When practices move to online consultation, the 8am phone rush is often replaced by an 8am online rush (see the 8am Rush analysis). One explanation offered is that many practices only open their online consultation tool to requests from 8am, so if they accepted requests around the clock the rush would go away. The alternative is capacity: if same-day care is allocated each morning and runs out, patients have a reason to get in early, whenever the front door opens.
Some practices already take OC requests 24/7, which allows the two explanations to be tested. This page groups practices by when their OC submissions actually arrive and compares their calls, OC submissions, appointments and patient experience in September 2026.
Not really. When practices opened their OC to requests overnight and at weekends, the share of their calls arriving at 8–10am did not fall (+0.4 points, 95% CI −0.4 to +1.3; 24 practices). When practices closed their OC out of hours, the share of calls and OC arriving at 8–10am rose by less than one point (+0.7; 170 practices).
Comparing practices gives the same picture. In practices open 24/7 for clinical requests, 28.9% of weekday calls and OC submissions arrive between 8 and 10am, against 30.9% in practices open in core hours only. The difference is in OC; their phone peak is no smaller. Opening 24/7 for admin requests only makes little difference (29.7%).
The team's morning workload is the same. Requests sent overnight or at the weekend are dealt with when the practice opens, so every group handles about a third of its week's contacts between 8 and 10am.
The results fit the capacity explanation better than the opening-hours one. Practices with a smaller morning peak also offer more appointments that can be booked ahead.
Practices with 300+ OC submissions in September 2026, grouped by when submissions arrived.
| Group | Practices | OC / 1k / weekday | Median list | Rule used |
|---|---|---|---|---|
| Core hours only | 1,401 | 8.0 | 9,861 | No weekend submissions; ≤3 weekday nights with any |
| Weekday early opening | 489 | 8.6 | 11,208 | Submissions on ≥18 of 22 weekday nights, ≤1 weekend day. Almost all before 8am, very few after 18:30 |
| 24/7, admin only | 252 | 10.4 | 10,584 | ≥7 of 8 weekend days and ≥18 nights, but no clinical requests at weekends |
| 24/7 incl. clinical | 145 | 3.0 | 9,929 | As above, with clinical requests on ≥6 of 8 weekend days |
"Nights" are weekday dates with any submission between 18:30 and 08:00. Practices fitting none of the four patterns are left out. Most 24/7 clinical practices rely mainly on the phone, with well under half the usual OC volume.
The clearest test is what happened when practices changed their OC hours. Opening OC overnight and at weekends did not reduce the share of calls arriving at 8–10am, and closing it did not increase it. Each practice's change is measured against practices that kept the same hours over the same months.
| Change in share arriving 8–10am | Opened OC out of hours | Closed OC out of hours |
|---|---|---|
| Phone calls | +0.4 points (−0.4 to +1.3), n=24 | −0.9 points (−1.5 to −0.3), n=170 |
| Calls + OC | +0.1 points (−1.0 to +1.1), n=24 | +0.7 points (+0.2 to +1.3), n=170 |
| OC only | −2.6 points (median), n=46 | +2.1 points (median), n=257 |
Shares of weekday contacts, January 2025 to September 2026. Phone and calls + OC rows: averages with 95% confidence intervals, for practices with telephony data in both months. OC only: medians, because a few practices with large changes make the average unreliable.
Opening OC out of hours moves some OC requests out of the 8–10am window, and closing it moves them back, but the phone peak does not change and the combined effect is under one percentage point. Few practices opened OC out of hours, so a small effect cannot be ruled out.
Since January 2025 more practices have stopped taking OC requests out of hours than have started. Most practices now open 24/7 for clinical requests have been that way for some time: of the 172 in September 2026, 56 were already open 24/7 in January 2025.
| Practices with 300+ OC submissions | Jan 2025 | Dec 2025–Mar 2026 | Sep 2026 |
|---|---|---|---|
| Open 24/7 | 26% | 20–21% | 16% |
| Core hours only | 42% | 50–52% | 55% |
January 2025 uses an older file with no dates or clinical/admin split, so practices are grouped by the share of OC arriving at weekends and overnight; checked against the full rules for January and September 2026, almost every practice was placed in the same group. Remaining practices had some OC out of hours without meeting either rule. About 2,100 practices reached 300 submissions in January 2025, against about 4,100 now.
