If you read our same-day urgent access readiness sprint back in February, you may be wondering whether the Neighbourhood Health Framework published on 17 March 2026 changes anything. The short answer: the April 2026 obligation still stands, but there is now a specific measurable target and a later deadline to meet it.
In brief: The 2026/27 GP contract requires same-day access for clinically urgent patients from April 2026, with no specific percentage. The Neighbourhood Health Framework sets a target of 90% of clinically urgent patients seen same-day by March 2027. This is a two-stage approach: obligation now, measurable standard in 12 months. 2026-27 is the baseline year.
What has actually changed?
Nothing about the April 2026 deadline has been pushed back. The contractual obligation to provide same-day access for clinically urgent patients takes effect this April, exactly as set out in the 2026/27 GP contract letter. That has not moved.
What the Neighbourhood Health Framework adds is specificity. Where the contract said "same-day access for clinically urgent patients" without defining a numerical standard, the framework now sets a target: 90% of clinically urgent patients seen on the same day, by March 2027.
This is an important distinction. The April 2026 requirement is a principle: your practice must provide same-day access. The March 2027 requirement is a measurable standard, and 90% is the bar.
The two-stage timeline
Date | What applies | What is measured |
|---|---|---|
April 2026 | Contractual obligation: same-day access for clinically urgent patients. No specific percentage. | New access metrics begin collection through GPAD (from the 2026/27 GP contract): call waiting times, % urgent seen same-day, % non-urgent within one and two weeks. |
April 2026 – March 2027 | Baseline year. Data is collected. Practices are expected to be working toward the target. | GPAD data builds your practice's baseline. |
March 2027 | Framework target: 90% of clinically urgent patients seen same-day. | The framework does not specify consequences for missing the target, but access data will be visible to ICBs and is likely to inform commissioning and support decisions. |
The baseline year is not a grace period. The contractual obligation is live from April. But the framework acknowledges that hitting 90% requires data infrastructure, process maturity, and sometimes capacity changes that cannot all happen overnight. 2026-27 is the year to get there.
Why 90% and not 100%?
The framework does not explain the rationale for the 90% figure, but the threshold is pragmatic. There will always be legitimate clinical situations where a same-day response is not achieved despite best efforts:
A patient contacts the practice at 6:15pm, 15 minutes before core hours end, with a problem that cannot be resolved by phone in 15 minutes
A genuine capacity spike (post-bank-holiday Mondays, flu outbreaks, multi-casualty incidents) where demand temporarily exceeds all available resource
Patients who are triaged as urgent but then cannot be contacted for their same-day appointment
Complex presentations that are triaged as urgent but where the patient and clinician agree a next-day planned appointment is clinically preferable to a rushed same-day slot
The 10% headroom is not an excuse. It is recognition that primary care operates in the real world. Practices consistently below 90% will need to demonstrate why and show an improvement trajectory.
What the baseline year is for
If you have already completed the readiness sprint or done similar preparation work, you are well positioned. The baseline year (April 2026 to March 2027) is your opportunity to:
Verify your data is accurate
The 90% target is measured through GPAD data, which is extracted from your clinical system. If your urgency coding is incomplete or inconsistent, your reported performance will be worse than your actual performance.
During the baseline year:
Audit urgency coding completeness monthly. What percentage of triaged contacts have an urgency category recorded? Target 95%+ before the March 2027 deadline.
Check your coding reflects your triage decisions. If reception triages a patient as urgent and the patient is seen same-day, but neither the urgency category nor the same-day resolution is coded, that success is invisible in your data.
Review your GPAD dashboard weekly (updated Thursdays) to understand what your metrics look like. If the numbers do not match your experience, the problem is data capture, not clinical performance.
Establish your true baseline
Your first quarter of GPAD data (April to June 2026) will establish your practice's starting position. This matters because:
ICBs will use baseline data to identify "unwarranted variation." Practices significantly below peers will attract attention and support (or scrutiny) earlier.
Your baseline is your improvement evidence. Going from 78% to 91% by March 2027 is a credible story. Going from "we don't know" to 91% is harder to demonstrate.
Spring is your kindest quarter. April through June is typically the lowest-demand period. Your baseline will likely be your best quarter. If you are below 90% in spring, you have a structural capacity problem that needs addressing before winter.
Refine your triage protocol
The readiness sprint got your triage protocol in place. The baseline year is for tuning it. Common issues that emerge in the first three months:
Over-triaging: Too many patients classified as urgent, flooding same-day capacity. If more than 30-35% of contacts are triaged as urgent, your threshold may be too low.
Under-triaging: Genuinely urgent patients classified as routine, improving your numbers but creating clinical risk. Review any patients who re-presented as emergencies within 24 hours of a non-urgent triage decision.
Inconsistency across staff: Different receptionists applying different thresholds. Monthly calibration sessions (15 minutes, using anonymised scenarios) keep everyone aligned.
Channel inconsistency: Phone callers triaged differently from online consultation submissions. Same criteria must apply regardless of how the patient contacts you.
Build capacity where needed
If your spring baseline shows you below 85%, you likely have a capacity gap that process improvements alone will not close. Use the baseline year to:
Model your urgent demand. How many genuine same-day-urgent contacts do you receive daily? Multiply by average consultation time. Compare against available same-day clinical sessions.
Explore the 2026/27 funding changes. The practice-level GP reimbursement scheme (replacing PCN-level CASP/CAIP) may fund additional sessions. ARRS restrictions on experienced GP recruitment have been removed.
Consider your appointment mix. If you are running a high proportion of pre-bookable routine slots and a low proportion of same-day urgent slots, the balance may need adjusting.
