The 2026-27 GP contract makes same-day access for clinically urgent patients a contractual obligation from April 2026. If a patient is triaged as clinically urgent (as determined by your practice) they must be dealt with on the same day. NHS England will collect five new access metrics from April, including the percentage of clinically urgent patients seen same-day.
Here's the good news: most practices already see urgent patients on the same day. You're probably closer to compliant than you think. The real work isn't reinventing your clinical model. It's formalising your triage process, fixing your data capture so the metrics reflect what you're actually doing, and closing a few specific gaps before April.
This is a compressed readiness sprint, not a leisurely improvement programme. Five weeks to get contractually compliant, then use the quieter spring and summer months to optimise properly.
Implementation timeframe: 5-week sprint to April compliance + ongoing summer optimisation
Why This Matters
For Your Practice
This isn't guidance or best practice. It's a contractual obligation. From April 2026:
Same-day urgent access is mandatory: Patients identified as clinically urgent must be "dealt with" on the same day. "Dealt with" includes face-to-face, telephone, video consultation, or a clinical triage decision that results in a definitive outcome (prescription, referral, safety-netting advice). It doesn't have to be a face-to-face appointment, but it must be a clinical response, not just an acknowledgement.
Five access metrics will be collected: Call waiting times (peak and core hours), percentage of urgent patients seen same-day, and percentage of non-urgent patients seen within one and two weeks. This data flows via GPAD and your cloud-based telephony supplier.
"Call back tomorrow" is explicitly prohibited: In any form: "try again at 8am", "fully booked today, ring back tomorrow", "no appointments left, call back Monday." This is now a contractual breach, not just poor practice.
Online consultation caps during core hours are banned: If your system currently limits daily submissions, this becomes a contract breach from April.
ICBs will scrutinise "unwarranted variation": Practices showing poor metrics must engage with ICB support. Refusing to engage is itself a contractual breach. CQC can use these metrics for targeted Responsive assessments.
The timing works in your favour. April through June is typically your lowest-demand quarter. You'll be bedding in new processes when pressure is at its lightest.
For Your Professional Development
By leading this readiness sprint, you'll demonstrate:
Contract change management: Translating new contractual requirements into operational changes under time pressure. Exactly the kind of proactive leadership that partners value.
Data-driven governance: Using GPAD metrics and clinical system data to identify gaps, measure compliance, and demonstrate improvement to commissioners.
Access model expertise: Understanding triage design, capacity planning, and the relationship between process, data capture, and reported performance.
Stakeholder coordination: Aligning clinical leads, reception teams, and partners around a shared deadline with clear deliverables.
Add this to your year-end evaluation: "Led 5-week contract readiness sprint for same-day urgent access. Delivered documented triage protocol, urgency coding implementation, staff training programme, and ongoing metrics framework, achieving contractual compliance ahead of April deadline."
Prerequisites and Preparation
What You Need Before Starting
GPAD dashboard access: Log in at the GPAD portal (updated Thursdays) to see your current appointment data, including same-day, next-day, and longer wait buckets. This is your baseline.
Clinical system admin access: You'll need to configure urgency categories in EMIS, SystmOne, or Vision. Identify who has admin rights now.
CBT telephony data: Your cloud-based telephony supplier already submits call waiting data. Access your dashboard to understand current phone performance.
Last year's April–June data: If available, pull appointment volumes and patterns from spring 2025. This gives you a demand forecast for the period when your new processes go live.
Clinical lead engagement: Your triage protocol needs clinical sign-off. Brief your clinical lead early, ideally before Week 1.
Partner awareness: Partners need to know this is a contractual change, not an optional improvement. A 5-minute briefing at the next partners' meeting is enough.
Estimated Time Investment
Total sprint: 5 weeks (your time: 4-6 hours per week)
Clinical lead time: 2-3 hours total (protocol review and sign-off)
Reception team training: 2-3 hours (one session plus follow-up)
Clinician briefing: 1 hour (coding and documentation requirements)
Whole-team briefing: 30 minutes (Week 5, pre-go-live)
The Readiness Sprint
Week 1: Self-Assessment
Before changing anything, find out where you actually stand. This is an afternoon's work with the right data.
