The LMC is writing to all practices to provide an update on this Enhanced Service, introduced from 01 April 2025 (in terms of eligible claims) and with a current date of expiry of 31 March 2026.
The £80 million national funding for this Enhanced Service originated from outside the “Primary Care” allocation and therefore represented “new” funding to general practice. The LMC is aware that many colleagues already sought advice from specialist colleagues in terms of managing patients. Due to the new funding arrangement, the LMC therefore encouraged all GP practices to sign up for this Enhanced Service, which formalised and funded existing arrangements.
Commissioner feedback has been positive, which is important because this Enhanced Service is not guaranteed to rollover into 2026/27, but this would be a negotiating aim. It is also important to note that not all specialties within Trusts were able to offer this service at the commencement of the Enhanced Service, primarily because of the need to create dedicated time for a specialist response, and in some specialities, this remains the case. This job planning continues to be prioritised as part of the ICBs Working Groups. The intended specialist turnaround time for providing advice is five days.
Colleagues are reminded that the purpose of Advice and Guidance is to request information that may assist GP colleagues in managing a patient within their practice. GP colleagues can request whatever information would assist that, but should, if not completing the request directly, review any such draft requests from non-GP colleagues before they are sent. If the response is:
- Simply a list of suggested investigations without management context,
- Unrealistic in terms of the investigatory and /or diagnostic facilities available in General
Practice, - So delayed it doesn’t represent a helpful management approach,
the LMC recommends a normal referral is made. Advice & Guidance is a “pre-referral” option: it should not be sought from a specialist if the patient has already been referred to the specialty. It is also not designed to represent a request to expedite an appointment.
It still remains open to GP colleagues to simply make a referral, which should obviously be done if no A&G service exists within the specialty required. Specialist colleagues may also recommend a referral, or (more helpfully) simply convert an A&G request into a referral but should let you know if this has occurred.
GP practices should now be receiving payments for appropriate A&G requests; although both nationally and locally the A&G budget is capped, for the present there are no changes in current local arrangements that we have been made aware.
Further information about A&G is available at:
Advice and guidance for referrers and referring clinician teams – NHS England Digital
The LMC is encouraging roll-out of this service within all specialties and would encourage feedback based on colleagues’ positive and negative experiences.
Dr Julius Parker, Chief Executive