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Answers are needed from NHS England and others on 11 issues to make sure its controversial expansion of advice and guidance is safe, the Care Quality Commission has declared.

Advice and guidance allows GPs to seek pre-referral advice from specialist clinicians working in secondary care, and is designed in part to reduce referrals. 

NHS England has planned to substantially ramp up its use this year, including by making its use mandatory – rather than initial referral – in at least 10 locally-chosen specialties. This has proven controversial with many clinicians, particularly GPs. 

NHSE last month issued a letter seeking to clarify some aspects of the policy, including stepping back from a target that in the chosen specialties there would be a “diversion rate of at least 25 per cent by March 2027”.

British Medical Association GP Committee chair Katie Bramall had also written to the Care Quality Comission in March to raise concerns express the BMA’s reservations relating to the national implementation of mandated A&G.

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Source: HSJ, 27 May 2026

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