Action: Pull Your Baseline Data
From GPAD dashboard:
What percentage of appointments are currently booked same-day? (GPAD already tracks this in time-from-booking buckets)
What's your total daily appointment volume, and how does it break down by urgency? (If your system doesn't currently distinguish urgency, that's your first gap identified)
What does the weekly pattern look like? Which days are worst?
From your clinical system:
Do you currently have urgency categories configured at the point of booking or triage? (Check your appointment book setup. EMIS, SystmOne, and Vision all support this, but it may not be switched on)
When reception books a same-day appointment, is the urgency category recorded?
Can you run a report showing triage outcomes by urgency category? If not, your GPAD metrics will look bad even if you're performing well.
From your online consultation platform:
Is there a daily cap on submissions? If yes, this needs removing before April.
Is the platform open for the full core hours period (8am–6:30pm)?
Do submissions get triaged by urgency, and is that urgency category fed back into your clinical system?
From your reception team (ask directly):
What do you say when all same-day appointments are gone and someone calls with an urgent problem?
Have you ever told a patient to "call back tomorrow" or "try again at 8am"?
Can you explain how we decide who gets seen same-day?
Output: Your Gap Assessment
Score yourself honestly:
Triage protocol: Do you have a written, clinically-approved triage protocol? (Yes = ready. No = Week 2 priority)
Urgency coding: Does your clinical system capture urgency at booking/triage? (Yes = ready. No = Week 3 priority)
Reception training: Can staff explain the triage process and never say "call back tomorrow"? (Yes = ready. No = Week 3 priority)
Online consultation compliance: Open all core hours, no caps? (Yes = ready. No = fix immediately)
Data visibility: Can you report on % urgent seen same-day? (Yes = ready. No = Week 3 priority)
If you scored "ready" on most of these, your sprint is mostly formalisation and documentation. If you scored "no" on several, you have real work to do, but five weeks is enough.
Week 2: Formalise Your Triage Protocol
This is the most important deliverable. Your practice determines what "clinically urgent" means. There's no national definition. That clinical autonomy is valuable, but it means you need a documented protocol that's applied consistently.
Action: Define Your Urgency Categories
These categories are commonly used in general practice, drawing on BMA triage guidance. Adapt them to your practice:
Red / Same-Day: New problems where the patient is unwell today and would deteriorate within 24 hours if untreated. Also: acute mental health crisis, safeguarding concerns requiring immediate action, clinical situations where delay would cause harm.
Amber / Within 1 Week: Problems requiring clinical attention but not same-day. Worsening chronic conditions, new symptoms needing investigation, follow-up from recent illness.
Green / Within 2 Weeks: Lower acuity but still needs timely review. Routine follow-up, stable chronic disease review, non-urgent investigations.
Routine: Can wait for standard appointment. Administrative reviews, routine health checks, medication reviews without clinical concern.
Critical: Your protocol must apply equally across all contact channels: phone, online consultation, and walk-in. If phone callers get triaged differently from online submissions, you have an equity problem and a data problem.
Action: Define What "Dealt With" Means
Document your practice's interpretation of same-day response for urgent patients:
Face-to-face consultation
Telephone consultation with clinical outcome (prescription, referral, safety-netting advice)
Video consultation with clinical outcome
Clinical triage decision that results in a definitive action (not just "we'll look at this tomorrow")
The 5pm problem: The contract doesn't specify what happens when an urgent request arrives at 5pm with only 90 minutes of core hours remaining. Document your local interpretation now. Reasonable approaches: brief telephone assessment before 6:30pm, or signposting to out-of-hours with documented clinical rationale. Having this written down protects you if challenged.
Action: Get Clinical Lead Sign-Off
Your clinical lead reviews and approves the protocol. This takes 30-60 minutes. The protocol needs to be:
Clinically defensible (categories make clinical sense)
Operationally practical (reception staff can apply it with training)
Consistent across channels (same criteria for phone, online, walk-in)
Documented with version control and review date
Need a triage protocol document quickly? My Practice Manager subscribers can generate one using the SOP generator in about a minute, or browse the compliance library for templates to customise manually.
Week 3: Fix the Data and Train Your Team
Two parallel workstreams this week: technical (data capture) and human (staff training).
Action: Configure Urgency Coding in Your Clinical System
This is the hidden gotcha. You might be seeing every urgent patient same-day, but if your clinical system isn't recording urgency categories at the point of booking or triage, your GPAD metrics will look terrible, or simply won't report against the new metric at all.
