The new advice and guidance (A&G) enhanced service specification has confirmed that GPs will receive £20 for each ‘episode of care’, which could include several interactions with consultants.
Yesterday, just days before the service is set to begin, NHS England published full details of the £80m A&G enhanced service as part of the 2025/26 GP contract changes, recently accepted in full by the BMA.
The specification stipulated that A&G requests are ‘GP led’, meaning that any requests ‘initiated’ by a non-GP member of staff ‘must be reviewed by a GP’ before submission to ‘ensure appropriateness, quality control and relevant content’.
It also set out details for the ICB funding cap, which is intended to ensure ‘expenditure stays within the £80m national funding envelope’ while also maximising A&G requests.
This means ICBs will be able to 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.
NHS England clarified: ‘At any point during the year, the ICB may set a cap or change a cap. If a cap is changed in year, it will not be set below the level of delivered activity at that point.
‘Each practice that signs up to this ES will be notified by its ICB of any cap (where applicable) and any in year changes to the cap.’
As previously confirmed by the Government, the £20 Item of Service (IoS) fee is intended to cover a single episode of care, rather than each interaction with hospital specialists.
The specification said: ‘Only one claim can be made per episode of care (i.e. multiple contacts between the practice and specialist for the same clinical issue are counted as one A&G referral).’
It added: ‘For the avoidance of doubt, ongoing communication between the referrer and the respondent regarding the same episode of care will not attract a further IoS fee.’
NHS England also clarified that the enhanced service is not intended to mandate A&G for particular specialties, emphasising that the ‘requests are not limited to specific specialties or clinical conditions’.
The service begins on 1 April, and GP practices wishing to participate must sign up on or before 30 April.
Practices must make manual monthly claims for payment within 12 days of the end of the month when the A&G guidance was requested.
This new £20 per A&G payment was first announced ahead of the 2025/26 contract as part of the Government’s ‘elective reform’ plan to bring down hospital waiting lists.
NHS England is aiming to increase uptake of A&G via this new incentive, bringing the total number of requests up from 2.4 million 2023/25 to 4 million in 2025/26.
The BMA had also said that the impact of the new ES on GPs will be reviewed in the spring, and also that local systems will be required to review the availability of secondary care advice channels.
Hooray !!
This is so sensible. It makes great use of all that spare capacity in Primary care AND it will provide funding so that we can have chocolate biscuits every now and again in the coffee room instead of those horrible plain ones (I haven’t personally been to the coffee room in years – but the ARRS staff have told me many times about the horrors of the current snack selection). I am seriously going to have to reconsider my decision to take early retirement following this breakthrough.
Going rate for a decent solicitor or accountant is at least £240 per hour. GP’S should price their time accordingly so the £20 on offer covers 5 minutes of GP time.
NHSE micromanaging something into useless oblivion again.
Goodbye, don’t let the revolving door hit you on the way out and don’t forget to turn the lights off.
Timid. The bulk of pay for GPs should be fee for service. Very small fee for telephone consults bigger to face to face with a sliding scale depending on when last seen: With 1 month less cash more 3 months more money and a year or more since last seen give a fat fee, This would discourage doctors like churning the same patients and detox out frequent attenders. Also have fees a for service for doing stuff, avoiding hospital referrals. I also work in Australia, where long waits to see a GP, are almost unknown. No patients seen=zero income. A busy day is tiring but happier doctor as income up. Also Oz GPs DO things for patients, such as skin removals even plastering. Fee for service is not perfect but better than what we have. The way us GPs in the UK are not paid directly to see patients is obtuse.
So sad and disrespectful that our time and skill is priced for such derisory amount and doesn’t bode well for our new contract negotiations.
Pathetic; won’t even cover the reception/admin/secretarial time involved in generating/sending/receiving/processing/actioning the A&G, before even considering clinician time.
Hey NHSE I suggest you roll that 20 up real tight and shove it up past your dentate line. And later you can flush it, along your whole organisation. Adios NHSE.