The 8am scramble is not over: 2.1 million requests in one hour, 3,300 patients per GP in Brent, and a same-day rate that has not moved

Every month NHS England publishes how many appointments each of England's 6,000-odd GP practices recorded, how far ahead they were booked, whether they were face to face and whether the patient turned up. Every year the GP Patient Survey asks 650,000 people whether they could get through on the phone and what they thought of the experience. Every quarter the workforce statistics count the doctors. And since 2024 a separate file records, practice by practice and hour by hour, when people press 'submit' on an online request. Nobody joins these up by area. This piece does: 6,176 practices mapped to their local authority, every London borough and 150 upper-tier councils ranked on same-day booking, long waits, phone access, patient experience, doctors per patient and how front-loaded the morning rush is, with the method, the caveats and the full tables attached. The latest practice-level appointments month that could be retrieved is July 2026; the survey is 2026; the workforce file is December 2025; the online requests file is February 2026.¹³⁴⁶⁷⁸

Two million people, one hour

The phrase comes from the phone queue, and the phone queue is not measured: no official dataset records when people ring. The online requests are, to the minute, and they show the same reflex. Of 8,525,352 requests submitted on weekdays in February 2026, 2,096,286 were submitted between 08:00 and 08:59. The next hour took 1,195,994, the hour after that 953,704; by mid-afternoon the rate was a quarter of the morning's and after six o'clock it was almost nothing. Mondays carried 27.5% of the month's requests, Fridays 16.4%. London is a little less front-loaded, 21.4% in the eight o'clock hour, and the boroughs vary four-fold: Enfield 41.4%, the most 8am-heavy area in England, Sutton 29.8%, Barking and Dagenham 25.9%, against Hammersmith and Fulham 12.3%, the least, Kensington and Chelsea 15.3% and Westminster 16.3%. The rule since 1 October 2025 is that every practice's online tool must stay open through core hours, so the spike is not people racing a shutter any more; it is a habit, and in the areas where it is strongest the phones are harder too. Across the 150 areas the 8am share is weakly related to how many appointments are same-day and negatively related to how easy patients say the phone is.⁷¹²¹⁸

Healthwatch England's poll of 4,050 adults in September 2026 found the phone still the first choice for 52% of people, online forms or the app for 34%, and that a quarter said their practice 'did not offer alternative contact methods or preferred them to use a particular method'; half of those who used an online form said they did so 'because no other method was available'. One participant in its focus groups, aged over 70, described the form and the phone in a single breath: 'as you're typing what you want to see the doctor about, the appointment's gone. Then you're pushed onto the phone, which you try to use at eight o'clock in the morning, and there's already a call queue when it opens.' A second Healthwatch poll, published on 8 October, found 32% of people who booked an appointment were offered no choice of time, format or place, and 41% of the over-55s.²⁶²⁷

More appointments, same scramble

July 2026 is the latest month for which NHS England's practice-level file could be retrieved, and the comparison with the same month in 2023, 2024 and 2025 is the cleanest test of what has changed. Practices recorded 33,928,829 appointments, 535 for every 1,000 registered patients and 1,475,166 per working day, up 13.5% on July 2023. Of those, 44.7% took place on the day they were booked, 69.6% within a week and 17.9% more than a fortnight after booking; 5.4% were booked more than four weeks ahead, up from 4.3%. Six in ten were face to face, down from 68.3% in 2023, with video and online consultations taking the difference; 44.5% were with a GP; 4.3% were not attended. The same-day share, which is the number the 'scramble' is about, was 43.6% in July 2023, 43.9% in 2024, 43.7% in 2025 and 44.7% in 2026. On Mondays it is 51%; on Fridays 45%. Over a full year NHS England counts 388 million appointments and 83 million online requests, and calls both records. The fall in face-to-face care is the one trend ministers have promised to resist: 'GPs must provide face-to-face appointments, alongside remote consultations,' the minister told the Commons in March 2025, and 'patients have a right to request a face-to-face appointment'.¹²²³⁴⁰

