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The King's Fund - Activity in the NHS

Over the past 10 years, it has often been stated that the NHS treats more than a million people every 36 hours, but is that still true? 

Here, we analyse NHS activity (for example, calls, appointments, attendances and admissions) and explore some of the underlying trends that lie behind these headline statistics. Following the disruption caused by the Covid-19 pandemic, NHS activity has almost returned to pre-pandemic levels.

Patient contact

There were an estimated 600 million patient contacts with GP, community, hospital, NHS 111 and ambulance services in 2023/24 (or the most recent year for which data was available). This is equivalent to 1.7 million interactions with patients every day. 

Primary care

The largest volume of NHS activity is in primary care – people receiving services from their local GP practice. This could be in person, over the phone or online, and with a GP or another member of the practice staff, such as a nurse or physiotherapist. In 2023/24, there were an estimated 353 million appointments in primary care. In recent years, there has been an increase in the proportion of GP appointments conducted by telephone; however, in 2023/24 two-thirds of appointments were still face to face. 

Community health services

Community health services also represent a large proportion of NHS activity, though the exact quantity is hard to estimate. This activity covers services such as visits from district nurses who carry out nursing duties in a person’s home, for example, wound care, medication administration and advice. It also covers contacts with, or visits from, community-based allied health professionals, such as physiotherapists and occupational therapists, and health visitors who support children and their families from birth to five years old. It is difficult to obtain consistent and comprehensive national data for these services, but the best estimates suggest that there were around 73 million interactions with patients in 2021/22.

NHS hospitals

Before the Covid-19 pandemic, activity had been rising substantially in accident and emergency (A&E) departments, hospital inpatient services (eg, on-the-day surgery or an overnight stay in hospital), and outpatient services (eg, follow-up with a consultant). In 2022/23, there were 141 million patient interactions in hospital, similar to pre-pandemic levels. 

Ambulance service and 111 calls

In 2023/24, there were an average of 25 calls every minute to the ambulance service and 41 calls every minute to NHS 111. 

NHS 111 received nearly nine million more calls in 2023/24 compared with 2014/15, when it was first fully rolled out, though calls to both the ambulance service and NHS 111 have fallen for the past two years. 


It is very hard to definitively define NHS activity so here we have largely focused on services commissioned and provided by the NHS. There is limited information on activity that is paid for by the NHS but provided by non-NHS providers, and work that is done by NHS hospitals for a fee, for example, private patient units. Data availability in some sectors, such as primary care and community health care, is improving but is not as consistent as it is for the hospital sector.

These figures are for NHS services that are provided free at the point of use. If we included services where patients may be asked to contribute to the cost of their care, for example, dentistry, prescriptions or opticians’ appointments, the number of interactions would be significantly higher.

The work to support the estimate that the NHS sees a million people every 36 hourswas undertaken nearly 20 years ago. Using the methodology we have described, and with the caveats we have outlined, we estimate that NHS activity has increased to an average of 2.5 million interactions with patients every 36 hours, or a million interactions every 15 hours.

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