Government sets target for one in four GP referrals to be ‘diverted’ by 2027
The Government is aiming for 25% of GP referrals to be ‘diverted’ back to GPs via amendments to advice and guidance (A&G) by 2027 for 10 ‘high volume specialties’.
This will help achieve a target for 92% of patients to start treatment within 18 weeks of a referral – known as the referral-to-treatment standard – by 2029, according to the Department of Health and Social Care.
The aim comes as part of a newly published neighbourhood health framework which also confirmed NHS trusts will have commissioning responsibilities for primary care.
The framework set a target to ‘reduce variation in referrals to outpatient services across system through single point of access (SpoA) and multidisciplinary team model’.
‘We aim to contribute to a diversion rate of at least 25% by March 2027 for at least 10 high volume specialties, supporting overall RTT trajectories of 70% by March 2027 and 92% by March 2029.’
NHS England defines a diverted request as a request ‘returned to the referrer with advice’ where it is expected that the advice diverted a referral.
NHS England has already asked GPs to choose 10 specialties for which all referrals should go through A&G in 2026/27. In a medium-term planning document published in October, it asked providers to identify 10 specialties ‘which have the most potential for this model to be effective’.
The new framework identifies gastroenterology, ENT, cardiology, respiratory, diabetes, gynaecology and urology as core specialties to focus on.
From April, practices will be contractually required to use A&G across specialities ‘prior to or in place of a planned care referral where clinically appropriate’, but the BMA is currently getting legal advice on this amid fears that the requirement could remove GPs’ right to refer.
Last week, NHS England primary care director wrote in an exclusive op-ed for Pulse about how the move will reduce GP bureaucracy. But she also doubled down on the fact that it will be up to consultants, not GPs, if a patient sees a specialist under the single point of access model.
The Government also received criticism on its move to mandate A&G in a debate in Parliament this week, from shadow health minister Dr Luke Evans, who is a GP.
He told primary care minister Stephen Kinnock during a debate in the House of Commons that the new GP contract was published ‘with more questions than answers’, including what clinical evidence supported the new A&G requirement
Dr Evans told Parliament that the new requirement means GPs ‘will no longer be able to refer directly to a consultant’ even when they ‘believe it’s clinically appropriate’.
He asked primary care minister Stephen Kinnock to publish evidence supporting the change and said that by effectively mandating A&G, the Government is ‘managing the waiting list by keeping patients in primary care’ rather than treating them in secondary care.
Mr Kinnock defended the requirement, adding that A&G has been a ‘stunning success’ and that take up across the country ‘has been huge’ since an incentive was introduced last year.
Dr Evans said: ‘This health secretary and his team have perfected the sales pitch for NHS reform. The problem is the detail never seems to arrive.
‘A 10-year health plan with no delivery chapter, the abolition of NHS England, yet no price tag. And now a new GP contract with more questions than answers.
‘Take advice and guidance. In practice, this appears to create a single point of access for referrals.
‘GPs will no longer be able to refer directly to a consultant even when they believe it’s clinically appropriate.
‘So will the Government publish the clinical evidence supporting this approach, and who will carry the legal responsibility if, in a GP’s professional judgment, a patient needs to see a consultant, but must first go through advice and guidance?
‘If advice and guidance becomes mandatory as an extra layer before referral is the Government not, in essence, managing the waiting list by keeping patients in primary care rather than treating them in secondary care? Waiting lists will look shorter on paper, yet patients are simply waiting elsewhere in the system.’
Mr Kinnock said: ‘I think the evidence speaks for itself. We introduced advice, advice and guidance in the last contract with an 80 million pound investment. It has been a stunning success. Take up across the country has been huge, and the stat that matters most of all, 1.3 million referrals that would have ended up in electives have been dealt with by GPs.
‘The honourable gentleman doesn’t seem to care what actually matters for patients, which is that through advice and guidance, they’re able to get a response from their GP within about 48 hours.
‘It takes a lot longer to get an outpatient appointment, I can tell him that. So I think if he’s looking for stats on advice and guidance, I’ll give him this one: 1.3 million taken off electives and dealt with, and that is part of the hospital to community shift.’