How the 90% target is likely to be measured
The framework does not detail the measurement methodology, but GPAD (General Practice Appointment Data) is the existing infrastructure for GP access metrics and is the most likely mechanism. Based on current GPAD definitions and the 2026/27 contract's access metrics:
Numerator: Patients triaged as clinically urgent who receive a same-day clinical response (face-to-face, telephone, video, or a definitive clinical triage decision)
Denominator: All patients triaged as clinically urgent
"Same-day" means: A clinical response on the day the patient was triaged, not the day they contacted the practice (though in most cases these are the same)
"Dealt with" includes: Face-to-face consultation, telephone consultation with a clinical outcome, video consultation with a clinical outcome, or a clinical triage decision that results in a definitive action (prescription, referral, documented safety-netting advice)
"Dealt with" does not include: An acknowledgement without clinical input, a message saying "a clinician will call you tomorrow," or a deferral to the next day without clinical rationale
The data quality point cannot be overstated. If your practice sees 95% of urgent patients same-day but only codes urgency on 60% of contacts, your GPAD metric could report well below 90%. The baseline year is as much about fixing data capture as it is about fixing clinical processes.
What if you have not started yet?
If your practice has not begun preparing for same-day urgent access, you are behind but not lost. Twelve months is enough to get compliant if you start now. Here is a compressed timeline:
Months 1-2 (April – May 2026): Follow the readiness sprint. It covers triage protocol creation, urgency coding configuration, reception training, and a dry run. The sprint was designed for five weeks but can be compressed to three if needed.
Months 3-6 (June – September 2026): Baseline and refine. Your spring GPAD data gives you a starting position. Summer is low-demand, so use it to tune triage thresholds, improve coding completeness, and address capacity gaps.
Months 7-9 (October – December 2026): Winter stress test. Demand peaks in autumn and winter. This is when your processes face their hardest test. If you are above 90% through winter, you will meet the March 2027 target.
Months 10-12 (January – March 2027): Final review and evidence compilation. Ensure your data tells the right story. Prepare your evidence for any ICB scrutiny.
How this fits with the broader Neighbourhood Health Framework
The 90% same-day access target is one of several key expectations in the Neighbourhood Health Framework. It sits alongside requirements for shared care records, population health management, Integrated Neighbourhood Team participation, care planning for complex patients, and specialist referral pathways.
The access target is likely the most immediately measurable of these. It is also the one where practices have the most direct control. Other expectations, particularly INT participation and shared care records, depend on system-level infrastructure that is still being built. Same-day access depends on your triage, your coding, your capacity, and your team. That makes it the logical place to start.
Frequently asked questions
Has the April 2026 same-day access deadline been pushed back?
No. The April 2026 contractual obligation is unchanged. From April, practices must provide same-day access for clinically urgent patients. The Neighbourhood Health Framework adds a specific 90% target with a March 2027 deadline. These are two separate requirements: the obligation (April 2026) and the measurable standard (March 2027).
What happens if my practice does not hit 90% by March 2027?
The framework does not specify consequences for missing the target. However, practices below 90% will be visible in GPAD data and can expect ICB engagement. Separately, the 2026/27 GP contract requires practices showing significant variation in access metrics to engage with ICB support, and CQC may use access data to inform inspection decisions. The combination of the framework target and the contract obligation means practices that are consistently below 90% are likely to attract attention from multiple directions.
Does "90% seen same-day" mean face-to-face appointments only?
No. "Dealt with" includes face-to-face, telephone, and video consultations, as well as definitive clinical triage decisions (prescription, referral, documented safety-netting). A telephone consultation that results in a prescription counts. A clinical triage decision that results in a documented referral counts. What does not count is a non-clinical acknowledgement or a deferral to the next day.
How is "clinically urgent" defined?
Your practice defines it. There is no national definition of clinical urgency in the GP contract or the framework. Your triage protocol determines the threshold. This is clinical autonomy, but it also means your protocol must be documented, clinically approved, and applied consistently. If your definition is too broad (triaging 50%+ as urgent), you will struggle to meet 90% and should recalibrate.
What if our GPAD data looks bad because of coding problems, not clinical performance?
This is common and fixable. If your practice is clinically compliant but your data does not reflect it, use the baseline year to fix the data capture. Audit urgency coding completeness monthly. Make urgency selection mandatory (not optional) in the booking workflow. Test that the data flows from your clinical system into GPAD correctly. Your clinical system supplier can help with configuration.
Should we aim for 90% or higher?
Aim for consistent performance above 90% so that seasonal variation and bad weeks do not drop you below the threshold. A practice averaging 93-95% has headroom for winter surges. A practice averaging exactly 90% will dip below during peak demand. The 90% is a floor, not a ceiling.
What data should we be collecting from April 2026?
Five new GPAD access metrics are being collected from April: call waiting times (peak hours and core hours), percentage of clinically urgent patients seen same-day, and percentage of non-urgent patients seen within one week and two weeks. Additionally, track your own internal metrics: urgency coding completeness, triage category distribution (what percentage are triaged urgent vs. routine), and late-afternoon urgent request volumes.
Where can I read the full Neighbourhood Health Framework?
The framework was published on GOV.UK on 17 March 2026. For a practice-manager-focused summary covering the key requirements, deadlines, and new structures, see our Neighbourhood Health Framework explainer.
This article is for informational purposes only and reflects understanding as of 17 March 2026. The Neighbourhood Health Framework is a new publication and implementation guidance has not yet been released. The 90% same-day access target and its measurement methodology may be further clarified in upcoming NHS England operational guidance. Practices should consult with their LMC, ICB, and PCN Clinical Director for local implementation plans and always refer to the latest official guidance from NHS England and DHSC.