RCGP: General Practice Requests for Advice and Guidance (updated March 2026)

Summary

The General Practice Requests for Advice and Guidance (A&G) is an enhanced service within the NHS that supports general practice teams to seek specialist advice from secondary care before or instead of making a planned care referral. This service is designed to support the Government's commitment to move more care from secondary into community settings. It aims to ensure patients receive care in the right place at the right time via the use of specialist advice and guidance by general practice. Participation is optional but practice that have signed up are eligible to claim payment for pre-referral A&G requests made since 1 April 2025. 

The Royal College of Practitioners (RCGP) proposes 6 key recommendations for the use of A&G which includes shared clinical risk between primary and secondary care and aims to ensure that advice and guidance continues as one option for clinicians within a referral process and must not be mandated.

Content

1. Further support for collaboration between primary and secondary care is essential to enable the backlog of care exacerbated as a result of the pandemic to be managed and streamline patient care.
2. If work is to be transferred from secondary to primary care, via A&G, then resource (time, money and people) must follow the patient and not stay in secondary care.
3. A&G should be optional and not mandated.
4. Other tools to promote closer working between primary and secondary care aiming to streamline patient care are available and should be considered by providers as alternatives, allowing choice. These include direct telephone calls, emails, teledermatology and commercial apps that are able to connect primary and secondary care.
5. Clinical care governance and risk must be shared between primary and secondary care during A&G conversations, and this must be understood by all clinicians and their patients when A&G is used.
6. When using A&G, all clinicians must uphold the standards of good medical record keeping as per GMC advice, documenting decisions and actions, identifying who has made the decisions and is agreeing with the actions, in the patient clinical record. This should apply to both primary and secondary care and not rely solely on primary care updating the clinical records.