CQC and GMC demand ‘clarity’ from NHS England on mandated A&G

The CQC and the GMC have asked NHS England for ‘clarity’ on 11 areas related to advice and guidance (A&G), including a clearer articulation of A&G, GP indemnity, and patient safety implications. 

The watchdog and the regulator, along with the Health Services Safety Investigations Body (HSSIB), said that they take the BMA’s concerns about A&G ‘seriously’.

It comes after the BMA wrote to all three bodies in March requesting they initiate the Emerging Concerns Protocol (ECP) – meant to share information about ’emerging concerns’ with regulators and system partners – to ‘assess the emerging patient-safety risks’ of mandated A&G. 

A response to the BMA’s GP committee chair Dr Katie Bramall, sent by the CQC on behalf of the three bodies and seen by Pulse, said they had ‘identified a number of specific areas where further clarity and assurance are required from NHS England and system partners’.  

These include explanations on how professional accountability for GPs and hospital consultants is defined and managed within A&G pathways, and what legal advice was sought by NHSE during the development and implementation of A&G, including ‘consideration of patient safety implications’ (see box for the 11 areas in full).

The letter said a ‘multi-agency meeting’ had been held with NHS England on 24 April where it was ‘acknowledged that implementation has been inconsistent and that, in some areas, patients and clinicians have experienced delays, lack of clarity around responsibility, and poor communication’.  

However, it added that ‘these examples represent poor patient care, rather than an inevitable consequence of A&G as a policy and require action and assurance’. 

Another area the letter said it sought clarity on from NHS England was on ‘whether there is a named hospital consultant responsible for each A&G interaction’. 

Supplementary documents to the 2026/27 GP contract which have since been published by NHS England state there is ‘a requirement on providers that specialist advice is provided by, or under the accountability and oversight of a named consultant’. 

The letter also said HSSIB was ‘investigating patient safety concerns’ relating to A&G ‘as part of the investigation into Electronic Patient Records’, and that it was ‘engaging with LMCs across the country, practices and other stakeholders’. Its interim report will be published in August, the CQC said.

It added: ‘We have asked NHSE to coordinate a written response addressing these points, to be shared with the BMA, the General Medical Council (GMC), the Health Services Safety Investigations Body (HSSIB), and other relevant system partners, supported by clear and consistent messaging to the wider NHS system.’

Dr Bramall had initially written to the CQC, GMC and HSSIB requesting that they ‘assess the emerging patient-safety risks’ of mandated A&G and ‘determine whether a joint regulatory response is required’. 

The letter from Dr Katie Bramall, also seen by Pulse, cited concerns over ‘delayed diagnoses, inappropriate deflection of referrals, and ambiguity about responsibility for follow-up actions’.  

‘These issues are not isolated incidents, but a pattern of systemic tension across multiple organisations’, Dr Bramall said in her letter. 

The CQC said that having considered the available information at this point, it is ‘not currently in a position to trigger the Emerging Concerns Protocol’ but that it reserves the right to trigger the ECP ‘should further evidence indicate escalating or unmitigated risk to patient safety’.

A CQC spokesperson told Pulse: ‘The health and care system relies on supportive relationships and processes, thoughtfully designed to drive the best outcomes for the people who use services and to enable staff to carry out their role to the best of their abilities.

‘We will continue to listen to and work with our systems partners to explore concerns and drive improvements, both in our own approach, and in partnership with other bodies.’

HSSIB told Pulse that their patient safety investigation is currently underway and that until their evidence collection and analysis is complete they are unable to share any findings or comment further on this issue.

Responding, an NHS England spokesperson told Pulse: ‘We have already discussed the points raised with the BMA, and we will continue to engage with stakeholders on the advice and guidance service including on any further communications we publish.

‘There is so much we can achieve for both our staff and patients by strengthening the interface between GPs and specialist services, building on what we’ve delivered through the use of advice and guidance over a number of years.’

They also referred to a letter of clarification on A&G referrals issued by national primary care director Dr Amanda Doyle last month, in which she denied there was a national target for referrals being sent back to general practice.

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.

Pulse has contacted the GMC for comment.