GPs taking specialist training to ‘feel safe’ practising under mandated A&G
GPs are taking additional specialist medicine training in their own time, to feel ‘safe’ practising under the expansion of advice and guidance (A&G) in place of referrals.
This was the finding within a briefing from the Rebuild General Practice campaign last week, chaired by Pulse’s editor-in-chief Jaimie Kaffash.
The panel session also covered GP concerns with the Government’s neighbourhood health plans, the single patient record and GP recruitment issues.
In the session, panellists were asked if felt they were acting above a comfortable level of competence when caring for patients under consultant advice in place of a hospital referral.
Dr Eleanor Barnard, a salaried GP in Sutton, agreed and said that to feel comfortable using A&G, she has taken up additional specialist training.
Dr Barnard said: ‘I’m then basically doing in my own time, additional specialist training, just so that I can be a GP.’
‘I’m finding myself having to do that additional training so that I feel safe in what I’m doing.’
She said GPs in her borough have felt uncomfortable after receiving A&G instructions from consultants suggesting the use of highly specialist medications that they had not been trained in.
Dr Jessica Court, from Nottinghamshire LMC said: ‘Too often, the specialist advice that we receive is poor quality.
‘Sometimes it’s not even a fully formed sentence. Yet the responsibility falls back onto the GP to communicate it to the patient, arrange investigations, prescribe treatment and manage the ongoing clinical risk.’
Under the imposed 2026/27 GP contract, 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.
Also speaking in the panel session, GP partner and PCN clinical director in south-east Shropshire Dr Jess Harvey lamented that it is patients that are paying the price for a reduced capacity for outpatient appointments.
Dr Harvey said: ‘[Hospital consultants] are being pushed from their side to not be seeing people in clinic and they’re being pushed to give advice and guidance.
‘We’re being pushed to not be sending people to clinic but to ask for advice and guidance and then manage that. The whole thing just starts to get a little chaotic and it’s just sad because right in the middle of all this is the patient.’
It comes as consultants could help ‘block’ obligatory A&G following a vote at last month’s BMA annual representative meeting, which saw doctor leaders voting to ‘work together’ on the issue.
And the Health Services Safety Investigations Body (HSSIB) is currently investigating potential patient safety risks of mandated A&G, with an interim report expected in August.
The session also saw the panel raise concern about Palantir’s involvement in the Single Patient Record being established to underpin neighbourhood health.
Dr Barnard said: ‘A single shared record is essential to the success of integrated neighbourhood teams – it will not work without it – but we do not want an American multi-national to be the ones that have that record.’
Meanwhile, Dr Harvey highlighted how the shift to neighbourhood health could act as an adverse incentive for prospective GPs.
Dr Harvey said: ‘I’ve done quite a few interviews over the last sort of 9 to 12 months we’ve been recruiting and a lot of them have been around, the concern is around the workload, the demands, asking how many patients they’re going to see and what the admin burden is going to be.’
The Rebuild General Practice campaign is calling for secure fair funding for GPs within the wider NHS; the return of the family doctors to improve continuity of care; freedom and autonomy for GPs; for GPs to help shape the revised NHS workforce plan; and for GPs to be put at the heart of the NHS 10-year plan.
