Why can’t I get a GP appointment? Follow the money

General practice is not doing less

In April 2026, practices in England recorded 13,867,607 GP-delivered appointments. That was 6.1% higher than a year earlier. Across the latest completed 12-month period, practices continued to deliver hundreds of millions of appointments through GPs, nurses, healthcare assistants, pharmacists and other members of the primary care team.¹

The national data does not describe a service sitting idle. It describes one operating at sustained high volume, month after month, while also taking on work that may never appear in a conventional appointment count.

Every request must be received, interpreted and directed. Some requests become face-to-face consultations. Others become telephone calls, prescriptions, investigations, referrals, messages, advice, urgent escalation or work completed without the patient ever entering a consulting room.

The absence of a booked appointment therefore does not mean that no work took place. Increasingly, the appointment is only one possible outcome of a much larger clinical process.

National totals are important, but they can hide the local reality. Demand is not distributed evenly. Practices serving older populations, patients experiencing greater deprivation, higher levels of long-term illness or rapidly expanding housing developments may face substantially greater workload than the national average suggests.

Demand has not disappeared. It has multiplied.

Telephone contact was once the main alternative to a face-to-face consultation. General practice now receives demand through several front doors at once:

In April 2026, practices recorded 5,474,904 patient-submitted clinical online requests. That was approximately 58.2% more than in April 2025.¹

The phrase online consultation can be misleading. In many cases, the patient is not having a consultation at the moment they press submit. They are placing a written request into a clinical intake system. Someone within the practice must then read it, interpret it, assess urgency, review the patient record and decide what happens next.

The outcome may be an appointment, but it may instead be advice, a prescription, an investigation, a referral, a text response or a request for further information. The form is not the care itself. It is the beginning of another workflow.

Digital triage changes the queue. It does not remove it.

The policy argument for digital triage is understandable. Instead of patients competing for a limited number of telephone lines at 8am, they submit information that can be assessed according to clinical need. Practices gain a broader view of demand and can direct patients towards the most appropriate response.

When it works well, this can reduce repeated dialling, improve the information available at the first point of contact and help practices prioritise urgent problems more safely. It can also provide an alternative for patients who cannot remain on hold during the working day.

But the queue has not vanished. It has moved behind the screen.

A telephone queue contains its own friction. Lines become engaged, callers wait, some try again later and some abandon the attempt. That experience is frustrating and can be unsafe, but it also acts as a crude limit on how quickly demand reaches the practice.

An online form removes much of that friction. Hundreds of patients can submit requests almost simultaneously. This may be better for the patient than repeatedly hearing an engaged tone, but every accepted submission becomes work that the practice must process.

Is digital demand replacing telephone demand?

Some online requests undoubtedly replace calls that would otherwise have reached reception. However, the relationship is not necessarily one-for-one.

Easier access may also surface need that previously remained hidden: patients who could not get through, patients unable to wait on hold, patients who decided their concern was not worth another attempt, or patients who find a written request easier than explaining the problem verbally.

This is not automatically a bad outcome. Surfacing unmet need may be clinically valuable. Earlier contact could allow a problem to be managed sooner and may reduce barriers for some groups.

The operational problem arises when the system is designed to reveal more demand without providing the staff, time and infrastructure needed to absorb it.

What the practice-level analysis shows

We can now go beyond national totals and compare what is happening across individual GP practices.

Using published NHS England data, practices were grouped by how heavily they use online consultations. The analysis looked at online requests per 1,000 registered patients and divided practices into five groups — from the lowest users of online access to the highest.

The analysis included 6,107 practices with at least 1,000 registered patients.

There was a significant difference between groups. The lowest online-use practices received a median of 6.95 online requests per 1,000 patients in April 2026, compared with 278.08 per 1,000 patients in the highest-use group.

The hidden clinical layer

This is one of the most important weaknesses in how general-practice workload is discussed.

Appointment data measures appointments. It does not reliably measure all the work required to decide whether an appointment is needed.

Digital triage creates an additional clinical layer between the patient making contact and the eventual outcome. That layer can include:

• Reading the patient’s account and clarifying the problem
• Reviewing medical history, medication and recent consultations
• Assessing urgency and potential clinical risk
• Requesting photographs, readings or additional information
• Providing written or telephone advice
• Issuing treatment, investigations or referrals
• Documenting the decision and arranging follow-up

Much of this work consumes clinical time but may never become a separately counted appointment. A practice processing large numbers of online requests can therefore look less productive if productivity is judged only by appointments per clinician.

