Advice and Guidance (A&G) Enhanced Service

We are writing to update colleagues now that the national Advice and Guidance Enhanced Service which was published on the 27 March 2025. 

ICBs have also been sent an operational delivery framework for implementing Advice and Guidance. 

LMC advice

1. This is a national Enhanced Service so the provisions within the specification, such as the fee payable, cannot be changed locally. However, elements of implementation will need to be adjusted to local circumstances. 
   
   The 2025/26 budget for this Enhanced Service is £80 million across England; this would support approximately 4 million such requests, an approximately 40% increase. 
   
   
2. All Primary Medical Service Contractors [GMS / PMS / APMS] are entitled to sign up to this service and the LMC encourages colleagues to do so, since it now will fund Advice and Guidance requests colleagues will be making already. A fee of £20 will be paid for each eligible Advice and Guidance request made and colleagues should code these in a searchable form.
   
   Practices should be contacted by their ICB by 13th May 2025 offering sign up to this Enhanced Service before 27th May 2025. Eligible requests are however claimable from 1st April 2025. There is a three month notice clause for both the practice and ICB.
    
   Claims will be made through CQRS but for 2025/26 must be made monthly, manually, within 12 days of the end of each month.
   
   
3. Although local arrangements may vary, the principle behind Advice and Guidance is that a General Practitioner/General Practice can obtain advice from a clinical specialist colleague that may enable a patient to be managed directly at their practice. This does not cover administrative issues. This advice can potentially be a phone call, dedicated email, and e-RS. The LMC will support an offer of all those modalities operating locally, but colleagues should for now continue with current arrangements and await any new detailed local information on making Advice and Guidance requests.
   
   
4. The request should be designed to potentially facilitate the care of patients within General Practice; some of these patients may have needed to be referred directly if this Enhanced Service were not available and some of this cohort of patients may subsequently need referral. A specialist can convert an Advice and Guidance request to a referral. 
   
   
5. There will be no requirement that an Advice and Guidance request must be made prior to a referral; colleagues are asked to contact the LMC if a specialist-led service appears to be operating such a policy. 
   
   
6. GP practices should develop a protocol to ensure the appropriate use of Advice and Guidance. This should include: 
   
   
   • Ensuring patients are aware of this process, including that this does not mean a specialist appointment is being requested. 
     
     
   • Any such requests must be “reviewed by a GP ahead of being submitted to ensure appropriateness, quality control and relevant content”. 
     
     
   • Practices should follow local arrangements in terms of submitting and recording the requests.
     
     
   • Multiple requests or subsequent interactions between the practice and specialists relating to the same episode of care represent only one eligible claim. ICBs may operate a post-payment verification process especially if unexplained increases in Advice and Guidance requests are noted.
     
7. ICBs can implement a defined cap on the number of Advice and Guidance requests that can be claimed per practice. This can be changed during the year, and should be discussed with the LMC.
   
   
8. ICBs have been given guidance in relation to delivering monitoring and evaluating Advice and Guidance, including a benchmark turn around time of 24–48 hours for urgent requests and not exceeding ten days for routine requests. The process of monitoring and evaluation will need to be organised via interface meetings but the LMC will encourage ICBs to ensure a feedback mechanism from both GPs and specialist colleagues to ensure improvement and learning opportunities. 

LMC Summary 

The LMC encourages colleagues to continue to use Advice and Guidance requests as they have already been doing, for the comparatively limited cohort of patients for whom referral to specialist services may be necessary, but whom the GP identifies and confirms by making such a request, that obtaining specialist guidance may make such a referral unneeded. The Enhanced Service introduces a fee for this administrative request, work that for General Practice has up to now been unfunded. 

If the Advice and Guidance received is helpful, a referral may be avoided. Given the disadvantages of specialist waiting lists for all concerned, this premise underpins the introduction of the Enhanced Service. 

If the Advice and Guidance does not enable the patients care to occur within General Practice, then many such patients, most if their selection is specific, will need a referral. This will also be true if the management plan received is incompatible with the provision of primary medical services and instead provides an insight into the appropriate management of a patient at a consultant-led specialist out-patient appointment. 

The LMC would strongly urge colleagues, on professional grounds, not to alter their approach to Advice and guidance requests. ICBs will be allocated a fixed funding pot. Implementation of Advice and Guidance will be via current Interface meetings, and ICBs will monitor the level of such requests. Continuing current approaches […] is the best advice in terms of optimising the benefits of this new Enhanced Service for General Practice and for patients. 

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