What needs to happen:
Enable urgency category fields in your appointment booking workflow (EMIS, SystmOne, and Vision all support this; contact your system supplier if unsure how)
Map your triage categories (Red/Amber/Green/Routine) to the system's urgency fields
Ensure the urgency category is captured at the point of triage, not retrospectively
Test that urgency data flows through to your appointment reports (this is what GPAD will extract)
If you're not sure how to configure this: Contact your clinical system supplier's support team. Explain you need urgency categories captured at booking to comply with the 2026-27 contract metrics. They will have seen this request from other practices already.
Action: Train Reception on the "Call Back Tomorrow" Prohibition
This is the single most visible change. Reception staff need to understand:
What's prohibited: "Call back tomorrow", "ring again at 8am", "try again Monday", "no appointments left today, call back", "we're fully booked, try another day." Any variation of asking a patient to re-contact another day.
What replaces it: Every contact gets triaged. Urgent = same-day clinical response. Non-urgent = "I've logged your request and a clinician will respond by [timeframe]. You don't need to call back."
Why it matters: This is now a specific contractual requirement, not just good practice. It will be monitored.
Role-play these scenarios in training:
Patient calls at 4pm with an urgent problem and all slots are gone
Patient calls with a non-urgent issue and wants to be seen today
Patient is frustrated and insists on an appointment now
Patient asks "should I call back tomorrow morning?"
The correct response in every case is to triage, not to defer. Urgent cases get a same-day clinical response. Non-urgent cases get a clear next step and timeframe.
Action: Brief Clinicians on Documentation Requirements
Clinicians need to know:
When they triage a patient as urgent and respond same-day, the clinical record must show: urgency category assigned, time of triage decision, time of clinical response, modality of response (phone, face-to-face, video)
This documentation is your evidence that same-day access is happening. Without it, you can't defend your metrics.
It doesn't need to be burdensome: a coded entry at the point of triage and a timestamped consultation note is sufficient.
Action: Fix Online Consultation Compliance (If Needed)
If your Week 1 gap assessment flagged online consultation caps or early closures, fix them now. Contact your platform supplier and remove caps, and ensure submissions are accepted throughout core hours (8am–6:30pm). If staff have been closing forms early to manage workload, address the root cause (capacity) rather than the symptom (form closure).
Set up training tracking with Task Management. Create tasks for each training session with completion dates and attendee records. This gives you an audit trail for CQC.
Week 4: Dry Run
Run your new processes for one full week and measure the results yourself, before the contract takes effect.
Action: Collect Your Own Metrics
Track these daily for one week:
Total contacts triaged (all channels)
Number categorised as clinically urgent
Number of urgent patients dealt with same-day (and modality: face-to-face, phone, video)
Any urgent patients NOT dealt with same-day (and why)
Urgency coding completeness (% of appointments with urgency category recorded)
Any "call back tomorrow" incidents (ask reception to self-report honestly, no blame, just data)
Action: Identify and Fix Gaps
Look for patterns:
Specific days worse? Monday and post-bank-holiday surges are predictable. Plan extra capacity.
Specific times worse? Late afternoon urgent requests with no remaining slots. Consider holding 2-3 urgent slots for after 4pm.
Specific staff struggling? Additional coaching, not criticism. Reception staff adapt at different speeds.
Coding completeness low? Simplify the workflow. If urgency coding takes three clicks, it won't happen consistently. Work with your system supplier to make it one click.
This is your chance to find problems before they show up in your published GPAD data.
Week 5: Safety Net and Go-Live
Action: Arrange Your Capacity Buffer
Book locum sessions for April and May. This isn't an admission that you can't cope. It's sensible insurance while you optimise. A few extra GP sessions per week gives you breathing room to:
Handle the transition without overwhelming your regular team
Cover for days when demand spikes unexpectedly
Give clinicians time to adapt to new triage documentation requirements
Funding context: The 2026-27 contract introduces a £292 million practice-level GP reimbursement scheme (repurposed from PCN-level CASP and CAIP funding). Implementation details are expected at the NHS England webinar on 2 March 2026. This could help fund additional GP sessions. Get clarity from your PCN finance lead on how much CASP/CAIP your practice has been receiving, so you can model the impact.
