GP A&G requests set to fall short of budget allocated for scheme

GP advice and guidance (A&G) request figures are unlikely to meet the overall budgetary allocation for the scheme this year.

A £20 financial incentive for GPs was introduced in April 2025 as part of an £80m A&G enhanced service to reduce elective waiting lists. NHS England had hoped the incentive could increase advice requests to four million in 2025/26, and help divert two million requests from elective care. 

However, data up to the end of December 2025 indicates both targets will be missed, with around 2.6 million A&G requests and 1.1 million diversions having been made so far. 

Around 15,800 A&G requests per working day were expected, but since last April that daily average has not exceeded 14,800 in any month. 

To meet the four million target, more than 20,000 A&G requests are required each working day in the last three months of the financial year. 

Similarly, there have just over half the target number of ‘diverted’ requests – defined as requests responded to and ‘returned to referrer with advice’, where it is expected that the advice diverted a referral – in the first three-quarters of the year. 

To bridge the gap, 13,000 requests per day would need to be returned to GPs by secondary care between January and March. The average for the 2025/26 so far is only around 6,000. 

An NHS England document published last year setting out its targets said: ‘In an expansion of the current approach, GPs will receive £20 per A&G request, to recognise the importance of their role in ensuring patient care takes place in the most appropriate setting.  

‘We expect this to increase uptake, with more patients benefitting from their GP accessing rapid specialist advice, so they receive the care they need in primary and community care settings, as opposed to being added to the elective waiting list.’ 

It comes as last week, the Government announced the A&G enhanced service would be scrapped and embedded within core general practice funding. 

At the same time, the use of A&G is set to continue to expand, with NHS England telling practices they will be ‘required’ to use A&G ‘prior to or in place of a planned care referral where clinically appropriate’.  

Currently, the £80m A&G enhanced service enables GP access to a ‘pre-referral requests’ payment. GPs receive £20 for each ‘episode of care’, which could include several interactions with consultants.

A DHSC spokesperson told Pulse: ‘The advice and guidance scheme is just one tool this Government is using to successfully cut the huge NHS waiting lists we inherited. The Elective Reform Plan provided funding for “up to” four million referrals, rather than set a target, to support a significant increase in requests, and the data shows that is being achieved.

‘Progress is already clear, with more than 20% more requests being processed per working day – and, as reporting catches up, the final position will show even greater improvement.

‘With almost all GPs already signed up, we’re doubling down. From October, the NHS will use a “single front door” to support clinical triage – and the new GP contract for 2026/27 embeds advice and guidance as routine clinical practice, removes the need for annual signups, and provides more predictable funding.’

A&G requests rose by a quarter from April to October 2025, compared to the same six-month period the previous year.

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