GPs to get say in mandatory A&G, says NHS England
ICBs will have to reach agreements with local GP practices before expanding the use of advice and guidance (A&G), NHS England has said.
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’.
However, at a webinar for GPs this week, NHS England’s director of primary care Dr Amanda Doyle said that ICBs will need to agree local pathways with GP practices before this happens.
The BMA has warned that the contract change could put ‘potential barriers’ in place around specialist referrals, while other GP leaders said it could worsen patient care and restrict GP decision-making.
Dr Doyle said that ‘there will be nothing that removes the right of GPs to refer’, but 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 Doyle said: ‘All of the money currently spent on advice and guidance, which about £80m, is put into global sum and shared out as per global sum shares.
‘And then we will ask that GP practices follow locally agreed referral pathways, including single points of access once they’re introduced.
‘We’re really clear that when we say locally agreed referral pathways, local agreement needs to include the involvement of an agreement of local general practice as part of agreeing those pathways.
‘As single points of access get rolled out, what you will be asked to do is send in electronic referrals without specifying whether it’s for an appointment or for an advice and guidance.
‘And the trusts will pick them up and sift them at their end, but those pathways will be agreed locally, and local general practice will be part of who is agreeing how it works.’
She also said that trusts will need to ‘recognise where Jess’s Rule comes into play’, and they will be provided with guidance on this.
As part of Jess’s Rule, GPs were asked to ‘think again’ if after three appointments – about the same symptoms or concerns – they have been unable to offer a ‘substantial diagnosis’ or if a patient’s symptoms have escalated.
Dr Doyle said: ‘If practices are making referrals because somebody has presented several times with the same complaint, then that’s flagged and those patients are seen by specialists, rather than advice and back to GPs, and so we will make sure that that’s embedded in the guidance to trusts.
‘There will be nothing that introduces sweeping new referral pathways locally without local GPs being consulted. This is about the changes to elective care pathways, which were going to make it very difficult for us to pay individually for advice and guidance, but we wanted to keep the money.’
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.
A&G requests have risen significantly since the Government introduced the incentive for GP practices last April.
Read all of our coverage of the 2026/27 contract here.
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READERS' COMMENTS [10]
Please note, only GPs are permitted to add comments to articles
Agree or impose?
CAMHS bravely beat the path…….ruthless referral rejection with useless “advice”, then brag about achieving waiting time targets whilst maintaining the illusion that “we accept GP referrals”.
It was inevitable everyone else in Secondary Care would enviously copy this model
And who will pick up the pieces when diagnosis is delayed, patients are fuming and complaints are raining in? Got it in one!!
Getting local agreement around interface issues has proved challenging enough. I remain to be convinced that this is a sensible way forward.
Single point of access and just trust the system hasn’t worked for us locally in any of the areas it’s been imposed. We’ve had SPoA for musculoskeletal problems for years, and it has mostly led to ‘you didn’t fill in a hip and knee score’ and straight to physio even, memorably recently for a patient referred by a physio after failed physio treatment and an abnormal MRI, but hey, kept the patient from showing up in the waiting list figures, and only came back to us 4 times in the interim and everyone knows our time is in a special pocket of the space-time continuum where everyone can just keep adding tasks indefinitely.
…Dr Doyle said that ‘there will be nothing that removes the right of GPs to refer’….
this is our get out phrase. I will continue to insist secondary care see a patient if I feel they need to.
Top tip: if they refuse a referral, advise the patient to contact the speciality copying in the chief exec of the trust and medical director, threatening a formal complaint if they do not get an appointment- the appointment always comes after this,
It is the nuclear option but works every time.
The only thing trusts fear is a patient complaint.
I thought from the headline we would actually have a say. Silly me.
Is there anyone in secondary care, or any referral taking specialism, that actually likes their job or the people their job entails talking to? Do they want to sit at a screen and absorb all the clinical risk of my complicated questions without seeing a patient? I’ve had one back from ENT today that’s 2 pages long of questions back – would’ve been faster to call the patient themselves. I can’t believe they’ve any job satisfaction at all typing all afternoon back to me (all I asked was if PPPD was a diagnosis of exclusion)
Dr Doyle said: ‘If practices are making referrals because somebody has presented several times with the same complaint, then that’s flagged and those patients are seen by specialists, rather than advice and back to GPs, and so we will make sure that that’s embedded in the guidance to trusts.”
What other patients do we refer to secondary care?? If I can handle the problem in general practice, I do. Everyone we refer could potentially meet Jess’s Rule. Guess we include that now in the referral to get people seen. Dr Doyle, just trust me to refer appropriately and my decision on who needs seeing and who I am happy with advice only. I’ve been doing the job for over 35 years!
The asymmetric slow back and forth between specialist and patient with the GP as some kind of medical medium conduit makes a mockery of consulting models and patient involvement in their management. ‘Try this drug’ on advice of specialist is not a meeting of expert in the condition and expert on the patient. .
I just so admire the present system. The GP sends a details-of-case letter, without specific direction, – and someone better qualified decides who should see the case, if at all. If not, advise and guidance for community management is sent. This is so well fitted to modern medicine, where the paperwork is all.