Action: Whole-Team Briefing
30-minute all-staff briefing covering:
What changes from April 1st (same-day urgent access is now contractual)
The triage protocol (quick recap of categories and process)
What "dealt with" means (clinical response, not just acknowledgement)
What's prohibited ("call back tomorrow" in any form)
How metrics will be collected (GPAD extracts from your system, so urgency coding matters)
Where to get help (who to escalate to when unsure about urgency)
Action: Update External-Facing Information
Before April 1st:
Website: Display opening times for all access modes (phone, online consultation, walk-in). The contract requires this.
Practice leaflet: Same information, updated version.
Waiting room: Consider a simple poster explaining how triage works: "We prioritise by clinical need, not time of contact."
My Practice Manager subscribers can generate patient-facing communications using the AI document tools in about a minute, or draft manually.
Phase 2: Summer Optimisation (April–September)
You're now contractually compliant. April through September is your window to get genuinely good at this. Demand is lower, and you have real metrics to learn from.
Month 1 (May): Review Your First Real Metrics
Pull your April GPAD data and compare against your Week 4 dry run
Are urgent patients consistently dealt with same-day?
Is urgency coding complete and accurate?
Are there capacity gaps on specific days?
Share results with clinical lead and partners
Months 2-3: Refine and Build Capacity
Refine triage categories: Your initial categories were a best guess. Real data will show whether you're over-triaging (too many "urgent") or under-triaging (missing genuine urgency). Adjust with clinical lead input.
Explore the £292m practice-level scheme: Once implementation details are published, apply for funding to build permanent GP capacity.
Consider ARRS GP recruitment: The restriction limiting ARRS to recently-qualified GPs is removed from 2026-27, and the maximum reimbursement is increasing significantly. PCNs can now recruit experienced GPs via ARRS. Coordinate with your PCN.
Move toward total triage if not already there: If you're still running a hybrid model (some triage, some traditional appointment book), the quieter months are the time to complete the transition.
Months 4-6: Embed and Sustain
Replace locum buffer with permanent capacity where possible
Establish quarterly review cycle (metrics, protocol review, staff feedback)
Feed findings into your CQC evidence folder for the Responsive key question
Plan for winter surge (October onwards, when demand returns to peak)
Common Problems and Solutions
Problem 1: "We genuinely can't see everyone same-day"
Why this happens: Insufficient clinical sessions relative to urgent demand. Often worse on Mondays and after bank holidays. May also reflect over-triaging (too many patients categorised as urgent).
How to address it:
Check your triage categorisation first. Are patients being marked "urgent" who are actually "amber" or "green"? Over-triaging floods same-day capacity.
Model your actual urgent demand: pull a week's data, count genuine same-day-urgent cases, multiply by average consultation time. Is the gap 2 sessions or 20?
For short-term gaps: locum sessions, extended hours, telephone-first for lower-acuity urgent cases.
For structural gaps: business case to partners using the £292m practice-level scheme and ARRS expansion.
Prevention: Monthly capacity review against demand data. Adjust triage thresholds if urgent category is growing disproportionately.
Problem 2: "Reception staff keep saying 'call back tomorrow' out of habit"
Why this happens: Years of ingrained behaviour. When all slots were gone, "call back tomorrow" was the only option. The new system requires a different response, but muscle memory is powerful, especially under pressure.
How to address it:
Don't frame it as blame. Frame it as a script change. Old script: "No appointments, call back tomorrow." New script: "I've logged your request and a clinician will respond today/by [timeframe]."
Practice the new script in role-play (feels awkward, but works).
Put the new script on a card at every reception desk for the first month.
Monitor for the first two weeks: listen in (with staff knowledge) and give immediate positive feedback when the new language is used.
Prevention: Include in new starter induction. Refresher at team meetings quarterly. Celebrate the change once embedded.
Problem 3: "Our clinical system doesn't capture urgency categories at booking"
Why this happens: Many practices never configured urgency fields because there was no contractual requirement to do so. The data infrastructure exists in EMIS, SystmOne, and Vision. It's just not switched on.
How to address it: Follow the steps in Week 3 above: contact your supplier, configure urgency fields, and test the data flow. Most suppliers will have a standard setup process for this by now.
Prevention: When configuring, make urgency selection mandatory (not optional) in the booking workflow. Optional fields get skipped under pressure.
