A&G to be embedded into core practice funding as part of new GP contract
The GP contract will be amended to ’embed’ the current advice and guidance (A&G) enhanced service within core practice funding, NHS England has announced.
In a letter to GPs, NHS England said practices will be ‘required’ to use A&G ‘prior to or in place of a planned care referral where clinically appropriate’.
Setting out the contract changes, NHSE said that these will include a £485m uplift and A&G, currently part of an enhanced service worth £80m, will be brought into core funding.
This further normalises the practice of GPs taking a wider responsibility for formerly specialist services, with the rollout having started in earnest in 2022, when NHSE said it should be the main referral pathway for access to dermatology services.
NHS England’s national director for primary care Dr Amanda Doyle said in the letter: ‘We will amend the contract to embed the current advice and guidance enhanced service funding within core practice funding.
‘Practices will be required to use advice and guidance prior to or in place of a planned care referral where clinically appropriate and to follow locally agreed referral pathways, including single point of access models once introduced.
‘Advice and Guidance has shown clear value in supporting timely specialist input, reducing unnecessary referrals and ensuring patients receive timely care in the most appropriate setting.’
The letter also referenced plans for NHS trusts to ‘work towards achieving national operational processing standards’ to ensure specialist advice is ‘consistently and timely’ across referral pathways.
The BMA said the change could put ‘potential barriers’ in place around specialist referrals.
BMA GP committee chair Dr Katie Bramall said: ‘We expect the Government to frame this GP contract as a major win for patient access, but hard working family doctors will be deeply concerned about setting up even more unrealistic expectations of unlimited same‑day urgent care provision alongside potential barriers being put in place around specialist referrals, all while trying to keep practices open and prevent even more surgery closures.’
Dr Paul Evans, a GP and chair of Gateshead & South Tyneside LMC, said the move could worsen patient care and restrict GP decision-making.
He told Pulse: ‘The removal of the right of a GP to refer directly to a consultant peer will undoubtedly lead to definitive patient care being delayed, the removal of the right of a patient to seek specialist opinion and GPs left holding clinical risk and increased workload as patients decline whilst being processed through ‘single point of access’ systems that restrict any actual input from doctors.
‘Harm will be done to practices as they become overwhelmed as well as to individual patients and GPs.’
Mark Cubbon, NHS England’s national priority programme director for planned care, had hinted at a board meeting earlier this month there would be ‘significant rollout’ of ‘broader adoption’ of A&G, though did not clarify if A&G would be mandated for all specialties.
Currently, the £80m A&G enhanced service enables GP access to a £20 Item of Service (IoS) fee for ‘pre-referral requests’. GPs receive £20 for each ‘episode of care’, which could include several interactions with consultants.
But ICBs cap the number of A&G requests claimed per practice and if GPs exceed the cap they will not be able to claim payment. ICBs can set or change this cap at any point during the year.
A&G requests have risen significantly since the Government introduced the incentive for GP practices last April.
Visit Pulse Reference for details on 140 symptoms, including easily searchable symptoms and categories, offering you a free platform to check symptoms and receive potential diagnoses during consultations.