That creates a measurement problem as well as a workload problem. Workforce models based predominantly on appointment counts risk underestimating the clinical time required to run an online-first access system.

A technically efficient system can still feel difficult

Access is not judged only by whether a request eventually reaches a clinician. Patients also judge how understandable, predictable and human the process feels.

A telephone queue is visibly frustrating. An online queue can be less visible but equally uncertain. Patients may not know:

• who has read the request;
• when they will receive a response;
• whether they are waiting for triage or an appointment;
• whether they should contact the practice again;
• what to do if their condition changes;
• or why an appointment was not offered.

From the practice perspective, the request may have been assessed and safely directed. From the patient perspective, the experience can still feel like a barrier between them and their GP.

Good digital access therefore requires more than a form. It needs clear response times, visible safety-netting, accessible alternatives, understandable decisions and routes for patients who cannot use the digital process.

What does the national data tell us about the 8am rush?

Digital access is often presented as the answer to the traditional 8am telephone scramble. In theory, patients should no longer need to compete for a limited number of telephone lines at the start of the day.

The national telephony data shows that the morning rush is still very real. Across England, weekday inbound call demand remains heavily concentrated between 8am and 10am, with Monday producing the largest morning peak.

The pattern is visible not only in the number of calls received, but also in the waiting-time distribution. A substantial proportion of patients are answered quickly, but a significant group still waits more than five minutes before their call is answered.

Has digital access ended the rush — or moved it?

The national call data can show us the visible telephone queue. It cannot show the full amount of work arriving through other channels at the same time.

Online consultation requests also tend to arrive heavily in the morning. Every submission must be read, checked, assessed and directed. Even where the number of telephone calls falls, the total volume of actionable work reaching the practice may not fall with it.

Digital access may ease the telephone rush while intensifying the clinical intake rush behind it.

That distinction matters. A quieter phone line is a better experience for patients trying to call, but it should not automatically be interpreted as lower workload for the practice.

Are patients happier with modern access?

The national GP Patient Survey provides a more nuanced answer than a simple yes or no.

In the 2025 survey, several headline access measures improved compared with the previous year. Nationally:

Ease of contact also improved across all three national access channels: telephone, practice websites and the NHS App.

Improvement does not mean every part of the experience is better

The national results do not support the claim that patients are uniformly less satisfied. The overall picture is more positive than the year before.

However, the areas that declined are revealing. The proportion of patients reporting that they had a preferred healthcare professional fell, and confidence in managing their own health also slipped slightly.

That is an important distinction. Digital access may improve the front end of the patient journey while making the service feel more transactional if requests are repeatedly routed to whichever clinician is available.

A modern access model should therefore be judged not only by how easy it is to submit a request, but by whether the patient receives a clear response, feels that their needs were understood and retains continuity where it adds clinical value.

Access is not the same as continuity

Triage systems are designed to move each request towards the next available and appropriate response. That can be efficient for a self-contained problem.

General practice, however, is not only a collection of isolated transactions. Much of its value comes from continuity: a clinician who understands the patient’s history, recognises changes over time and can connect today’s concern with previous consultations.

A system optimised entirely around rapid distribution can fragment that relationship. The request may be handled by whichever clinician is processing the triage queue rather than the clinician who knows the patient best.

This matters particularly for multimorbidity, mental health, frailty, safeguarding and long-term condition management. These are areas where speed of initial contact is valuable, but relational knowledge may be just as important as rapid routing.

The challenge is therefore not to choose between access and continuity. It is to design access systems that protect continuity where continuity adds clinical value.

Why the telephone experience can still feel so difficult

For many patients, the pressure becomes visible at 8am. That makes the telephone system an easy target, but the queue is usually a symptom of the wider capacity problem rather than its cause.

The available national telephony data for April 2026 recorded 28,838,492 incoming calls from the practices submitting data. Of those calls:

• Calls answered 61.9%
• Calls abandoned before answer 26.5%
• Average wait before answer 2 minutes 12 seconds
• Calls per 1,000 registered patients 559
• Calls requesting a callback 7.3%

These figures cover 4,953 of 6,220 practices, representing 79.6% of practices and approximately 51.6 million registered patients.² They should therefore be interpreted with the reporting coverage in mind.

