The shift toward same-day access in NHS primary care is accelerating. Driven by contractual reform, rising patient expectations, and the persistent challenge of access demand outstripping GP capacity, same-day access hubs, urgent treatment centres, and integrated urgent care services are reshaping how primary care is delivered — and who delivers it. For clinicians, PCN leaders, and GP practices planning their workforce for the next two to three years, understanding this shift is no longer optional.
What Is Driving the Same-Day Access Agenda?
GP Contract changes introduced from 2023 committed NHS England to ensuring patients could contact their GP practice on the same day they call and receive a routine appointment within two weeks. Practices that cannot demonstrate adequate access face targeted support and scrutiny from ICBs. This has accelerated the development of same-day access infrastructure at both practice and PCN level across England.
At the same time, NHS 111 and A&E pressures have increased the volume of urgent care demand being directed back into primary care settings — particularly urgent treatment centres (UTCs) and GP-led urgent care hubs. The result is a rapidly growing market for clinicians with acute presentation skills who can work at pace in time-pressured primary care environments.
Growth in ECP and ENP bookings via SHR Group since 2022
Urgent treatment centres now operational across England
Of GP practices now operating some form of same-day access hub
The Four Roles at the Forefront of Same-Day Access
Emergency Care Practitioner
Demand: Very High & Rising
ECPs — typically paramedics or nurses who have completed advanced urgent care training — are the backbone of many same-day access services. They assess and manage undifferentiated acute presentations autonomously, decide care pathways, and significantly reduce GP and emergency department burden. In-demand across GP hubs, OOH providers, and UTCs.
Emergency Nurse Practitioner
Demand: High & Growing
ENPs bring specialist minor injury assessment and management skills — particularly valuable in MIUs, UTCs, and integrated urgent care services. Their contribution to primary care significantly reduces A&E presentations for minor injuries and illnesses. Increasingly deployed in GP-led urgent care hubs and extended access services.
Primary Care Paramedic
Demand: High via ARRS
Paramedic practitioners are increasingly deployed within PCNs under ARRS, managing home visits, acute same-day presentations, and minor illness. Their pre-hospital assessment skills — rapid triage, risk stratification, pathway decisions — translate directly and powerfully to primary care same-day demand management.
Advanced Nurse / Clinical Practitioner
Demand: Consistent & High
ANPs and ACPs with acute and primary care experience are core clinicians in same-day access hubs, providing autonomous consultation across the full range of presentations. Independent prescribers in this group can manage the majority of same-day demand without GP input — the highest-value deployment for GP capacity release.
The Integrated Urgent Care Model: Where Primary Care Is Heading
The NHS Long Term Workforce Plan and the NHS England Access Recovery Plan both point toward an integrated urgent care model where primary care, NHS 111, community services, and urgent treatment centres work more closely together. In this model, clinical triage happens centrally — typically through 111 or GP-led triage — and patients are directed to the most appropriate clinician based on need rather than simply the next available GP appointment.
For clinicians, this creates a richer range of working environments and clinical variety. A paramedic practitioner may see patients in a GP surgery in the morning and conduct home visits through an urgent care service in the afternoon. An ANP may work across a same-day access hub and a chronic disease clinic in the same week. Portfolio working within primary care settings is becoming the norm rather than the exception.
What This Means for Workforce Planning
Same-day access models require a fundamentally different approach to workforce planning compared to traditional GP appointment booking. Key considerations for GP practices and PCNs:
- Multi-professional deployment — the right clinician must see the right patient. Clinical triage by an ANP or paramedic at the front of the access system significantly improves capacity utilisation by matching acuity to clinician skill level
- Flexible rota management — same-day demand is inherently variable, requiring more flexible staffing models than standard scheduled appointments. Locum capacity for surge periods is an important planning tool
- Training investment — deploying paramedics or ENPs in primary care settings requires investment in induction and primary care-specific training. Skills acquired in emergency settings do not automatically transfer without support
- Performance monitoring — tracking outcomes, patient satisfaction, onward referral rates, and appointment conversion rates by clinician type enables continuous optimisation of the access model
- Locum capacity for peaks — seasonal and day-of-week variation in same-day demand means locum ECP, ENP, and GP capacity remains essential even for well-staffed services
For Clinicians: Career Opportunities in Same-Day Access
The growth of same-day access services has created significant new career opportunities for ECPs, ENPs, paramedic practitioners, and advanced nurses in primary care settings. Compared to pure emergency department work, primary care same-day access roles typically offer:
- More regular and predictable working hours (daytime and evenings rather than full shift patterns)
- Greater clinical variety — managing both acute and sub-acute presentations
- Closer integration with long-term care and follow-up, providing more satisfying clinical continuity
- Competitive locum rates — particularly in the current high-demand market
- ARRS reimbursement eligibility for paramedic practitioner roles in PCN settings