Problem 4: "GPs are triaging everything as urgent to avoid risk"
Why this happens: Clinicians fear being blamed if a patient categorised as "non-urgent" deteriorates. Marking everything urgent feels safer, but it defeats the triage system and floods same-day capacity.
How to address it:
Acknowledge the fear openly. This is legitimate clinical anxiety, not laziness.
Reinforce that your practice defines urgency, not the patient. A well-documented triage decision (with safety-netting) is clinically and contractually defensible.
Review the data: if >50% of patients are triaged as "urgent," the threshold is too low. Recalibrate with the clinical lead.
Implement safety-netting as standard: every non-urgent triage decision includes documented worsening advice. This protects the clinician.
Prevention: Monthly triage outcome review with clinical lead. Positive feedback for appropriate non-urgent decisions, not just scrutiny of urgent misses.
Problem 5: "We get urgent requests at 5:30pm with no capacity left"
Why this happens: The contract runs to 6:30pm but most GP sessions end at 5-5:30pm. Late urgent requests hit an empty rota.
How to address it:
Document your local interpretation of the "5pm problem" in your triage protocol. Reasonable options: brief telephone assessment before 6:30pm by duty clinician, or clinically-justified signposting to out-of-hours.
Consider holding one short late-afternoon session (4:30-6:30pm) specifically for urgent triage overflow.
Ensure your out-of-hours handover process is clear. When you signpost a patient to OOH, document the clinical rationale and ensure the patient knows what to do.
Prevention: Track late-afternoon urgent volumes. If this is a recurring pattern (not a rare edge case), it needs a structural solution, not daily improvisation.
Success Criteria and Evidence
You'll Know You've Succeeded When:
Documented triage protocol in place, clinically approved, with defined urgency categories
Urgency coding configured and consistently captured in your clinical system (>95% completeness)
Zero "call back tomorrow" language from any staff member, verified through observation and self-reporting
GPAD metrics showing your same-day urgent response rate (and you're confident in the number)
Reception staff can explain the triage process clearly when asked
Access policy updated for 2026-27 contract requirements
Late-afternoon urgent protocol documented and understood
Evidence You Can Show to CQC:
Documentation:
Written triage protocol with clinical lead approval, version control, and review date
Staff training records with attendance and content covered
Updated access policy reflecting 2026-27 contractual requirements
Meeting minutes from kick-off, training sessions, and reviews
Data and trends:
GPAD metrics showing same-day urgent response rates from April onwards
Week 4 dry-run data showing pre-go-live baseline
Urgency coding completeness rates
Call waiting times from CBT data
Operational evidence:
Reception scripts and quick reference cards
Online consultation platform configuration (no caps, full core-hours availability)
Locum booking records showing proactive capacity planning
Quarterly review schedule with metrics dashboard
Maintaining the Improvement
Weekly (first month): Reception observation spot-checks, urgency coding completeness, any "call back tomorrow" incidents
Monthly: GPAD metrics review, triage category distribution analysis, capacity vs demand check
Quarterly: Full protocol review with clinical lead, staff refresher, metrics trend analysis shared with partners
Annually: Protocol revision aligned with any contract updates, full staff retraining, CQC evidence folder refresh
Additional Resources
My Practice Manager Tools
AI Document Tools Generate triage protocols, access policies, patient communications, and training materials in about a minute. Use the SOP generator for your triage protocol or the policy generator for your updated access policy.
Compliance Library Browse access management policies, triage SOPs, and appointment audit templates with built-in regulatory citations and CQC mappings.
Task Management Set up your readiness sprint as tracked tasks with deadlines: training sessions, system configuration, document approvals, weekly metric reviews. Provides an audit trail for CQC showing systematic implementation.
Hands-On Support
The My Practice Manager team has hands-on experience helping practices implement total triage and navigate access model transitions. If you need tailored guidance beyond this plan, whether that's capacity modelling, triage protocol design, or staff training support, get in touch at contact@mypracticemanager.co.uk for bespoke consulting.
Related Improvement Plans
Improving Access Safety and Performance: the natural follow-on once your same-day access is running. Systematic audit of safety, equity, and performance.
This improvement plan is provided as practical guidance for GP practice managers. While based on the 2026-27 GP contract letter published 24 February 2026, some implementation details (particularly around the practice-level GP reimbursement scheme and access metric thresholds) are awaiting further guidance from NHS England. Exercise professional judgment and adapt recommendations to your practice's specific circumstances.