The NHS is increasingly focused on improving patient care by ensuring that specialist advice is available at the right time, without unnecessary delays or referrals. The Advice and Guidance (A&G) service has been developed as part of this wider strategy, allowing GPs to seek specialist input electronically before deciding whether a full referral is necessary.
A&G services help to reduce unnecessary outpatient appointments, enabling patients to receive timely care while optimising the use of NHS resources. By improving communication between primary and secondary care, this service ensures that patients are only referred to hospital when absolutely necessary, reducing waiting lists and improving patient experience.
Over the past few years, NHS England has expanded the use of A&G services across the country, making them a core part of elective care recovery plans. The 2025/26 Enhanced Service Specification outlines how general practices can engage with this service and receive appropriate funding for their participation.
GPs and other primary care clinicians can use an approved digital platform (such as the NHS e-Referral Service (e-RS) or other locally commissioned systems) to submit Advice and Guidance requests to specialists. These requests allow GPs to ask specific clinical questions regarding patient management.
A&G requests can cover:
Clinical decision-making: Seeking specialist input to determine the best course of action before referring a patient.
Diagnostic interpretation: Clarification of test results where specialist input may influence management.
Treatment options: Ensuring that all appropriate primary care treatments have been explored before referral.
When a request is submitted, a specialist will review the details and provide guidance on the next steps. This may include recommendations for further tests, reassurance that a referral is unnecessary, or confirmation that secondary care intervention is required.
The expectation is that GPs should use A&G services where appropriate before making routine referrals, as this aligns with NHS England’s push for more efficient patient pathways.
To qualify for payments under the 2025/26 Enhanced Service, practices must meet a set of requirements designed to ensure effective participation in the A&G scheme. Payments will be linked to activity levels and compliance with these requirements.
1. Use Approved Digital Systems
Practices must use NHS e-RS or another locally agreed platform to submit and manage A&G requests. These systems ensure that communication between GPs and specialists is recorded and traceable, supporting both clinical governance and funding requirements.
2. Provide Clinically Appropriate Requests
All A&G requests must include sufficient clinical information for the specialist to provide meaningful advice. Poorly documented requests or those without adequate history, examination findings, or test results may be rejected or lead to delays.
3. Adhere to Timely Responses and Follow-Up Actions
Practices should ensure that they act on the advice given by specialists in a timely manner. This may include arranging further tests, prescribing recommended treatments, or escalating the case for referral if required.
4. Maintain Accurate Record-Keeping
All A&G interactions must be recorded in the patient’s medical notes, ensuring continuity of care. Proper documentation is essential for audit purposes and may be required for payment validation.
5. Meet Activity Targets
The NHS may set specific activity targets for A&G use, such as requiring a minimum percentage of referrals to be preceded by an A&G request. Practices will need to monitor their engagement with the service to ensure they meet these thresholds.
Payment structures will be outlined in the final commissioning arrangements but are likely to include:
Activity-based funding: Practices may receive payments based on the number of A&G requests submitted and completed.
Incentive payments: Additional funding may be available for practices that exceed engagement targets or demonstrate improved patient outcomes through A&G.
Compliance requirements: Practices must adhere to reporting requirements and quality standards to ensure payments are processed.
Failure to meet the service criteria could result in non-payment or clawback of funds, so it is essential that practices understand and comply with the expectations set by commissioners.
To ensure eligibility for funding, practices should:
Familiarise themselves with the full service specification and understand the local commissioning expectations.
Ensure that staff are trained in using the appropriate digital platforms for A&G requests.
Monitor their use of A&G to ensure they meet required targets.
Maintain accurate documentation of all A&G interactions within patient records.