There was a time — not all that long ago — when every practice manager and GP partner could quote the rule: patients should be able to see a GP within 48 hours.
It sounded clear and measurable. In truth, it was only ever partly real.
The 48-hour target, introduced in the early 2000s, was meant to guarantee quick access, but it ignored the underlying truth that demand for GP care will always exceed supply. Many practices worked hard to meet the target — holding back same-day slots, restricting pre-bookable appointments, or rebranding urgent work as “routine.” It created the appearance of responsiveness, while masking the unsolved problem beneath.
Access was never simple. It just looked simpler when it was measured crudely.
The End of the 48-Hour Era
When the target disappeared around 2010, it wasn’t replaced with anything clearer. Instead, the language softened: practices were expected to provide “timely access to appropriate care.”
That shift reflected a recognition — or perhaps an admission — that the old model couldn’t keep pace with the pressures of modern general practice. Rising complexity, an ageing population, and workforce shortages meant that even well-run surgeries could no longer meet every patient’s expectation of rapid access to a GP.
The target was quietly dropped, and “access” began to mean something broader and more ambiguous.
The Diversification of Access
In its place came a new model: more routes into primary care, delivered by a wider team.
Through the Additional Roles Reimbursement Scheme (ARRS), practices gained pharmacists, paramedics, physiotherapists, and social prescribers. Pharmacy First and other community services expanded further. On paper, this looked like an access revolution — the promise that patients could see the right person at the right time.
But this diversification also fragmented the system. The more doors we opened, the harder it became for patients to know which one to walk through.
The Clinical Iceberg Rises
One of the most under-discussed realities of modern access is the clinical iceberg — the vast volume of health need that exists below the surface of what patients actually present with.
For decades, GPs managed that hidden demand through a kind of informal triage: familiarity with patients, continuity, and the subtle social boundaries that determined when someone did or didn’t come in.
The arrival of Total Triage and digital-first access has disrupted that balance. By lowering the threshold for contact — “just fill in a quick online form” — we’ve effectively exposed the clinical iceberg. Every symptom, worry, and uncertainty now arrives instantly in the inbox, demanding review, triage, and response.
A 2022 NHS England evaluation of total-triage pilots found exactly this: consultation volumes increased in most practices, not because illness rose, but because friction fell. When the door is permanently open, more people walk through it — including those who might previously have self-managed or waited a few days.
More recent analysis using Accurx data showed that UK practices delivered around 356 million appointments in 2023 — a 14% rise over 2019 — reflecting how easier access inflates total demand rather than relieving it.¹
This is why so many practices report feeling overwhelmed. The system isn’t failing — it’s simply revealing what was always there, in a way that no finite workforce can sustain.
A Different Approach
At our practice, we’ve consciously resisted total triage. Instead, we’ve focused on strong navigation, not digital filtration.
Our reception team know their patients and their clinicians. They’re confident directing people to Pharmacy First, or to the right professional within the practice. The result? Routine GP appointments are usually available within a week, and we maintain same-day capacity for urgent needs.
This hybrid model allows us to combine responsiveness with continuity — and our patient feedback reflects that balance.
Continuity hasn’t disappeared; it just needs protecting.
Access, Redefined and Reclaimed
So how did we move from a national promise of a 48-hour appointment to a system where many patients wait weeks — while being told access has “improved”?
The answer lies in how we’ve redefined success. Access no longer means seeing your GP — it means interacting with the system. Yet most patients still equate good access with being seen by someone who knows them.
If we’re serious about improving access, we need to reclaim its human dimension. That means designing systems that don’t just open doors, but guide patients through them — with continuity, trust, and realism about what general practice can deliver.
Because the truth is this: the clinical iceberg will always exist, and no algorithm can melt it away. The art of general practice lies not in exposing every hidden need, but in managing demand safely, humanely, and with continuity at its core.
Access without continuity is contact, not care. And general practice, at its best, has always been about care.
References & Further Reading
Implementing Accurx for Total Triage: Enhancing Care Navigation and Patient Experience — BMJ Open Quality, 2024. Read here ›
Quantifying Unmet Need in General Practice: A Retrospective Cohort Study of Administrative Data, 2023 — BMJ Open (Scotland study showing 14% more GP contact time would be needed to meet morbidity-based demand). Read here ›
Rethinking Access to General Practice: It’s Not All About Supply — Health Foundation, 2023. Read here ›
Access to GP Care: State of Care Report 2021/22 — CQC, 2022. Read here ›
Continuity of Care: Why It Still Matters — RCGP, 2024. Read here ›
Seeing the Same GP Improves Patient Health and Cuts Workload of Doctors — University of Cambridge / The Guardian, 2024. Read here ›