Consultants could help 'block' obligatory A&G following BMA vote

Doctor leaders have voted to ‘work together’ across all branches of practice to block ‘obligatory’ GP advice and guidance (A&G).

A motion which called to ‘reject the concept of obligatory pre-referral advice’ was carried in all parts at the BMA’s annual representative meeting (ARM) yesterday, with GP leaders warning that mandating A&G risked creating a ‘dystopian future’ for doctors and patients.

It comes after NHS England claimed A&G was not mandated and that GPs would never be in breach of contract if they chose to make a direct referral to a specialist instead.

GP practices in England are required under this year’s contract 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 ARM motion called on the profession to both ‘reaffirm GPs’ right to refer their patients to specialists’ and ‘reject the concept of obligatory pre-referral advice, and call on all branches of practice to work together to block its imposition’.

The motion said ‘the doctor who has consulted with the patient is likely to have a clearer idea of when specialist input may be necessary that someone making a decision based on a letter or referral form’.

Proposing the motion, Oxfordshire GP Dr Helen Salisbury said: ‘There is a dystopian future where there are frustrated GPs, there are patients who are denied care, and there are consultants spending increasing amounts of time sifting through referrals, trying to identify the ones that they can reject, rather than actually spending time seeing patients.’

Meanwhile, BMA consultants committee co-chair Dr Shanu Datta, who supported the motion, said: ‘The requirement for a response from a named consultant with accountability implies a shift of duty to consultants for a patient that they have not seen. This is not acceptable.

‘In years gone past, we’d have called this out for the rationing of healthcare that it is, but in these stricken times, there is, in addition, the common vein of the attack on our medical professionalism that permeates throughout health services.’

A clear majority (87%) of ARM attendees voted to carry the motion in all parts.

The Health Services Safety Investigations Body (HSSIB) is currently investigating the potential patient safety risks of mandating A&G after the BMA wrote to the CQC and GMC in March outlining its concerns. Its interim report is set to be published in August.

Pulse has contacted NHS England for comment.

Motion in full

Motion by SOUTH CENTRAL REGIONAL COUNCIL: That this meeting notes with dismay the move towards compulsory requests for advice before, or instead of, referral that was signalled in the recently imposed GP contract variations (2026/27).

This removes a GP’s right to refer and a patient’s ability to have a specialist opinion. It will lead to transfer of work from consultants to GPs and uncertainty over medicolegal responsibility if a referral is rejected and clinical harm ensues. CARRIED IN ALL PARTS

Consultants will spend increased amounts of time triaging and rejecting patients rather than seeing them. We ask this meeting to:

i) reaffirm GPs’ right to refer their patients to specialists;

ii) reject the concept of obligatory pre-referral advice, and call on all branches of practice to work together to block its imposition;

iii) recognise that the doctor who has consulted with the patient is likely to have a clearer idea of when specialist input may be necessary that someone making a decision based on a letter or referral form;

iv) work with relevant bodies to continue to develop user-friendly systems through which GPs and consultants can communicate when advice is wanted. Queries sent and answers received must be automatically included in the medical record at both ends.

Source: BMA