Advice and guidance requests by GPs increase since payment introduced

Advice and guidance (A&G) requests have risen by 11% since the Government made a payment available for practices in April. 

There were 296,624 ‘pre-referral specialist advice requests’ in June, or 11,763 per working day, according to new NHS England figures. 

This represents an 11% increase in A&G requests since the payment was introduced and a 26% increase over the last 12 months. 

The 2025/26 GP contract offers practices access to an £80m A&G funding pot, which enables access to a £20 Item of Service (IoS) fee for ‘pre-referral requests’ as part of a new enhanced service specification.

NHS England said it would ‘incentivise even closer working between general practice and secondary care’.

GPs receive £20 for each ‘episode of care’, which could include several interactions with consultants.  

However, ICBs cap the number of A&G requests claimed per practice – on a monthly, quarterly or annual basis – and if GPs exceed the cap they will not be able to claim payment.

Interpreting the figures, Dr Paul Evans, chair of Gateshead and South Tyneside LMC, said: ‘Some of this is GPs prioritising questions they would have asked anyway, but using this pathway specifically to get them done, rather than, say, picking up the phone to a consultant colleague, because they get the same answer in timely fashion.  

‘And this time it comes with a bit of resource attached to it, which is excellent, because this work does require resource.  

‘Some of it may be because GPs know it’s quite likely that an advice and guidance request will be converted into a referral, as many of them are.  

‘Of course, this new advice and guidance resource is welcome, but it’s no substitute for actually uplifting the core contract, which would have been far preferable.’ 

Requests for all types of specialist advice – pre-referral, post-referral, and ‘other’ – have risen by 66% in the last three years and specialists in England are now receiving over a million requests every month. 

But the Royal College of Physicians warned that the increase in A&G requests is impacting on time available to hospital consultants.

Dr Hilary Williams, RCP clinical vice president, said: ‘Specialist advice and guidance is now a key part of the NHS’s approach to ensuring patients get the right care without unnecessary delay.

‘This system has helped keep millions of requests off waiting lists and is a welcome part of getting patients specialist input at an early point in their care journey.  

‘As more and more clinicians make use of this system, we have to make sure specialists have dedicated time to respond to requests.’

Last year, Pulse revealed hospital specialists in Hampshire using the A&G process had downgraded GP cancer referrals, causing ‘considerable alarm’ due to the risk of missed diagnoses. 

GPs have told Pulse that the effect of this is that fast-track cancer referrals are being received as A&G and being downgraded by hospital specialists, which could bring an increase in risk of missed cancers. 

They argued that this goes against national cancer guidance, which says that referrals should not be downgraded without a discussion with the referrer.