NHS England has retired the Advice and Guidance Enhanced Service and incorporated the funding into Global Sum. This accounts for £1.28 of the total £5.35 uplift in 2026/27.
The LMC’s advice remains unchanged from April 2025. There will be some patients who can be managed safely within general practice with additional specialist input, and in these cases it is reasonable to use Advice and Guidance.
However, from April 2026 there is no separate item of service payment for this activity.
Advice and Guidance should be used to support management within general practice. You may request whatever information is needed to do this, but where requests are drafted by non-GP staff, a GP should review them before submission.
If the response:
- is limited to a list of investigations without clear management advice
- requires tests or pathways not realistically available in general practice
- is delayed to the point that it is no longer clinically useful
then it is reasonable to proceed with a referral instead.
Advice and Guidance is a pre-referral tool. It should not be used once a patient has already been referred, and it is not a mechanism for expediting appointments.
GPs can always choose to refer directly, particularly where no Advice and Guidance service exists. Where appropriate, specialists may advise referral or convert an Advice and Guidance request into a referral, but should inform you if this has been done.