low-online practices. And their patients were less satisfied, 74% reporting a good overall experience against 80%, across every domain in the survey. High-online practices are also much larger, so the comparison is not clean, but it is the closest thing to evidence on the question, and it does not show that more online access buys more or faster care.²⁴

Inside the practice: the safety argument

The BMA's objection was never to online forms, which most practices had used for years. It was to being unable to close them. Under the old arrangement a practice that had filled its urgent slots by 10am could switch the form off and let the phone catch anything that could not wait; a form that stays open until 6.30pm with no cap will, the union argued, fill with requests nobody can read until tomorrow, some of which are emergencies mislabelled as routine. In February 2025 it accepted the all-day rule on the written condition that "necessary safeguards" would be in place; by October it said none were, and entered dispute, working "under protest". Its own survey of 1,341 practices in November found 70% had received medically inappropriate online requests, 74% reported higher workload, 42% had cut face-to-face appointments to cope, and 55% said patient care had suffered. One practice described a patient who submitted a form at 6.20pm reporting a high fever and breathlessness and needed an ambulance for sepsis.¹³¹⁴¹⁵

The government's answer has been that the risk is manageable and the demand real. Stephen Kinnock, then the primary care minister, called all-day online access "a cast iron commitment" and said the union's escalation was "founded on untruths". NHS England pointed to practices like Brondesbury Medical Centre in north London, which said it had halved its daily phone calls and cut routine waits from about two weeks to three days after going live. And the department's own justification is a number: it says 6.6% of people who cannot reach their GP by phone end up in A&E, and that four million A&E attendances a year are for non-urgent problems that could not get through to a practice.⁷⁸⁹¹⁸

The row hardened in 2026. The 2026/27 contract, imposed rather than agreed, added the same-day urgent requirement and a ban on capping or switching off online requests, alongside a £485m uplift and £292m ringfenced for practices to hire about 1,600 more GPs. In March, 98.9% of GPs voting in a BMA referendum rejected it, on a 55% turnout; collective action began in May. Dr Katie Bramall, who chairs the BMA's GP committee, said mandating unlimited access without the staff to deliver it "is not a plan, but a fast-track to collapse GP services". On 17 September the union said it had written confirmation that ministers would re-enter formal talks and paused further escalation. The all-day rule remains in force.^10111617

That quote is from 2023, and the practice Pulse examined then, a York surgery held up as a model of online triage, had a four-week wait for routine appointments and had stopped taking requests overnight because Monday mornings had become unmanageable. Three years on, the same argument is being had with larger numbers on both sides. The general practitioners' case is not that online access fails; it is that a door with no lock does not create rooms.²⁸

Who is being left outside

The contract says online, phone and walk-in access must be equal, and DHSC says 98.7% of practices offer all three. The lived experience of older people suggests the routes are not equal in practice. Re-engage, a charity working with isolated older people, surveyed 668 people over 75 and sent freedom of information requests to every integrated care board. One in three respondents said they could only get a GP appointment by booking online; nearly nine in ten preferred to phone or go in; 77% did not want online booking to spread further; and 63% said the shift had made them feel lonelier. Its FOI returns found that 81% of ICBs in England said practices offered phone or in-person booking, against 71% in Wales and 21% in Scotland. "This quest for a digital default system is not helpful for many older people," its chief executive, Jenny Willott, said.⁹¹¹²³

The forms have a second exclusion built in: they are in English, they ask for a written account of symptoms, and they reward the articulate. The ONS finding that difficulty contacting a practice tracks education and housing tenure rather than age alone suggests the digital door, like the old phone queue, is easiest for those who need it least. None of the national data sets records what language a request was written in or whether someone helped.²²

The next door: AI triage in the NHS App

The government's plan is to route more of this through the NHS App. Its 10 Year Health Plan promised the app would be "a full front door to the entire NHS" by 2028; Full Fact's tracker rates that as in progress, with GP online consultation improvements listed as under development. In July, NHS England announced an AI triage tool inside the app that asks adaptive questions and either directs the patient to a pharmacy, 111 or self-care or hands the practice a prioritised request. It will reach 200,000 patients within a year and all app users by April 2028. The evidence offered was one Sussex practice reporting a 29% fall in its phone queue with patient satisfaction unchanged. Commercial triage systems already used by a few hundred practices claim much larger effects, including a 73% cut in waiting times, but those figures are the companies' own and have not been through the kind of controlled evaluation the NHS would demand of a drug.²⁶²⁷

Triage that works would answer the BMA's safety objection, because a form that recognises sepsis is not a form anyone needs to switch off. It would not answer the capacity one. A triage tool can decide who should be seen first; it cannot create the face-to-face appointment with a GP that the Manchester study found patients value most, and the 2026/27 contract's own access metrics, call waiting times, same-day urgent rates and routine waits within one and two weeks, will from this year measure exactly that.¹¹²⁵

The verdict

Are people getting seen? More people are getting through, and they say so: contact is easier by every measure the surveys use, the 8am scramble is smaller where forms are used most, and the NHS App has become the most satisfying way to reach a practice. Whether they are seen sooner is not shown by any published data; the timing figures for routine appointments are flat, the share of appointments with a GP or in person keeps falling, and the one analysis that compared heavy-online practices with the rest found slightly more appointments and noticeably less satisfied patients. The online form has fixed the queue. It has not fixed what is at the end of it, because that was never a software problem, and the next stage of this argument, in the talks that reopened this month, is about whether £50 more per patient buys the doctors to stand behind the door.¹⁷¹⁹²⁴