All A&G requests must come from named GPs, says NHS England

All advice and guidance (A&G) requests must be submitted or approved by a named GP, NHS England has said.

The commissioner also said that GPs should report trusts to their ICBs if A&G standard response times are not being met.

In a webinar on the new single point of access model, NHS England faced questions by GPs on the new A&G requirements introduced as part of this year’s GP contract, including response times from trusts and whether other members of staff, such as experienced ACPs, will be able to submit A&G requests on behalf of GPs.

Under changes to the GP contract for this financial year, GP practices are contractually required to use A&G across specialities ‘prior to or in place of a planned care referral where clinically appropriate’, with ‘single point of access’ routes to be finalised locally by 1 October.

The commissioner said: ‘In the same way as specialist advice must be provided by or approved by a consultant, requests for specialist advice should be requested by or approved by a GP. This principle applies equally to referrals.’

Supplementary documents published by NHS England confirmed this, adding that it is ‘consistent’ with the requirement for the advice to be signed off by a named consultant.

NHS England previously clarified that requests for referral or specialist advice will need to receive a response ‘from a named consultant’ – following concern raised in Parliament that non-doctors could refuse GP referrals.

The documents said: ‘All A&G requests and referrals should be clinically appropriate and authorised by a named GP, consistent with the corresponding requirement on providers that specialist advice is provided by, or under the accountability and oversight of a named consultant.’

NHSE’s clinical director for elective care Ian Eardley said that GPs should raise delays in response times through their ICB.

He said: ‘If the response times are not meeting the sort of standards and targets that are alluded to, that will be something that the local GPs will be able to raise through the ICB with the different providers.

‘It’s become quite clear that different consultants do it in very different ways. Some people do very quick, short, perhaps slightly dismissive responses, and others don’t.

‘So we are moving to a system where people who want to do it, do it on a regular basis, it’s in their job plan to do it, and quite frankly, a single point of access will make it a bit more easy and coordinated for us.’

As revealed by Pulse, hospital trusts are required to respond to GP advice and guidance (A&G) requests within five working days.

It has now clarified that response times are as follows:

• routine referrals: five working days from receipt of referral to actioning next step

• urgent referrals: two working days from receipt of referral to actioning next step

• specialist advice request: a response within five working days from receipt of request

Trusts are now required to open existing digital channels (e-RS and third-party systems) for all specialties where A&G is ‘clinically appropriate’, and the new e-RS A&G functionality will be available and implemented through ‘a scaled approach’.

By October, trusts are to have implemented ‘consultant-led clinical review’ of all A&G requests and elective referrals within the 10 specialties prioritised for A&G.

Last week, Pulse revealed that one hospital has moved to stop consultants refusing patient referrals from GPs by downgrading them to A&G.

Pulse previously revealed that GPs had raised concerns about specialists downgrading their cancer referrals to A&G, creating a risk of missed diagnoses. Pulse was told that this was happening for cancer referrals to specialties including dermatology, gynaecology, lower GI, urology and respiratory. 

LMC representatives from around the UK recently demanded that Governments ensure any advice and A&G systems ‘are optional’ and do not delay access to clinical care.

And the BMA said it was seeking legal advice on the new A&G requirement, amid fears it removes GPs’ right to refer.