From April 2026, the new GP contract will include the current advice and guidance (A&G) service within core GP practice funding and hospital referrals under the scheme will be mandatory.
In a letter to GPs dated 24 February 2026, NHS England (NHSE) said practices will be required to use A&G “prior to or in place of a planned care referral where clinically appropriate” in relation to 10 specialties, which are to be agreed at provider level.
A&G allows GPs to seek specialist input before referring patients to hospital. It was introduced around 10 years ago but after elective waiting lists grew due to the COVID-19 pandemic NHSE expanded the service. The current A&G Enhanced Service, under which GPs can make direct referrals to hospital consultants, will be retired. Instead, GPs will need to follow locally agreed referral pathways, including using “single points of access” to which they must submit all electronic referral requests.
Referral requests will then be reviewed remotely by hospital clinicians, who will decide whether to arrange an appointment with a specialist, provide written advice to the GP or redirect the patient.
Secondary care clinicians may be less likely to consider that referral to a specialist is necessary, which would mean more patients would be managed by primary care. It will therefore be essential under the new mandatory system for GPs to provide all relevant information when making referrals under the A&G service to ensure that urgent cases are recognised and acted upon appropriately, and to prevent referrals from being erroneously rejected or incorrectly prioritised for specialist treatment.
Risks to patient safety and responsibility for patients who do not receive the required care due to rejected referrals or delayed treatment will be concerns for GPs and trusts alike. The Health Service Journal has reported that some trusts, such as Croydon Health Services NHS Trust and Nottingham University Hospitals NHS Trust, have already established WhatsApp groups with GPs and hospital specialists so GPs can highlight when a referral has not been accepted. These WhatsApp messages will form part of patients’ records so need to be accessible when GPs respond to subject access requests. They are also likely to be considered closely by lawyers and experts in the event of a claim relating to delayed treatment.
Clear communication will be crucial from the outset between primary and secondary care providers to ensure the mandatory A&G service delivers high quality care for patients.
