NHS England has confirmed that a £20 payment for advice and guidance (A&G) requests will be made available to GP practices by a national enhanced service from April.
The 2025/26 GP contract offer, accepted by the BMA and announced this morning, set out further details of the £80m A&G funding pot, which was first revealed in January as part of the Government’s plan to bring down the elective waiting list.
Practices will be able to access a £20 Item of Service (IoS) fee for ‘pre-referral requests’ under a new enhanced service ‘worth up to £80m’.
The BMA said the funding will be capped per ICB, and that local commissioners will receive funding ‘according to activity delivered so they are not incentivised to withhold it from general practice’.
NHS England has not clarified what will happen if the number of GP A&G requests within an ICB area outstrips the capped spend.
More details of the ‘eligibility criteria’ for claiming the £20 payment will be set out in the full enhanced service specification, which is not yet published.
However, health minister Karin Smyth clarified in the House of Commons last month that the £20 payment can cover multiple interactions between GPs and consultants, rather than just the initial request.
She said: ‘Each Advice and Guidance request will be funded at £20, which is to cover any back and forth required between a GP and a hospital specialist to reach a resolution, and this may be one interaction or several dependent interactions.’
NHS England said in its letter to practices this morning that the A&G enhanced service ‘will incentivise even closer working’ between GPs and secondary care, and support the Government’s goal to shift care from hospital to community.
‘It will help to ensure that patients receive care in the right place at the right time via the use of specialist advice and guidance, whilst also supporting elective recovery,’ primary care director Dr Amanda Doyle said.
The £80m funding, which is separate to the £889m boost to the core contract, is intended to ensure both primary and secondary care are resourced to deliver advice and guidance.
In last month’s elective reform plan, NHS England said this would be achieved by ‘splitting the existing elective tariff’ – but the commissioner has not clarified how much secondary care providers receive to process A&G.
The BMA’s summary of the 2025/26 contract changes also said that local systems ‘will be required to review the availability of secondary care advice channels’, while the ‘impact on GPs will be reviewed during spring 2025’.
Following the initial announcement of the £20 payment in January, the union’s GP Committee England said it was a ‘positive step’ and the ‘first example’ of the Government’s commitment to shift resources ‘outside of the acutes’.
The committee also suggested that its current advice for GPs to stop A&G may be ‘dropped’ from its collective action options if the payment is ‘successfully negotiated’ into the 2025/26 contract.
But since accepting the contract deal yesterday, the BMA has said it will now pause collective action altogether while working with the Government to secure the ‘necessary assurances’.
The RCGP had also responded positively last month to the proposal for GPs to be paid for A&G, saying it will help enable services to move out of hospitals into the community where ‘care is more cost effective’.
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