Every few months, the NHS seems to unveil a new “big idea” that promises to transform access, streamline care, and modernise general practice. And every few months, those of us who’ve actually run practices look at the detail and think: here we go again. The latest proposal — to centralise all online consultation systems through the NHS App — is a perfect example of a plan that sounds great but falls apart the moment you apply real world logic.

The idea is simple enough: instead of practices choosing from systems like AccuRx, eConsult, PATCHS or Klinik, the NHS would create one national online consultation platform, delivered through the NHS App and built under a £160 million contract with IBM. On paper, it’s sold as consistency, efficiency, and “a single digital front door”. It removes choice, creates a single point of national failure, and hands NHS England unprecedented oversight of every GP practice in the country.

Let’s start with the most obvious problem: it strips practices of autonomy.

For years, practices have selected systems that suit their population, staffing, and workflow. A small suburban practice doesn’t need the same tools as a large urban one. A system that works brilliantly for one team can be a disaster for another. Centralising everything into one national model assumes that general practice is uniform — when anyone who has ever worked in it knows the opposite is true.

Then there’s the operational risk.

If AccuRx goes down today, only AccuRx practices feel it. If eConsult crashes, the impact is localised. But if the NHS App becomes the only route for online requests, then one outage — one server glitch, one cyber incident, one failed update — takes down every practice in England. We’ve seen national systems fail before the Spine, EPS, NHSmail, even the NHS App itself. Creating a single point of failure for the entire country is not resilience. It’s fragility dressed up as progress.

And we can’t ignore the “big brother” element. A centralised system gives NHS England real‑time visibility of:

• how many requests your practice receives
• how quickly you respond
• how many you divert
• how many become appointments
• how many are “urgent”
• how many are “inappropriate”

This isn’t about patient care — it’s about monitoring, managing, and enforcing. In the context of the imposed 2026/27 GP contract, with its same‑day response expectations, this system becomes a tool for oversight rather than support. Once the data exists, it will be used. And not always in ways that help practices.

There’s also a point that rarely gets mentioned but is absolutely crucial: competition drives quality. The current market of online consultation suppliers — worth around £32 million a year — has produced real innovation precisely because companies have to compete. They have to listen to practices, respond to feedback, and keep improving their systems.

Many of the platforms in use today were shaped directly by GPs and practice managers across the country, who helped design workflows, triage questions, and patient journeys. Remove competition, and you remove the incentive to innovate. A single national system risks becoming slow, rigid, and detached from the realities of frontline general practice.

The irony is that this move is being presented as innovation, when in fact it risks slowing innovation to a crawl. If the NHS App becomes the only option, suppliers disappear, and with them the incentive to improve. We’ve seen what happens when the NHS builds national IT systems: they become monolithic, slow to evolve, and difficult to adapt.

This is not to say the current system is perfect. Patients do face a postcode lottery of digital access. Some platforms are better than others. But the solution is not to bulldoze the entire landscape and replace it with a single, centrally controlled system. The solution is to set standards, support practices, and allow choice within a framework — not impose uniformity from above.

Once again, we have a policy designed from the centre, with little understanding of how general practice works. It’s another example of a well‑intentioned idea that hasn’t been thought through. And as usual, the people who will feel the consequences are not the policymakers, but the practices, the staff, and the patients who rely on systems that are flexible, resilient, and responsive to local needs.

General practice doesn’t need another grand digital restructure. It needs stability, investment, and trust. Centralising online consultations delivers none of those.

References

(Short, non‑copyrighted summaries of publicly available reporting)

• NHS England Primary Care Bulletin, 21 May 2026 – details on digital access and NHS App expansion.
• Health Service Journal reporting (May 2026) on the £160m IBM contract and plans to centralise online consultations.
• Pulse and GPOnline coverage (May 2026) on the potential end of the £32m online consultation supplier market.
• BMA GP Committee statements (May 2026) on concerns regarding centralisation, data control, and contract enforcement.