Practices are facing pressure from everywhere around access. But, as the second part of our series on Access all Areas shows, appointment numbers are increasing all round. This doesn’t seem to be translating into increased patient satisfaction, however. Jaimie Kaffash reports
As we saw in the first part of our series, the prevailing narrative around GP access suggests that access is getting worse. But, looking solely at the number of appointments offered – including total numbers, those with GPs, face to face and on the day – the picture is rosier, with numbers increasing across the board.
There was understandably a sharp drop in the total number of appointments during Covid, but the number per patient per day has now surpassed pre-pandemic figures.
Despite the fuss around the reduction in face-to-face appointments, this has almost returned to pre-pandemic levels. But this doesn’t tell the full story, as it is likely that more consultations would have moved online, regardless of the pandemic. Indeed, then health secretary Matt Hancock was famously a major advocate of remote consultations and even said in 2020 that post-Covid ‘all consultations should be teleconsultations unless there’s a compelling clinical reason not to.’
Equally, we are not seeing a decrease in the total number of appointments provided by GPs. Successive governments have increased the number of non-GP healthcare staff in general practice, predominantly through the additional roles reimbursement scheme (ARRS). GP numbers are going down, but they are maintaining the number of appointments offered with GPs. This is because GPs are individually providing more appointments per year – up from 5,069 a year in 2019 to 5,900 this year (extrapolated).
Based on 25 days’ annual leave, this is an increase from 22.2 appointments a day in 2019 to 25.8 a day in 2025 – and of course non-clinical work is on top of this.
According to the NHS Digital data sets, individual patients are having more appointments at their GP practice every year – up from 5.22 in 2018 to 5.88 in 2025.
At the same time – despite the prevailing narrative – the time between booking an appointment and having the consultation has remained fairly stable, however you look at it.
Applying a midpoint analysis, including urgent appointments (those on the day or within 24 hours) waiting times remain at just under a week, according to the NHS Digital data set. Meanwhile, the percentage of appointments that are either on the day or within 24 hours is going up, notwithstanding the anomaly that is 2020.
There should be caution over the NHS Digital figures, however. NHS Digital says the GP systems are not designed specifically for data analysis, and while there is guidance on inputting data for practices, there are still variations in data. The Health Foundation says there is variability in the way that different suppliers of GP IT systems store and structure the data they hold.
But another issue with the data is that it doesn’t seem to correlate with self-reported data from patients. According to the survey, which includes 700,000 respondents, the number of people saying they’d had a GP appointment in the past six months hasn’t yet returned to pre-pandemic levels
One explanation could be a concentration of appointments in a smaller number of patients. The Strategy Unit says: ‘The use of GP practice consultations increases with age and with levels of morbidity. Since 2008, the population has aged and age-specific morbidity levels have increased. This suggests that need for GP practice consultations has grown, whilst the average number of consultations per person has reduced.’
Professor Azeem Majeed, a GP and professor of public health and primary care at Imperial College London, echoes this sentiment: ‘One reason for the apparent discrepancy may be due to the way demand is distributed across the population. A relatively small proportion of patients – often those with long-term conditions, frailty, or higher care needs – account for a large proportion of appointments. If activity is increasingly concentrated in these groups, then the overall number of appointments will rise, but many patients may experience fewer or no appointments in a given period.’
However, there is contrary evidence – the Strategy Unit found that ‘even patients who are likely to fall into these high-need subsets such as those aged over 85 years or with a long-term illness or disability, report reductions in appointments.’ This is a vital question that doesn’t seem to have an obvious answer – why appointments are going up, but all patient groups are reporting fewer appointments.
This downturn in patients reporting fewer appointments does at least fit in with the general malaise in patients’ attitude towards general practice.
This has been well documented. Patients are reporting issues around booking appointments and waiting times. Fewer patients report receiving a booking on the same day or the day after, while the number of people waiting more than a week from booking an appointment is increasing.
But the real problems in patient satisfaction come when looking at ease of access - contacting the practice. Until 2023, the patient survey asked respondents about their overall experience of booking an appointment, and this had been decreasing from 2018 to 2023, with a blip in 2021 due to Covid. It stopped asking this question in 2024, without a particularly close analogue. In terms of contacting the practice by phone, there has been a sharp dip from 80% saying it was easy to contact their practice by phone in 2013 to under 50% in 2024.
However, there has been a very slight uptick in this metric in 2025. This is backed up in other results from the patient survey, and by the Office for National Statistics (ONS), which has been commissioned by NHS England to start collecting responses on a monthly basis since July 2024 – an issue we will come back to later in the series.
But in our next feature in this series, we look deep into the data and see that – while access might be getting worse – there are deep systematic reasons for this, which have little to do with a practice’s competence.
You can find all the data and the methodology in the full report. Click here to download the full report.
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