ICBs have been reminded that advice and guidance (A&G) must not be used ‘in place of’ urgent cancer referrals, in new NHS England guidelines.
The guidance sets out how ICBs should implement A&G ‘effectively’ in their areas in order to improve uptake and quality, including a series of ‘minimum standards’ they must achieve in 2025/26.
This comes alongside the recent publication of the A&G enhanced service for general practice, which from this month will see GPs paid £20 per request in a bid to boost its usage and bring down waiting lists.
NHSE’s new ‘operational delivery framework’ for ICBs, released today, said that there is ‘considerable variation’ in how A&G is currently delivered, and so a ‘higher degree of rigour and standardisation is needed’.
On cancer, the guidance said: ‘It is important to recognise that Advice and Guidance should not be used in place of an urgent suspected cancer referral where a patient clearly meets the NG12 criteria.’
Pulse has previously reported on hospital specialists downgrading cancer referrals using advice and guidance, a measure which caused ‘considerable alarm’ among GPs.
On turnaround times for advice from specialists, NHSE also reiterated its expectation that GPs receive a response within 10 days for routine requests, and 24 to 48 hours for urgent requests.
But it said ICBs should determine specific turnaround times for each specialty, and implement processes to ensure outstanding requests ‘are addressed in a timely manner’.
The guidance also said ICBs should ‘ensure resource allocation’ for A&G is ‘included within job planning and clinical workforce plans within primary and secondary care’.
Other standards ICBs must meet on A&G:
- Offering patient choice: provide GPs with patient choice guidance and training, to help patients make informed, meaningful choices about how and where they receive treatment.
- Improving quality: put in place clinically led audits at specialty level to assess the quality of A&G requests and responses and to assess local ‘diversion’ to referral rates;
- If the rate of A&G requests being diverted to referrals goes above the national average of 45%, this should ‘trigger’ an exception audit at specialty level.
- Evaluation: regularly evaluate Advice and Guidance services (for example, annually) using quantitative and qualitative data and insights and including feedback gathered from patients and NHS staff.
Advice and guidance is a key part of the Government’s elective care reform plan, with NHSE hoping to increase uptake from 2.4 million requests in 2023/24 to 4 million in 2025/26.
By March 2026, ICBs will need to complete an evaluation from A&G in 2025/26 and set out a new plan for 2026/27.
When the new A&G enhanced service was announced with the 2025/26 contract changes in February, the BMA had said local systems would be ‘required to review the availability of secondary care advice channels’ along with the impact on GPs.
A version of this story first appeared in our sister title Healthcare Leader.
