BMA getting legal advice on A&G requirement amid fears it could remove GPs’ right to refer

The BMA may challenge a new contractual requirement around the expansion of advice and guidance (A&G), amid concerns that it could remove the right for GPs to directly refer patients.

The union’s GP committee chair Dr Katie Bramall told GPs at a webinar today that the GPC is ‘talking to legal colleagues’ to understand the implications of the 2026/27 GP contract being amended to include a mandatory requirement to use A&G ‘where clinically appropriate’.

From April, the GP contract will be amended to ‘embed’ the current A&G enhanced service within core practice funding, and practices will be ‘required’ to use A&G ‘prior to or in place of a planned care referral where clinically appropriate’. 

Dr Bramall said that she saw guidance that indicated this could lead to a ‘doom loop’ where GPs lose the right to refer and patients are not receiving the care they need.

And GPC deputy chair Dr Julius Parker added that the GPC’s determination is that GPs ‘will always have a right to refer directly’ and not have their referrals ‘submerged into a bureaucratic process’.

The GPC will wait to see what the specific wording is within the regulations but Dr Bramall said that this is something the committee will ‘think very carefully about’.

It comes after NHS England’s director of primary care Dr Amanda Doyle said earlier this week that ‘there will be nothing that removes the right of GPs to refer’ in the new contract changes.

But she added that when single points of access will be rolled out, GP practices will be asked to send referrals without specifying whether they are for an appointment or A&G, and trusts will ‘sift them at their end’. However, these pathways will need to be agreed with local GP practices first.

Dr Bramall said: ‘I have seen the guidance which has been sent to me, which very much describes, from a GP perspective, what could easily be seen as a doom loop where we are constantly trying to get what is required for the patient and yet it will keep on being returned to us.

‘Now, how that sits in the context of Jess’s rule around seeking specialist advice, how that sits around GMC duties when you are at the limits of what you can do, and having a duty to ensure the patient is receiving the care that they require with a specialist, is really important. We’re talking to our legal colleagues.

‘We’re also going to wait to see what actual wording is in the regulations. But there is something here for us to think very carefully about. As a profession, I think we’re going to have to be very unified in what we do.’

Dr Parker said that the requirement represents a ‘substantive change’ in terms of the way that GP referrals are being handled.

He said: ‘Some of you will already, locally, be dealing with single point of access systems which take our referrals and then subject them to NHS England’s desperate wish to avoid the waiting lists at secondary care increasing.

‘We think this is just another way of making things more difficult, ultimately, for our patients. Our determination is that colleagues will always have a right to refer directly and not have their referral submerged into a bureaucratic process.’

Dr Bramall added that the exact wording and the draft changes to the regulations have not been shared with the GPC yet, and that she expects these will be received ‘at some point this month’.

She added: ‘We’ll have to respond to them probably towards the end of April, as a deadline for them to get laid down in Parliament, often around June or July, or sometimes as late as October.

‘So there’s this kind of grey area window where on the first of April, the actual regulations haven’t changed, which has always been the case and gives us a little bit of jeopardy and a little bit of ambiguity.’

NHS England had hinted there would be a ‘significant rollout’ of ‘broader adoption’ of A&G, though did not clarify if A&G would be mandated for all specialties.     

Read all of our coverage of the 2026/27 contract here.