Per 1,000 patients per weekday, in two-hour bands. The three charts add up: calls plus OC equals all contacts.
24/7 clinical practices get less OC at 8–10am (1.4 vs 3.2 per 1,000), mainly because they get less OC overall. 14% of their OC arrives 8–9am, against 26% in core-hours-only practices; 8% arrives on weekday evenings and they get 1.1 per 1,000 per weekend day.
Even where requests can be sent at any time, few are sent overnight or at weekends. A request sent in the evening is usually not dealt with until the next working day, and practices generally advise patients to use 111 for urgent problems out of hours. If same-day care is allocated from 8am, there is little to gain by sending a request earlier, which may be why 8–9am is still the busiest hour.
24/7 clinical practices get the most 8–10am calls (7.4 vs 6.9 per 1,000), because most rely mainly on the phone.
Core-hours-only practices peak at 10.2 contacts per 1,000 at 8–10am, and 24/7 clinical and weekday early-opening practices at 8.8. In the early-opening group part of the peak moves to 6–8am. Bands are unequal: 0–6 is 00:00–05:59, 18 is 18:00–18:29, eve is 18:30–23:59. Weekdays only, pooled across practices. Hover or tap for values.
| Per 1,000 patients per weekday, all 24 hours | Core hours only | Weekday early opening | 24/7 admin | 24/7 clinical |
|---|---|---|---|---|
| Phone calls | 25.6 | 23.5 | 25.4 | 29.2 |
| OC submissions | 8.0 | 9.9 | 11.0 | 3.9 |
| Total contacts | 34.0 | 33.5 | 35.1 | 34.1 |
Median practice in each row, so rows need not add up exactly.
Patients contact 24/7 clinical practices as often as other practices, but more of them phone. Adjusted for deprivation, age, list size and region, these practices get 2.3 more calls per 1,000 per weekday (95% CI +0.4 to +4.2), 2.4 fewer OC submissions (−3.2 to −1.6), and no difference in total. Evening and weekend submissions replace contacts that would otherwise come in core hours, rather than adding to them.
The size of the 8am peak depends partly on how much OC a practice gets, and 24/7 clinical practices get little. To compare like with like, practices are split into three equal bands by OC use. Each cell is the share of weekday calls + OC arriving 8–10am (median practice).
| OC volume | Core hours only | Weekday early opening | 24/7 admin | 24/7 clinical |
|---|---|---|---|---|
| Low (<4.6/1k/wd) | 30.2% (496) | 26.6% (105) | 29.1% (63) | 28.1% (99) |
| Mid (4.6–11.0) | 28.5% (413) | 27.1% (237) | 28.4% (80) | 25.7% (32) |
| High (>11.0) | 29.3% (492) | 26.9% (147) | 27.7% (109) | 25.2% (14) |
Practice counts in brackets.
In every band, 24/7 clinical and weekday early-opening practices have a smaller morning share than core-hours-only practices, by 1.3 to 4.1 percentage points.
Here each OC request is assigned to the morning it would be dealt with: requests from a weekday evening or before 8am to that morning, weekend requests to Monday. The 8–10am workload is the calls arriving then plus all OC sent since the practice closed.
| Day | Core hours only | Weekday early opening | 24/7 admin | 24/7 clinical |
|---|---|---|---|---|
| Monday | 13.8 · 32.8% | 13.7 · 32.6% | 16.2 · 36.3% | 15.5 · 35.7% |
| Tuesday | 9.1 · 28.0% | 9.1 · 28.2% | 10.2 · 29.9% | 9.4 · 28.4% |
| Wednesday | 8.5 · 27.8% | 8.4 · 27.6% | 9.3 · 29.6% | 8.7 · 27.6% |
| Thursday | 7.9 · 27.5% | 7.9 · 27.7% | 8.6 · 29.1% | 8.2 · 28.7% |
| Friday | 7.9 · 28.0% | 7.8 · 28.1% | 8.7 · 29.5% | 8.1 · 28.7% |
| Whole week | 30.9% | 30.2% | 32.6% | 31.8% |
Each cell: contacts to handle 8–10am per 1,000 patients · share of that day's contacts (median practice). Whole week: share of the week's contacts, pooled. September 2026; 1 September left out because part of its queue arrived in August. Calls outside core hours are not counted, as they are not answered.
