Thinking Differently About Same Day Access: Qualitative Study of Primary Care Staff Experiences in England and...

Rising demand for GP services alongside limited change in supply is placing unprecedented pressure on primary healthcare systems in many countries, including the UK and Denmark. The 2026 English GP contract requires practices to provide same day access to all patients considered to have an urgent need.

To study primary care staff reflections on their experiences of prioritising same day access through different approaches, which their practices had chosen and adapted over months and years.

A subset of three case studies (two in England, one in Denmark) from a larger focussed ethnography. These practices were selected for the sub-study because they all prioritised same day access but had developed different approaches. We draw on formal and informal interviews with staff and observations in the practices.

The different rationales for introducing same day access in these three practices had been to reduce long waiting times, to tackle non-attendance at pre-booked appointments and to help address limited GP capacity. Systems were maintained by weekly and daily tinkering with appointment capacity, by managing the balance of access and continuity, understanding where exceptions were important for different patient groups and, in the English case studies but not in Denmark, by channelling patients to allied health care professionals. In all cases, consideration was given to the trade-off for patients between urgency and continuity. Staff drew on their own experiences to caution against entirely open appointment booking systems. Staff in all three sub-study practices had, based on their experiences, started to think differently about how best to manage same day access. Our findings, comparing the English and Danish practices, raise the counter-intuitive possibility that, rather than opening the floodgates, making it easier for patients to access GP appointments when needed might help moderate total demand.

These findings matter in relation to the 2026 GP contract, which has specified that 90% of appointments deemed 'urgent' by the practice must be seen on the same day. When dealing with seemingly overwhelming demand, it is tempting to introduce channels and diversions to protect supply, or even to question whether the demand is justified. Our findings suggest a pertinent metaphor: it is now recognised in flood prevention that the introduction of man-made channels has exacerbated the problem of flash flooding, while the use of open, naturally managed flood plains is beneficial. This metaphor may help practices to understand the consequences of their response to the new requirement for same day access.

The wider ethnographic study was guided from inception to completion by a PPI co-applicant and eight PPI representatives who, between them, represented a diversity of lived experience. In relation to this article, the PPI co-applicant reviewed practice summaries and provided sense-checking of our ideas and interpretations.