GP Practices to Receive £20 Payment for A&G Requests from April
NHS England has confirmed that GP practices will receive a £20 payment per Advice & Guidance (A&G) request under a new national enhanced service launching in April 2025.
The 2025/26 GP contract offer, which was accepted by the British Medical Association (BMA) on 28 February 2025, includes further details on how the £80 million A&G funding pot—originally announced in January—will be allocated. This initiative forms part of the Government’s elective recovery plan, aiming to reduce NHS waiting lists by enhancing GP access to specialist advice.
How Will the A&G Payment Work?
Under the new enhanced service, GP practices will be able to claim a £20 Item of Service (IoS) fee for pre-referral A&G requests. This funding is designed to encourage closer collaboration between primary and secondary care, ensuring patients receive timely specialist advice and potentially reducing unnecessary hospital referrals.
Key Details of the A&G Funding:
- Total funding available: Up to £80 million
- Fee per A&G request: £20 per case, covering multiple interactions between GPs and hospital consultants
- Funding allocation: Distributed to Integrated Care Boards (ICBs) based on local activity
- Capped spend per ICB: NHS England has not yet clarified what will happen if demand exceeds funding limits
While eligibility criteria for claiming the payment have not yet been published, NHS England has promised further details when the full enhanced service specification is released.
Ensuring Fair Distribution of Funds
According to the BMA, each ICB will receive funding based on actual activity levels, ensuring that local commissioners are not incentivised to withhold funds from general practice. However, NHS England has not yet clarified what will happen if demand exceeds the capped ICB budget.
Government’s Perspective on A&G Funding
Health Minister Karin Smyth confirmed in the House of Commons last month that the £20 payment covers multiple interactions, meaning GPs and specialists can engage in a back-and-forth dialogue without incurring additional costs.
She stated:
“Each Advice and Guidance request will be funded at £20, which is to cover any back and forth required between a GP and a hospital specialist to reach a resolution.”
Dr Amanda Doyle, Primary Care Director at NHS England, highlighted the wider benefits of the A&G initiative, saying:
“This enhanced service will incentivise even closer working between GPs and secondary care, ensuring that patients receive care in the right place at the right time.”
The funding forms part of a broader strategy to shift care from hospitals to community settings, supporting the Government’s commitment to elective recovery.
BMA and RCGP Reactions to the Contract Agreement
The BMA GP Committee England welcomed the funding as a “positive step”, describing it as the first concrete example of resources being redirected outside of hospital settings. The union had previously advised GPs to pause A&G requests as part of collective action, but following the contract agreement, they have now confirmed that all collective action will be paused while further negotiations continue.
The Royal College of General Practitioners (RCGP) also expressed support for the move, emphasising that funding A&G services will help shift more care into the community, where it is more cost-effective.
What Happens Next?
- Full eligibility criteria for the £20 A&G payment will be released when NHS England publishes the enhanced service specification.
- ICBs will review how secondary care providers offer A&G services.
- The impact on GP workload will be reviewed in Spring 2025.
Conclusion
The introduction of a nationally funded A&G enhanced service is a major step towards improving GP access to specialist advice while reducing elective waiting lists. However, with funding capped per ICB, questions remain about how oversubscription will be managed.
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