Trusts must respond to GP A&G requests within five working days, says NHS England
Exclusive Hospital trusts will be required to respond to GP advice and guidance (A&G) requests within five working days, under NHS England guidance.
In a document shared with ICBs and trusts, the commissioner also clarified that A&G should not be used in place of urgent suspected cancer referrals.
It said that the maximum number of working days to process an A&G request should be five days, and that trusts are required to implement processes to ensure open and outstanding A&G requests are addressed ‘in a timely manner’.
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.
Funding for A&G has also been moved into the core contract, with the item of service fee being scrapped. The move formalises a trajectory of NHSE moving towards A&G becoming the norm rather than traditional referrals – with the rollout having started in earnest in 2022, when NHSE said it should be the main referral pathway for access to dermatology services.
The NHSE document, seen by Pulse and marked as ‘sensitive’, said that A&G will be ‘consultant-led, multi-professionally delivered clinical review of general practice enquiries and referrals’, which has left some GPs concerned non-doctors could be asked to review and respond to requests.
Starting this month, trusts are required to open existing digital channels (e-RS and third-party systems) for all specialties where A&G is ‘clinically appropriate’, NHS England added, and the new e-RS A&G functionality will be available and implemented through ‘a scaled approach’ with further information on this still to come.
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.
The document added: ‘Providers are encouraged to broaden adoption beyond the priority 10, across further specialties and subspecialties within the planning period, in line with local readiness and workforce capacity.’
Pulse has previously revealed concerns about specialists downgrading cancer referrals to A&G, creating a risk of missed diagnoses.
But the NHS England document said: ‘Advice and Guidance should not be used in place of an urgent suspected Cancer referral, where a patient clearly meets NG12 NICE guideline: Suspected cancer: recognition and referral criteria for Urgent Suspected Cancer.
‘A&G requests, however, can be converted into an urgent suspected cancer referral in line with the local referral and commissioning guidelines.
‘This does give general practice the opportunity to use Advice and Guidance for borderline or uncertain cases, and we would encourage them to do so. Where this happens, this must be classed as an urgent suspected cancer referral, not a consultant upgrade.’
NHS England A&G guidance
Providers must work towards achieving the following:
- ADVICE & GUIDANCE – Number of working days from receipt of an A&G request to a response: 5 working days
- ROUTINE REFERRALS – Number of working days from receipt of referral to actioning next step: 5 working days
- URGENT REFERRALS – Number of working days from receipt of referral to actioning next step: 2 working days
Where a request is resolved through A&G alone or returned to the referrer (e.g. for more information), no RTT clock is started.
Key priorities for 2026/27
In shifting to a digital-first, patient-led model, ICBs and providers must continue to progress towards a model that improves access, efficiency, and patient experience. As outlined in the Medium Term Planning Framework, the key priorities for 2026/27 to enable more specialist care to be delivered closer to home and to improve coordination across services will be:
- expanding the use of Advice and Guidance
- moving to the e-Referral Service (e-RS) being used for all Advice and Guidance
requests and referrals from general practice (excluding urgent suspected cancer) - ensuring all referrals receive appropriate consultant led clinical review, flowing through a single point of access
To ensure a consistent and collaborative approach, the following deliverables should be led at a system level, working in partnership with providers:
Expanding the use of Advice & Guidance
- From April 2026, NHS providers of RTT consultant-led care must prioritise Advice and Guidance across at least 10 specialties, selected locally on the basis of where A&G is most likely to deliver the greatest overall benefit and shape delivery of elective
pathways in 2026/27 (refer Annex 2: Specialty Prioritisation Workbook). Selection and development of specialities should involve collaborating with commissioners, interface groups, general practice and providers - Providers who use A&G for 10 or more specialties, or with established A&G in a smaller number of specialties, should continue to improve their current services while moving further and faster to extend A&G to additional specialties within e-RS or
approved third-party platforms, focusing on where this will deliver the greatest overall benefit
Source: NHS England document seen by Pulse
Responding to a question in Parliament, primary care minister Stephen Kinnock appeared to refer to the NHS England document in question, saying this was shared with ICBs in February.
In the answer, made last week, he further said that GPs can re-submit a referral following a single point of access triage outcome ‘if they have concerns about the clinical decision.’
Mr Kinnock also said that under the new model, if a patient needs treatment, their Referral to Treatment (RTT) clock start date will be calculated from the date the A&G request or referral was received by the SPoA.
This is instead of the current process for A&G, where the clock start date is the date that the request or referral is converted to a treatment pathway. This will ensure that ‘patients’ waiting times are accurately reflected’, he added.
Commenting on the guidance, Tower Hamlets GP Dr Selva Selvarajah said: ‘I support it in principle, if you can get advice from a specialist on a particular query that we might have.
‘But this document mentions that this will be “consultant-led advice”, so it doesn’t mean I’m always going to get advice from a consultant. What does that mean in practical terms? What does that mean for medico-legal risks? Who’s going to take responsibility for following advice that is given by a “consultant-led team”? And can the hospitals realistically turn this around in five days?’
The BMA’s GP committee is threatening GP collective action from 30 April unless the Government ‘pauses’ its plans around mandated A&G. The doctors’ union is also currently seeking legal advice on the new requirements, amid fears it removes GPs’ right to refer.
The RCGP said that GPs have reported risks of delays with tests being required before any referral, ‘lost messages’ and staff without appropriate senior clinical oversight handling A&G requests.
Last month, a group of LMCs urged GPs nationwide to challenge any mandated use of A&G, amid concerns that it could introduce safety risks for patients.
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READERS' COMMENTS [8]
Please note, only GPs are permitted to add comments to articles
I thought NHSE was abolished?
I wonder how long it will be before we start getting A&G rejections…
A model that improves
access 0/110,
efficiency 10/10 if no activity takes place in secondary care
patient experience 0/10 as they are never seen by a partialist .
Failed already
The responses to A&G requests that I have received so far have been made by junior staff who have given no indication as to their NHS staff grade. So, If the replies we receive are from junior SHOs (or whatever they call themselves nowadays) then is the process worthwhile?
current waiting for cardiology a+g is 4 weeks+. Another system (consultant connect) is there to improve times but they are not connected to our hospitals so are not much use: they can’t assist in a “needs an outpatient appt/scan which we will convert this to”. Paeds don’t do it at all
This is not about doctors been losing the right to refer, it’s about patients losing their right to be seen by a specialist if their doctor thinks it’s necessary. It needs to be framed like this and the BMA should be writing to every MP asking them if they are aware of this, and asking them if they think their constituents support this.
healthcare is not a factory. You can standardise processes; you cannot standardise uncertainty.
So we’re required to implement it from April 1st but Trusts are required to “work towards” achieving a five day turnaround…our local dermatologists currently take two months to reply rejecting entirely reasonable referrals…