Pulse editor Sofia Lind on the Government remunerating GPs £20 for A&G as part of its ‘elective reform plan’
It looks as though GPs across England will begin to be remunerated for the controversial practice of advice and guidance (A&G). This seems, on the face of it, like good news. Details of the offer are, as yet, sparse but the headline figure announced is £20 per request, from a £80m total funding pot.
On the one hand, GPs are already expected to do A&G, for no amount of funding at all, so surely some money is a good thing, right? But on the other, the GP negotiators will want to think long and hard about whether £80m as an amount is as significant as the expected increase in GP workload.
Because the money isn’t just expected to cover current A&G workload but a significant expansion. There is also the question of whether the £20 is per interaction or per clinical episode.
NHS England has not yet specified how the payment would be made to practices, but BMA GP Committee chair Dr Katie Bramall-Stainer has confirmed that this forms part of ongoing contract negotiations for 2025/26.
Dr Bramall-Stainer stressed that ‘nothing is agreed until everything is agreed’, but did welcome the notion of money being moved from hospital to general practice as a positive direction.
But incentivising A&G was just one part of the Government’s new plan to bring down elective waits. And some parts of that plan were just plain bizarre, as GPs have been pointing out to me over the past couple of days. Notably, there is a case study which paints a picture of what a future referral scenario could look like, where a woman with a cold seemingly gets sent straight for a CT scan and later ends up getting a hearing aid.
As one GP partner described it to me: ‘It is very, very odd – essentially a patient with a cold and some hearing loss ends up having a CT in a shopping centre, MDT review, subsequent MRI, consultant review, naso-endoscopy and audiology and it really is quite perplexing.’
An ex-partner – now salaried – GP I spoke to added: ‘If that’s the future then I give the NHS six months.’
More widely, a concern of the plan is that it becomes another focus on a hospital target, that risks distracting from the Government’s other commitment to move resources into primary care. And £20 for A&G is a resource, but is it enough to bring parity with secondary care?
The plan talks about ‘splitting the existing elective tariff’ – but does £20 reflect what consultants are paid for their end of A&G, or indeed the cost of an outpatient appointment?
These will all be crucial questions for the BMA’s negotiators.
Sofia Lind is editor of Pulse. Find her at [email protected] or on X @sofialind_Pulse
Daftest idea yet. Either the patient has trivia or they will be only partly “sorted” and need to be properly seen. Or palmed off or sent to the A and E queue
The case study is completely nonsensical.
Alert! NHSE protocol for all cases of glue ear announced!!! : CT in a shopping centre, MDT review, subsequent MRI, consultant review, naso-endoscopy and audiology
Who are their GP advisers currently?
Completely nonsensical and again complete gaslighting. Yet more work and responsibility shift to primary care. This is the time to refuse these pittances and make em’ sweat to gain better negotiating ground.
No fee whatsoever should be attached. What matters is that there should be no compulsion, the choice of refer or A+G should be entirely ours, and that no referral can be bounced on account of A+G not being used first. Commentators have this round the wrong way. A harmed patient will see any fee as a bribe to not refer and you’re on the back foot already.