GP advice and guidance requests up nearly a quarter since payment introduced 

Advice and guidance (A&G) requests have risen by nearly quarter since the Government made a payment available for GP practices in April.   

Newly released NHS England shows 327,152 ‘pre-referral specialist advice requests’ were submitted in October – equivalent to 14,224 per working day that month.  

This is a 23.1% increase in requests since the financial incentive was introduced as part of the 2025/26 GP contract, and a 25.7% on-year annual increase. 

The data is also broken down by ‘processed’ A&G requests – where a specialist has received and responded to the request – and ‘diverted’ requests – where a specialist has received and responded to the request and ‘returned to referrer with advice’ where it is expected that the advice diverted a referral.  

The proportion of A&G requests, both processed and diverted, has remained steady since before the payment was introduced. 92% of requests were processed on average over the last 12 months, and 46% diverted – excluding the most recent month’s data which is prone to being significantly under-reported. 

The 2025/26 GP contract offers practices access to an £80m A&G funding pot, which enables access to a £20 Item of Service (IoS) fee for ‘pre-referral requests’ as part of a new enhanced service specification. 

GPs receive £20 for each ‘episode of care’, which could include several interactions with consultants.   

However, ICBs cap the number of A&G requests claimed per practice – on a monthly, quarterly or annual basis – 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.

Gateshead and South Tyneside LMC chair Dr Paul Evans told Pulse the increase could be explained by trusts using the introduction of the A&G scheme to ‘decline seeing patients’. 

‘We are seeing in our own area, with Newcastle upon Tyne Hospitals NHS Foundation Trust, a couple of departments have unilaterally decided that everything must go by advice and guidance’, he said. 

‘We pushed back on this and explained to them that, contractually, they can’t do this – but practices that were not initially willing to have these arguments were just doing as they were told to and making advice and guidance requests when previously they would have made referrals.  

‘So I think a lot of the rise is likely down to trust using advice and guidance as an excuse to push work into general practice and not see patients.’ 

Dr Evans added that the £20 A&G payment to practices per request was ‘absolutely not enough’ to cover the ‘long list of tasks’ a specialist asks a GP to carry out before they can make a referral. 

The House of Commons public accounts committee (PAC) recently criticised NHS England for failing to track the costs and benefits of the A&G scheme.

It claimed in a November report that DHSC has approved billions of pounds of spending ‘without sufficient focus on what exactly’ expansions of programmes like A&G will deliver.

And NHS England’s medium-term planning framework, published in October, says general practice should prioritise A&G for all referrals for 10 specialties (decided at local level) ‘prior to, or instead of, a planned care referral’ where ‘clinically appropriate’, excluding referrals for urgent suspected cancer.