NHS England first began a move to the potential mandating of A&G in 2022, when it said it should be the main referral pathway for access to dermatology services.
NHS England data showed that A&G requests have risen significantly in the last year, but the Government’s ambition that this would divert two million requests from elective care looks set to be missed.
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READERS' COMMENTS [17]
Please note, only GPs are permitted to add comments to articles
In order to achieve this target we will need to massively expand the number of referrals we are doing and massively reduce the quality to aim for such a loft figure. Come on guys if we try really hard we can do this. I believe in all of you.
We have had spoa for msk locally for years, wait time for a hip replacement before it? 18 months. Wait time now? 18 months
we’re saved!!!
More work dumped back on GP’s. Some of whom will eventually decide sod this and give up on the NHS. Where are Mr. Streeting and Mr. Kinnock going to conjure up the doctors to actually see patients face to face? A&G is all very well but cannot physically examine a patient to make a diagnosis
Absolute BS from Kinnock. Rise in A&G mandated, not a swell of success. Temporary decrease in waiting lists mostly due to validation lists and gaming (delays in notification of referral and diagnostics). More or less the same rates of joining waiting list as leaving it. Reputational management more important than truth or patient care. This will bite them in the arse in due course…when they’ll just go silent again and GPs will be left to manage the latest patient merry-go-round.
It is no longer possible to practice good medicine in the NHS. – although we retain ALL of the responsibility. Any shit that comes anywhere near any fan – it is our job to lick it up. My departure from this toxic cesspit comes in the nick of time. Early retirement (17 years early) beckons. To everyone that remains you truly are unlucky sods. You are all in my prayers.
We will not be the gate keeper . Why take risk, time, just refer will be the result
So who takes responsibility for these rejected or ‘diverted’ referrals. Basically taking away the ability for GPs to refer a patient.
I had a referral rejected today with advice. The advice given was ½ A4 long and asked that I read 2 seperate clinical documents.
Advice & guidance has a place but it is wrong to use it as a backdoor to reduce waiting lists. Perhaps they can explain to the patient why they can’t see the specialist.
I know of 1 case where patient had to go private to get a lower GI cancer diagnosis, her 2week wait referral was discharged after a telephone conversation because she had a CT scan within the prior 6 months.
It is hard to see an asynchronous series of exchanges between a specialist and patient delivered by the GP over a period of weeks as an effective consultation or meeting basic standards of informed consent and shared decision making.
It’s a bit like the scene in Ghost where Demi Moore makes love to Patrick Swayze via his possession of Whoopi Goldberg’s body.
We GPs are all Whoopi and when things go badly you can’t blame the absent ghost…
It’s complex- is this not also the way in for AI? Answering A&G? Will that mean generalism and human side more important again?
Assuming we have a Responsibility 2 Protect primary care from the “mass atrocity” being carried out by successive neoliberal Tory and Labour Govts, will the BMA be advising vigorous collective action any time before it’s death?
*its*
This is created to have a primary care that is provided by non medical prescribers, dovetails perfectly with vertical integration and media negativity towards GPs fostered over the last decade.
I’m goping to refer eveyr single slightly low vitamin D to rheumatology.
And every hypertension case to cardiology.
Then can divert those back helping them reach their targets. I don’t mind heling my colleagues.
As if we ever refer if we can manage in GP! Coz what’s the point? Waits are so long there is only ever a purpose when the need for care is so clearly outside primary care that there is no choice. Totally ridiculous.
Can we see Mr Kinnock’s evidence for this please? My own A&Gs have been 50% converted to referral, and all he seems to be spouting is process data where clinicians are concerned about outcome
Totally agree with FedUpGP – not possible to practice the job I used to love in this environment.
After battling for 3 + years with the burnout and anxiety that practising in such an unsafe environment created, I have put in for my pension and doubt I will return – going 5 years early and the NHS losing 30+ years of experience.
Where do we get the time to do all the actions from the reply telling us we are capable of undertaking this simple set of protocols on an handy link/ speciality published guidance . Give me some of your budget for the simple ‘even a GP can manage it’ work, and I’ll do it. Already we seem to have a 99% rejection rate for mental health and the wait is still appalling and the service rubbish. So we took on he responsibility the patient burden and work for what?