The national average hides a spread that is the real story. Among 5,844 practices with 3,000 or more patients, the median booked 42.3% of July's appointments for the same day; a tenth booked fewer than 27.5% and a tenth more than 60.5%; 626 practices ran above 60% and 377 at 25% or below. Central Surgery in Warwickshire, 20,096 patients, booked 84% of its 14,767 appointments same-day; College Street Medical Practice in Derbyshire booked 4.3% same-day and 58.8% more than a fortnight ahead. Neither number is good or bad on its own. NHS England's own notes say the time between booking and appointment 'is driven by availability, patient preference, urgency, GP advice and planned repeat bookings', and the areas at the bottom of the same-day table, Swindon, the Isle of Wight and Darlington, include the one with the best patient-reported experience in England, Darlington, which books ahead and whose patients like it. The survey question on whether the wait felt 'about right' is unrelated to how far ahead an area books. What the booking data can show is how a practice runs, not whether its patients are seen when they need to be.¹⁴

London: booked fastest, staffed worst

London does fewer appointments per head than any other region, 468 per 1,000 patients against 535 for England, and books them faster than any: 75.5% within a week and 11.6% more than a fortnight ahead, against 69.6% and 17.9% for England. More of its appointments are by phone, 30.3% against 24.4%, more are with a GP rather than another clinician, 53.1% against 44.5%, and more are missed, 5.7% against 4.3%. Its patients report phone access slightly better than the national average, 59.7% easy against 56.9%, and overall experience slightly worse, 75.4% good against 76.7%. And it has the thinnest GP cover in the country: 2,482 patients for every fully qualified full-time GP, against 2,228 nationally and 1,963 in the South West. The Department of Health put the gap at 2,501 against 1,967 when it announced a review of the funding formula last October.¹⁴⁶³⁵

Borough by borough the measures pull in different directions. Barnet books 58.4% of appointments same-day, the highest of any of the 150 areas in England, and only 8.2% more than a fortnight ahead; yet 48.7% of its patients say the phone is easy, the fourth-worst score in London. Hackney is second on same-day, 54.8%, and also has the best GP cover in London, 1,851 patients per GP, the best 'wait about right' score and 81.3% overall satisfaction. Haringey has the lowest long-wait share in England, 6.2%. Lewisham, at the other end, books 35.6% same-day, 147th of 150, and 18% more than a fortnight ahead, and does the fewest appointments per head of any area in England bar Southwark. Kensington and Chelsea's patients find the phone easiest in England, 77.1%, and Westminster's third easiest, 72.0%; Richmond, Wandsworth and Kensington and Chelsea are the only boroughs above 83% on overall experience. Tower Hamlets is last of the 150 areas on overall experience, 62.0%, and on whether the wait felt right, 54.9%, with Barking and Dagenham, Newham and Bexley alongside it in the bottom ten; Redbridge is 145th on overall experience and 147th on GP cover.¹⁴⁶

One practice shows how the measures can disagree. Stamford Hill Group Practice in Hackney, 18,288 patients, booked 78.4% of its 13,289 July appointments for the same day and 92.2% within a week, among the highest figures in England. Its patients' verdict on the phone: 31.2% found it easy to get through in 2026, 29.0% in 2025, 28.5% in 2024. It has 6.5 full-time fully qualified GPs, 2,800 patients each, and a quarter of its online requests arrive in the eight o'clock hour. Same-day booking at that scale is a triage system, in which almost everyone who gets a slot gets it today, and the queue is at the front door rather than in the diary.¹⁴⁶⁷

