In the 2026/27 imposed contract Advice and Guidance will no longer be a separately funded Enhanced Service but becomes part of ‘core.’
The next proposed step is to move away from Advice and Guidance to a Single Point of Access. This will provide just one route for a GP regardless of whether there is a barn-door requirement for a referral or not.
As part of this NHS England has issued the document: “Elective Single Point of Access: Technical Guidance for 2026/27” which for reasons which may or may not be clear is unavailable on the NHS England website.
The guidance implies but does not explicitly state that the main purpose is to reduce the number of referrals (and therefore the secondary care waiting list) although it does include the statement: “We must evolve how outpatient care is delivered: how clinicians across settings work together, where care is delivered, and who is best placed to provide it.” The document also makes it clear that the Referral to Treatment ‘clock’ does not start at the time of the GP SPoA referral, but only when the patient is “accepted onto a waiting list.”
The guidance includes “this creates an early opportunity for primary and secondary care clinicians to discuss and review the patient’s case and agree the most appropriate next step.” It must not become a method of further dumping of unfunded or clinically inappropriate work onto general practice.
It also states that “a general practice clinical enquiry or referral is clinically reviewed and may result in advice, straight-to-test diagnostics, referral to an alternative service, or acceptance onto a consultant-led elective pathway.” My reading is that this clearly states that if the referral needs to be redirected to a different speciality,
then the hospital should do this.
The guidance states that “Commissioners should consider engaging with local medical committees (LMCs).” So far, the LMC has not been approached by the ICB, but we have raised with them.
The guidance clearly states that “Local guidelines should be discussed and agreed between the commissioner and primary … care providers.” I only became aware of revised local guidelines when I was sent an email by the ICB telling me of the changes to both Gastroenterology and HPB Advice and refer model from 1st April 2026. We have made it clear to the ICB that no such change should be announced without prior agreement with the LMC about the pathways.
It appears that NHS England do not understand their policy and have not thought it through. On 12th March we learned that Dr Amanda Doyle (NHS England’s Director for Primary Care) stated that she recognised that using the SPoA will mean “additional work in core general practice” and that this was funded via transfer of the A&G Enhanced Service funding into core funding (whilst conveniently forgetting that this funding was never meant to cover transfer of additional unfunded work from secondary to primary care but purely the admin costs), that Jess’ rule should be recognised by trusts but “does not … create an automatic right to referral,” whilst at the same saying that it “does not impact the referrer’s decision to refer.” But she did note “It also means the onus is not on the GP to decide whether a referral should be for advice and guidance or an outpatient appointment, or simply to obtain diagnostics that aren’t accessible in the community,” and I am so glad that she is worried about my befuddled GP state of mind and inability to decide whether my patient just needs advice or a referral.
We previously advised regarding wording that practices could add to the end of every A&G/Referral letter in our May 2025 Newsletter. We now suggest that practices consider using the revised wording as below:
