ICBs told to get tighter grip on GP referrals

Integrated care boards have been told to significantly strengthen the drive to ensure that potential GP referrals are first scrutinised by hospital consultants.

The approach, known as “advice and guidance”, involves GPs discussing cases with specialist consultants. The discussions can lead to the patient being triaged to alternative services or the GP continuing to be responsible for their management, rather than being placed on a waiting list to see a consultant.

The use of A&G to reduce referrals is a key plank of NHS England’s plan to deal with the elective care backlog.

NHSE’s elective reform plan pledged to drive up A&G requests by GPs to 4 million in 2025-26, nearly double the amount seen in 2023-24. NHSE forecasts this would deliver 2 million “diversions” – cases where a referral is avoided. 

For the first time, GPs will be paid £20 each time they use the model, and the government has announced that an £80m pot has been allocated to fund the policy.  

But new guidance published by NHS England warns local systems must deliver a “higher degree of rigour and standardisation” in their A&G services. It also sounds the alarm about the “considerable variation” in A&G models operating in different areas. 

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Source: HSJ, 17 April 2025