Every group handles about a third of its contacts between 8 and 10am. Monday is the busiest morning everywhere, and busiest where OC is open 24/7 (36% of the day vs 33%), because requests sent over the weekend are dealt with on Monday morning.
Appointments in General Practice, September 2026. "Booked same day" means the appointment took place on the day it was booked.
| Median practice | Core hours only | Weekday early opening | 24/7 admin | 24/7 clinical |
|---|---|---|---|---|
| Appointments booked same day | 44.2% | 43.8% | 46.2% | 40.6% |
| GP appointments booked same day | 56.1% | 55.3% | 56.0% | 52.0% |
| Appointments per 1,000 patients | 509 | 531 | 551 | 556 |
| Same-day appointments per 1,000 patients | 224 | 230 | 255 | 225 |
| GP appointments per 1,000 patients | 237 | 239 | 242 | 237 |
| Adjusted difference, booked same day | — | −1.1pp | +0.4pp | −3.2pp (−5.2 to −1.1) |
| Adjusted difference, GP booked same day | — | +0.3pp | +0.3pp | −4.0pp (−6.6 to −1.5) |
| Adjusted difference, appointments per 1,000 | — | +16 | +32 | +40 (+11 to +68) |
Monthly totals; practices with 200+ appointments. Adjusted for deprivation, age, list size and region. May 2026 data showed the same pattern.
24/7 clinical practices provide as many same-day and GP appointments per patient as other practices, plus extra appointments booked for later days with other staff. With less of the day's care depending on contact at 8am, there is less reason to send requests early in the morning.
| Median practice | Core hours only | Weekday early opening | 24/7 admin | 24/7 clinical |
|---|---|---|---|---|
| Calls answered | 63.6% | 63.7% | 63.2% | 65.9% |
| Calls answered, 8–10am | 62.0% | 61.7% | 60.6% | 63.3% |
| Calls ended in the phone menu | 20.0% | 20.5% | 20.3% | 17.2% |
| Adjusted difference, calls answered | — | +1.3pp | +0.6pp | +1.5pp (−0.9 to +4.0) |
| Adjusted difference, answered 8–10am | — | +2.2pp | 0.0pp | +3.3pp (+0.4 to +6.3) |
| Good overall experience (GPPS) | 77.1% | 79.0% | 76.9% | 80.2% |
| Good experience of contacting the practice (GPPS) | 72.8% | 74.8% | 73.5% | 76.9% |
| Easy to get through on the phone (GPPS) | 56.3% | 58.3% | 57.1% | 64.5% |
| Adjusted difference, overall experience | — | +1.8pp | +0.9pp | +0.8pp (−1.0 to +2.6) |
| Adjusted difference, contacting the practice | — | +2.2pp | +1.1pp | +1.8pp (−0.2 to +3.9) |
| Adjusted difference, easy by phone | — | +3.6pp | +2.7pp | +3.6pp (+1.0 to +6.2) |
Calls: weekday core hours, September 2026, practices with 200+ calls; adjusted for deprivation, age, list size, region, OC and call volume. GP Patient Survey 2026 (fieldwork January–April), with practices grouped by their March 2026 OC hours (24/7 clinical n = 196); adjusted for deprivation, age, list size, region and OC volume.
24/7 clinical practices answer slightly more calls, clearest at 8–10am (+3.3 points adjusted). Their patients report higher satisfaction, but after adjustment only ease of getting through by phone is clearly higher (+3.6 points); the other extended-hours groups show similar gains.