Abandoned calls do not all represent separate patients who received no help. Some callers redial, use a callback option, submit an online request or make contact through another route.

Nevertheless, the figure clearly shows the frustration and repeated effort generated when demand reaches practices faster than teams can process it.

Now follow the money

The core General Medical Services global sum for 2026/27 is £130.07 per weighted patient.³ The word weighted matters: practices are not simply paid £130.07 for every person on their registered list.

The Carr-Hill formula adjusts practice populations to reflect factors including age, sex, morbidity, list turnover and local costs.

Applied to approximately 63,777,189 weighted patients across England, the global-sum rate produces an illustrative annual total of about £8.30 billion.

That sounds substantial — and it is — but it funds considerably more than a supply of GP appointments.

Practices may receive additional income through the Quality and Outcomes Framework, Primary Care Network arrangements, enhanced services, premises reimbursements and other schemes.

However, much of that funding is conditional, specified or tied to additional activity. It cannot automatically be treated as spare money available to create routine GP appointments or process an unlimited number of digital submissions.

What does the core funding look like against activity?

Dividing the estimated annual global sum by the latest trailing 12 months of GP-delivered appointments produces an illustrative figure of approximately £48.97 per GP appointment.

Dividing it by all recorded general-practice appointments produces an illustrative figure of approximately £21.76 per appointment.

The comparison also excludes significant work that is not always represented as a conventional appointment: reviewing results, issuing prescriptions, processing hospital correspondence, safeguarding work, referrals, reports, clinical supervision, care-home coordination and the clinical processing of online requests.

That is the structural issue. General practice is funded predominantly through population-based contractual arrangements, while demand arrives as an uncapped stream of calls, forms, messages, appointments and clinical risk.

Digital access exposes the funding gap

Digital triage does not create the underlying demand. It makes more of that demand visible and allows it to arrive with less friction.

That may be clinically and ethically preferable to demand being hidden behind an engaged telephone line. But once the demand is visible, the practice remains responsible for dealing with it safely.

This is where the policy ambition and the funding model collide. Practices are encouraged to open wider digital routes, surface unmet need and respond according to clinical priority. Yet the core payment does not automatically increase each time another form is submitted.

Why access can feel worse even when more work is being done

Access is experienced individually. A national increase of several million appointments offers little comfort to somebody who cannot secure the particular appointment they need at their own practice.

Both of these statements can therefore be true:

The contradiction disappears once we distinguish total activity from available capacity. A practice can be busier than ever and still have no safe additional appointments to release.

More contacts can also generate more follow-up work. An online request may lead to a telephone assessment, a face-to-face appointment, blood tests, a prescription and a referral. Counting only the eventual appointment misses the chain of work that produced it.

It can also miss the opportunity cost. Time spent processing immediate requests is time that cannot simultaneously be used for medication reviews, proactive prevention, continuity, long-term condition management or follow-up work.

Capacity is also physical

Workforce is only one constraint. A clinician cannot hold a confidential consultation without a suitable room, functioning equipment and the administrative infrastructure around them.

Lord Darzi’s 2024 investigation reported that 20% of the primary care estate predates the foundation of the NHS in 1948 .⁴

Practices may therefore be asked to expand teams and deliver more care from buildings that were never designed for modern multidisciplinary general practice. Recruiting another clinician does not create another consulting room.

What the analysis can — and cannot — tell us

The practice-level results answer two important questions more clearly than national totals alone.

Patient experience and continuity

The highest online-use group had a median GP Patient Survey score of 48.8% for ease of telephone contact, compared with 69.7% in the lowest-use group.

The continuity measure — patients reporting that they saw or spoke to their preferred healthcare professional — was 34.2% in the highest-use group and 46.8% in the lowest-use group.

Overall experience was also lower in the highest-use group: 75.9% compared with 81.9%.

The correlations were moderate for telephone experience (ρ = −0.36) and weak for continuity (ρ = −0.27) and overall experience (ρ = −0.22).

What would improve access?

There is no single switch that will solve the problem. Sustainable access requires the different parts of the system to move together.

Methodology and important context