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Winter Demand · Appointments, 111, Online Consultations, A&E · Monthly Publications
Winter adds 8% to general practice’s working day. The flu clinics are not the reason.
Two winters of NHS England appointments data say the same thing: between December and February practices deliver about 8% more appointments per working day than in the summer before, and the uplift gets bigger, not smaller, when the flu and vaccination clinics are taken out. Online consultations rise faster still, NHS 111 books its December surge straight into practices, and the emergency departments fill at the same time. This is the evidence base behind the new Winter Demand View.
By Dr Yogasakaran Arjuna · 10 October 2026 · NHS England data, April 2024 to September 2026 · 6,100 practices · 36 ICBs
01The winter working day
Measured per working day, so that bank holidays and short months do not flatter or punish a month, general practice in England runs about 8% harder from December to February than it did the previous summer. It did so in both winters in the data.
Summer 2025 (June to August) averaged 1,409,665 appointments per working day across England. Winter 2025/26 (December to February) averaged 1,524,285, an uplift of 8.1%. The winter before was 8.0% above its summer. And summer 2026 has come in at 1,486,454 per working day, only 2.5% below last winter, so the coming winter starts from a higher floor than the last one did.
October is the month everybody points at, and everybody is right about it: October 2025 ran 21% above summer. That is the flu and COVID vaccination programme. Appointments in the two planned-clinic categories nearly double in October (13.1 million against 7 to 8 million in a normal month). October is a workload month, not a demand month, and it is best kept out of any argument about winter pressure.
02Take the flu clinics out and the uplift grows
The obvious objection to the winter figure is that it is vaccination in disguise. The data lets you test that directly, because every appointment in the publication carries a national category.
Remove every appointment categorised as a planned clinic or a planned clinical procedure and the picture sharpens. Summer 2025 falls to 1,053,758 per working day; winter 2025/26 falls to 1,150,695. The uplift is 9.2%, higher than the all-appointments figure, because planned-clinic volume is slightly lower in December to February than in summer. Winter 2024/25 shows the same pattern: 8.9% without the planned categories against 8.0% with them.
Narrow it further to the categories that cannot be anything but demand (acute consultations, clinical triage, unplanned clinical activity, walk-ins and home visits) and the winter uplift is 12.1%, from 448,066 to 502,112 per working day. Routine consultations, by contrast, rise by about 7%. Winter is not a larger volume of the same work; it is a shift towards the urgent end of it.
Reading note. About 14% of appointments nationally carry the category “Inconsistent Mapping” and cannot be classified, so the category-level figures are indicative. The direction is not in doubt; the second decimal place is.
03The demand arrives by phone and online first
Appointments are the end of the pipe. The front of it is the phone system, the online consultation form and NHS 111, and all three move earlier and harder.
Online consultation submissions per working day were 45% higher in winter 2025/26 than in the summer before, and January 2026 was 51% above August 2025. Part of that is adoption, since more practices switch on online consultation every month, but the seasonal shape is unmistakable and it has not fallen back between winters.
NHS 111 received 1.91 million calls in December 2025, its busiest month, and booked 126,044 of them directly into GP practices, about 7% of answered calls nationally. In some systems the direct-booking share is far higher: in North Central London it was 19% in January 2026, one call in five. Where 111 is configured to book into practices, the winter 111 surge is a winter general practice surge by another name.
The telephony collection only began in October 2025, so there is no second winter to compare yet, but the first one is sobering: practices on cloud telephony took 29.8 million inbound calls in January 2026, and 32% of callers hung up before being answered.
04And the emergency departments fill at the same time
The argument for funding primary care in winter is usually made in terms of what it keeps out of hospital. The monthly A&E series shows the two systems moving together.
Type 1 attendances per day rose from 43,601 in August 2025 to 45,324 in January 2026, and January 2026 set a series high for patients waiting more than twelve hours after a decision to admit: 71,517. Type 1 four-hour performance fell to 57.0%. The hospital front door and the practice front door are under pressure in the same weeks, which is the case for planning them together.
05Thirty-six ICBs, a nine-point spread
The national 8% hides a wide range. Dorset practices ran 13% harder per working day last winter than the summer before; Bristol, North Somerset and South Gloucestershire ran 4.5% harder.
| ICB (top five and bottom five) | Winter uplift | October uplift |
|---|---|---|
| Dorset | +13.0% | +33.9% |
| Central East | +11.9% | +23.4% |
| Nottingham and Nottinghamshire | +11.4% | +23.2% |
| Essex | +10.7% | +22.4% |
| Birmingham and Solihull | +10.5% | +18.3% |
| Gloucestershire | +5.7% | +21.3% |
| West and North London | +5.6% | +12.6% |
| South East London | +5.5% | +14.1% |
| Cornwall and the Isles of Scilly | +5.3% | +22.7% |
| Bristol, North Somerset and South Gloucestershire | +4.5% | +18.7% |
The London systems sit at the bottom of the table. That is not because London has an easy winter: it is because London runs a same-day-heavy model all year, with less routine slack to convert into winter capacity. North Central London, for example, delivers 54% of its appointments on the day against 45% nationally, and 18% fewer appointments per registered patient. Its winter uplift was 8.7%, but it started from a higher baseline of urgency.
06How to use this for your own winter conversation
Every number above now comes from a single page on Arjus, and every practice in England can see its own version of it.
The Winter Demand View shows appointments, online consultations, phone calls, NHS 111 bookings and A&E attendances per working day for your practice, PCN, sub-ICB, ICB or England, with October to March shaded, last winter’s uplift against the summer before, and a switch that removes planned clinics and procedures so the flu objection can be answered on the spot. Below the tiles, the winter uplift table lists every practice in your PCN, sub-ICB or ICB, or every PCN in your area, so you can see where the winter landed. Practice-level history goes back to August 2023.
Two companion pages were built at the same time: the NHS 111 Dashboard, which shows calls, answer times, dispositions and direct bookings into practices by 111 contract area, and the Urgent and Emergency Care Dashboard, which shows A&E attendances, four-hour and twelve-hour waits and ambulance handovers for the trusts in your ICB.
If you are putting a case to your ICB, lead with the December to February figure per working day, show it with and without planned clinics, and put the 111 direct-booking share next to it. October belongs in the vaccination conversation, not the demand one.
Reading notes. Working days exclude weekends and English bank holidays. Winter is December to February; summer is June to August of the preceding year. Appointment counts come from the NHS England Appointments in General Practice publication (sub-ICB level for areas, the practice-level annex for practices and PCNs); category splits from the national category field in the same publication; online consultations from Submissions via Online Consultation Systems; telephony from the Cloud-Based Telephony collection; NHS 111 from the Integrated Urgent Care Aggregate Data Collection; A&E from A&E Attendances and Emergency Admissions. Figures describe recorded activity, not underlying need.