One call in eight answered straight away

The phone is where the scramble is felt and where the survey says things have improved. In the 2024 GP Patient Survey, after the questionnaire was redesigned, 49.7% of patients said it was easy to get through to their practice by phone; in 2025, 53.0%; in 2026, 56.9%. At practice level 4,387 practices improved over the two years and 1,726 got worse. The experience of making contact was rated good by 72.6%, up from 67.4%, and overall experience of the practice by 76.7%, up from 74.0%. But 'easy' is a low bar: only 13.0% of those who phoned said the call was answered straight away, and 1.2% could not make contact at all. The spread between practices is wider than the spread between years. At 319 practices with 50 or more responses, fewer than 30% of patients find the phone easy; at 342, 90% or more do. At Regis Medical Centre in Sandwell, 39,804 patients, 5.6% found it easy; at Teldoc in Telford, 51,598 patients, 6.2%; at Ellis Practice in Brent, London's lowest, 14.7%. At The Glebeland Surgery in Worcestershire and at a practice in Cheshire East, 100%.⁴⁵²⁴²⁵

Outside London the bottom of the phone table is the West Midlands and the new towns: Derby 34.8%, Telford and Wrekin 38.7%, Sandwell 39.7%, Torbay 40.3%, Solihull 40.4%, Bradford 40.7%, Peterborough and Medway 41.5%. The top is rural and northern: Westmorland and Furness 73.6%, Wigan and Richmond 70.3%, Darlington and Sunderland 70.1%. On overall experience the best area in England is Darlington, 86.9%, then Stockport, Bath and North East Somerset, Devon and Westmorland and Furness; the worst are Tower Hamlets, Medway, Sandwell, Peterborough and Bracknell Forest, all below 66%.⁴

Fewer doctors, unhappier patients

The measure that lines up best with how patients feel is the plainest one. Across the 150 areas, the number of patients per fully qualified full-time GP correlates at minus 0.63 with overall satisfaction and minus 0.39 with phone ease: fewer doctors, worse experience. Devon has 1,702 patients per GP and 84.2% satisfaction; Medway 3,402 and 64.6%; Brent 3,300 and 70.9%. England had 28,777 fully qualified full-time-equivalent GPs in December 2025, 2.3% more than the 28,129 of December 2019 and, on the BMA's reading of the same series, 142 fewer than in September 2015 while the registered population grew by 6.2 million. Lord Darzi's 2024 investigation found 'huge and unwarranted variations in the number of patients per GP', 15.8% fewer GPs per head than the OECD average, and 'the number of fully qualified GPs relative to the population falling'; the Royal College of General Practitioners puts the national figure at about 2,300 patients per GP, 13% more than in 2015.^6281038

The government says it has recruited 2,000 more GPs, 'double our manifesto commitment of 1,000'. The figure is a headcount of individual, mostly newly qualified GPs hired by primary care networks under the additional roles scheme since October 2024, not a net change in the workforce: the BMA's reading of the official statistics is that 1,429 full-time-equivalent GPs were funded through the scheme in July 2026, and the Department's own April 2025 release described the recruits as doctors who otherwise 'were due to graduate into unemployment'. The minister told the Commons in April that 'between 2019 and 2024, the number of fully qualified full-time equivalent GPs actually fell by 900'. The 2026/27 contract moves £292 million to practices to hire GPs or buy more sessions, which the Department says 'is equal to around 1,600' full-time GPs; it is funding, not yet doctors.^313736281415

