The 2025/26 GP contract is set to introduce one of the most significant operational shifts for primary care in years: the mandate for ‘always on’ online access. For busy practice managers, understanding the details behind the headlines is crucial for navigating this change effectively.
This new rule, effective from 1 October 2025, requires all GP practices in England to provide continuous online access for patients to submit non-urgent requests during core hours (8:00 am to 6:30 pm, Monday to Friday). It’s a key part of the government’s plan to modernise primary care and officially “end the 8am scramble”.
But what does this mean in practice? It’s not just about installing a new piece of software; it’s a fundamental change to how practices manage patient demand, moving from controlling the "front door" to managing a continuous stream of requests through robust internal processes.
What the 'always on' mandate requires
At its core, the new contractual obligation is about providing a consistent digital channel for patients. However, the scope is strictly defined to ensure safety and manageability.
The online system must allow patients to submit three specific types of non-urgent requests:
Appointment requests: For routine clinical issues.
Medication queries: Questions or requests related to prescriptions.
Administrative requests: Such as asking for a sick note or a non-urgent letter.
Crucially, this channel is not for urgent medical needs. A major challenge for practices will be ensuring that patients with potentially urgent symptoms are safely redirected to the right services, like NHS 111 or 999. This will require clear signposting and safety features built into the chosen online tools.
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Why is this happening now?
This mandate is a central pillar of the government's Delivery Plan for Recovering Access to Primary Care (PCARP). The policy aims to address long-standing public frustration with accessing GP services and empower patients with more convenient ways to make contact.
The shift also aligns with a broader NHS strategy to move from analogue to digital systems, which is seen as essential for improving efficiency and modernising general practice for the future. While the UK is a high adopter of telehealth, there is still room to improve the patient experience when compared to other countries.
Key dates and new requirements
1 October 2025: The firm deadline for all practices to have their ‘always on’ online consultation tool active during core hours.
1 October 2025: By the same date, every practice must publish a Patient Charter on its website. This document, based on NHS England guidelines, must clearly explain how to access care, set expectations for response times, and provide guidance on the appropriate use of digital channels. We've explored the likely shape of this patient charter here
Is this a risk or an opportunity?
The professional bodies have voiced significant concerns, particularly around workload and clinical safety. The BMA has described the mandate as the "most contentious" part of the new contract, fearing it could "open the floodgates" to unmanageable demand.
However, there is a critical clarification from NHS England: while practices must monitor requests during core hours, they are not contractually required to resolve every request on the same day. This allows practices to manage their workload by triaging requests based on clinical need, so long as response times are clearly communicated to patients in the new charter.
While there are no direct financial penalties for non-compliance, the indirect risks are significant. These include increased scrutiny from the Care Quality Commission (CQC), potential reputational damage from poor patient satisfaction scores, and ineligibility for important funding streams linked to digital transformation.
Viewed strategically, this mandate can be a catalyst for positive transformation. It forces a move away from the chaotic "8am scramble" towards a more structured, efficient, and data-driven operating model. Practices that use this as an opportunity to redesign workflows, train staff, and integrate technology effectively will be better positioned for the future of primary care.
How to prepare for the change
Successfully implementing this new system is not just an IT project but a whole-practice transformation. It requires a holistic approach focused on people, processes, and technology.
Now that you understand the what and why of the new mandate, you can begin planning the how. For a practical, step-by-step guide on implementation, from choosing your tools to training your team, you can read our companion article: GP Online Access made simple.
Disclaimer: This article is for informational purposes only and reflects understanding as of 21 June 2025. It does not constitute legal, financial, or medical advice. Practices should consult with relevant professional bodies or legal counsel for specific circumstances and always refer to the latest official NHS England (and other relevant bodies) guidance and contractual documents.