ICBs told to choose 10 specialties that GPs have to put through A&G

NHS England has asked GPs to ‘continue prioritising’ advice and guidance (A&G) and said all referrals for 10 specialties – decided at local level – should be going through A&G.

A medium-term planning document published today said the commissioner is ‘committed’ to returning to the ‘constitutional standard’ of 92% of people waiting less than 18 weeks for treatment and that A&G will help with this target.

The document asked general practice to prioritise A&G ‘prior to, or instead of, a planned care referral’ where ‘clinically appropriate’, excluding referrals for urgent suspected cancer.

It added: ‘There should be a move to all referrals going via Advice and Guidance for the 10 specialties at provider level which have the most potential for this model to be effective. We expect ICBs to support this, and bring it to life, through their strategic commissioning for 2026/27.

‘Our aim is for patients to receive more specialised support closer to home – that means working with GPs, community and neighbourhood teams and being digitally enabled where appropriate.’

Next month NHS England will publish a ‘model neighbourhood framework’ which will set out the ‘definitions, goals and scope of neighbourhood health’, along with ‘priority actions’ for 2026/27.

This framework is also expected to provide further details on plans for GPs to ‘manage more patients without the need for a referral’.

NHS England said that to support this increased use of A&G, ICBs should ensure all referrals receive ‘appropriate clinical triage’ through ‘a single point of access’.

‘This will ensure more patients wait less time to receive a diagnosis and start an appropriate form of treatment,’ the document added.

It also said that there should be a move toward the e-Referral Service (e-RS) being used for all A&G requests from primary care from July 2026, where these requests are managed within the e-RS user interface, and from October 2026 ‘where a third-party service is used’.

It added: ‘We will work with regions and providers to ensure rapid but manageable roll-out supported by appropriate platforms, including improvements to the functionality of e-RS.’

A&G requests have risen since the Government made a payment available for practices in April. 

The 2025/26 GP contract offered 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.

NHS England said it would ‘incentivise even closer working between general practice and secondary care’.

Currently 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.

Last year, Pulse revealed hospital specialists in Hampshire using the A&G process had downgraded GP cancer referrals, causing ‘considerable alarm’ due to the risk of missed diagnoses. 

GPs have told Pulse that the effect of this is that fast-track cancer referrals are being received as A&G and being downgraded by hospital specialists, which could bring an increase in risk of missed cancers.