Three ministers, one promise, no change in the data

The promise is older than this government. NHS England's May 2023 recovery plan opened with 'our commitment is to tackle the 8am rush' and said 'patients should no longer be asked to call back another day'; its headline target, 50 million more appointments a year than in 2019, was declared met that November. The 2024 Labour manifesto promised to 'deliver a modern appointment booking system to end the 8am scramble'. The first contract the new government agreed, in February 2025, made every practice keep its online request tool open for the whole of core hours from 1 October 2025, calling it 'a key intervention in the government's ambition to end the 8am scramble'; Wes Streeting called the deal 'the first step to fixing the front door to the NHS, bringing back the family doctor, and ending the 8am scramble'. The 10 Year Health Plan that July promised to 'end the 8am scramble by training thousands more GPs and building online advice into the NHS App', and that 'those who need it will get a digital or telephone consultation for the same day they request it'; by January 2026 the minister was describing it as a guarantee of 'consultations within 24 hours for those who need one'. On 1 October the Department announced the online rule had taken effect, noting that 'when patients can't get through on the phone, 6.6% end up in A&E'; by December 98.7% of practices said they complied, and in November Streeting told the Commons: 'This Labour Government were elected on a pledge to end the 8am scramble, and that is exactly what we are doing.' Then the Department answered a parliamentary question about what the rule had done. Same-day booking ran at '37.9% to 46% of appointments' in 2024 and '38.7% to 46%' in 2025, and appointments within two weeks at '74.9% to 82.7%' and '75% to 82.8%': 'consistent with the fact that many practices were already operating their systems in this way prior to the contractual change'. Eighty-five per cent of primary care networks had reported all their practices offering online consultations in core hours before the rule existed.^{11399121316211718341920}

The second contract went further and was imposed. From April 2026 practices must deal with requests they judge clinically urgent on the same day, must not tell patients to call back another day, must not cap online requests, must publish their opening hours for every channel, and will be measured on call waiting times between 8am and 10am. The BMA put it to a referendum of about 17,000 GPs; 99% rejected it; the government imposed it; practices began collective action on 1 May and the BMA says it remains 'in formal dispute' while talks resume. NHS England began publishing the new measures in July: in June 2026 there were 6.7 million appointments recorded as clinically urgent, and 76.9% of them were dealt with on the day they were booked. In the same month the GP Patient Survey reported its third year of improvement, and the then Secretary of State, James Murray, the second of three this year, said 'almost 77% of patients reporting a good experience, more than the last 2 years'. His successor told the Commons in September that satisfaction with access was 'up to 75% from 61% two years ago', a line from an ONS survey that ministers have quoted with baselines of 60%, 60.9% and 61% and dates of July, August and September 2024.^{14152930222433}

The patients' organisations are measured in their verdicts. Healthwatch, which says the government used its evidence to shape the 2026/27 contract, told the survey's publication that 'access still lags behind the quality of care patients receive'. The Patients Association and the Royal College, in a joint report in February, said every patient 'should be able to see their GP when they need to' and asked for workforce plans and continuity rather than channels. In the Lords in June, Baroness Gerada, a GP, said the new contract 'appears to be baking in access over continuity: my GP, when I want to see him', and that general practice 'receives less than 8% of the NHS budget, the lowest proportion for decades'. The minister closing that debate said the government was 'rebuilding access' and 'enhancing digital tools'; the peer who opened it said 'people in this Chamber are not convinced'.²⁵⁴¹³²

What this can and cannot tell you

It can tell you, for every practice and area in England, how many appointments were recorded in July 2026 and how far ahead they were booked, what patients said in the first three months of 2026 about getting through and being seen, how many doctors there were in December 2025 and when online requests arrived in February 2026, with the full tables attached. It cannot tell you when people phone, because nobody records it; the 8am figure is for online requests and is a measure of habit as much as of access. It cannot tell you whether a low same-day share is a practice that cannot see people or one that books ahead well, because NHS England's own notes say the time between booking and appointment reflects preference, planning and triage as much as capacity, and the survey suggests patients do not mind long booking horizons in themselves. Appointment counts depend on how each practice keeps its diary, telephone triage is often recorded as one block rather than individual slots, and only the GP staff type is recorded consistently. Survey results for a single practice rest on about 110 responses. Practices are placed by their main postcode, not where their patients live. August 2026, the latest published month, could not be retrieved because the publisher's website now blocks automated readers, so July is used throughout with the same month in earlier years for comparison. The practice names at the top and bottom of each table are published facts about recorded activity and survey responses, not judgements about the care given, and any practice that believes its figures misrepresent it is welcome to say so.¹⁴⁶⁷