Primary Care Challenges 2026: The Pressure Builds as Winter Approaches

A Week of Growing Pressure Across Primary Care

Primary care challenges 2026 continue to grow as general practice prepares for another demanding winter. This week has highlighted the pressure facing the NHS, with record summer activity, ongoing workforce concerns and further changes to how patients access healthcare.

The summer has traditionally given the NHS an opportunity to prepare for winter. This year, however, demand has remained exceptionally high. NHS England has reported record levels of activity across emergency departments, ambulance services and NHS 111 during June, July and August.

More than 7.3 million A&E attendances took place during the summer. This was around 240,000 more than during the same period last year.

For primary care, these figures matter.

When demand increases across urgent and emergency services, practices often feel the effects too. Patients may need follow-up appointments after hospital attendance. Others may require support with ongoing conditions or medication.

The question now is whether the NHS can enter winter with enough capacity to cope.

The NHS Faces Pressure Beyond Winter

One of the biggest stories this week has been the NHS’s busiest summer on record.

Five significant heatwaves contributed to increased demand across healthcare services. NHS 111 handled more than three million calls during the summer, while ambulance services recorded around 2.46 million callouts.

This changes the conversation around NHS capacity.

For years, healthcare leaders have focused heavily on winter planning. Influenza, respiratory illnesses, cold weather and increased hospital admissions have traditionally created predictable seasonal pressure.

Extreme heat is now adding another layer.

Primary care teams may see increased demand from patients with respiratory conditions, cardiovascular problems and dehydration. Vulnerable patients may also require additional monitoring and support.

This creates an important lesson for primary care leaders. Seasonal planning can no longer focus exclusively on winter.

Workforce Pressure Remains One of the Biggest Primary Care Challenges 

Workforce remains one of the most significant issues facing general practice.

The latest BMA analysis shows that 63.2 million patients were registered with GP practices in England in July 2026. That represents an increase of approximately 6.3 million patients since 2015.

At the same time, NHS general practices employed 29,057 fully qualified FTE GPs. The BMA reports that this figure is 307 lower than in September 2015.

The figures demonstrate the challenge clearly.

Practices are supporting more patients without seeing equivalent growth in the core GP workforce. The average number of patients per FTE GP has also increased.

Despite these pressures, GP teams continue to deliver huge numbers of appointments. Around 33.9 million standard appointments took place in July 2026 alone.

The issue is therefore not a lack of effort from primary care teams.

It is a question of capacity.

Increasing demand, administrative work and clinical complexity all place pressure on staff. Practices need sustainable workforce solutions rather than short-term measures that simply move workload from one service to another.

Workforce planning will therefore remain central to addressing the primary care challenges 2026 has brought into focus.

Digital Access Continues to Change General Practice

Digital access remains another major part of the changing primary care landscape.

Online consultations have become an established way for patients to contact their practices. However, increased digital demand has also created concerns about workload.

The BMA reports that more than half of practices responding to its survey reported negative effects on patient care following changes to online access. Around 42% reported reducing face-to-face appointments, while 74% reported increased workload.

This highlights an important point.

Digital access does not automatically mean greater capacity.

Every online consultation still requires review, triage and appropriate follow-up. Some requests may require clinical assessment, while others need administrative action.

For practices, the priority should be to ensure digital systems support staff rather than simply creating another queue of work.

Technology can improve access, but only when practices have the resources and processes required to manage the demand it creates.

Pharmacy First Expands to More Conditions

Another important development this week is the planned expansion of Pharmacy First.

From autumn, participating pharmacies in England will be able to provide treatment for additional conditions. These include acne, migraines, scabies, certain ear infections and allergic rhinitis.

NHS England expects the expanded service to support around two to three million consultations for these conditions once fully implemented.

For general practice, this could provide an opportunity to reduce pressure on routine appointments.

Pharmacists can manage suitable conditions closer to the community. They can also provide patients with another route into appropriate care.

However, successful implementation will depend on clear communication.

Patients need to understand which conditions pharmacies can treat and when they should contact their GP. Practice teams also need confidence that patients who require further assessment can move smoothly between services.

The expansion demonstrates how primary care is becoming a wider network of services rather than focusing solely on the GP practice.

Vaccination Requirements Continue to Develop

Vaccination planning is also moving quickly as September progresses.

NHS England updated its general practice vaccination and immunisation requirements on 8 September. The latest guidance includes changes to RSV, MMRV, shingles and pneumococcal vaccination programmes from 1 September 2026.

The updated requirements include RSV vaccination for eligible older adult care-home residents and pregnant women from 28 weeks.

For practices, vaccination programmes create significant operational work.

Teams need to identify eligible patients, manage invitations, arrange appointments and record vaccinations correctly. Practices must also monitor uptake and balance vaccination activity against routine appointments.

September is therefore an important time for workforce and capacity planning.

Early preparation can help practices avoid unnecessary pressure later in the autumn.

Vaccination planning will remain another important element of the primary care challenges 2026 brings to practices.

Prevention Must Be Matched With Capacity

Prevention remains a central theme across NHS policy.

Vaccination, screening, early diagnosis and proactive management of long-term conditions can all reduce future demand.

However, prevention does not happen without investment.

If practices identify more patients who need support, they also need the capacity to provide that support.

This is one of the key primary care challenges in 2026.

The NHS wants primary care to become more proactive, but practices must have sufficient time and resources to deliver proactive care effectively.

Prevention should therefore not become another layer of work added to already stretched teams.

Preparing for the Winter Ahead

The timing of this week’s developments is significant.

The NHS has just experienced its busiest summer on record, and winter pressures are approaching. NHS leaders therefore have very little time between one period of high demand and the next.

For primary care, preparation should go beyond simply increasing appointment numbers.

Practices need to consider workforce availability, vaccination delivery, prescription demand, care-home support, urgent appointments and communication with patients.

They should also identify areas where administrative processes create unnecessary workload.

Small inefficiencies can become significant problems when demand increases.

Practice managers can use this period to review workflows, identify pressure points and ensure teams understand their responsibilities before winter demand increases.

The Management Message: Capacity Must Come First

This week’s developments demonstrate that primary care faces a complex set of pressures.

The NHS must manage rising demand, workforce challenges, digital access, preventative healthcare and seasonal pressures at the same time.

Primary care teams continue to deliver an enormous amount of work. The latest figures demonstrate that clearly.

The challenge now is making sure the system does not simply ask practices to do more.

The expansion of Pharmacy First, vaccination programmes and digital access can all provide benefits. However, each change needs appropriate planning and resources.

For practice managers and primary care leaders, capacity planning will remain essential throughout the autumn.

The future of general practice depends on creating services that are accessible to patients while remaining sustainable for the people who deliver them.

As we move towards winter, one message stands out from this week’s developments: primary care cannot build resilience through demand management alone. It needs investment, workforce capacity and practical support.

The primary care challenges 2026 has created are becoming increasingly complex. Meeting them will require collaboration across general practice, pharmacies, PCNs, community services and the wider NHS.

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