Advice and guidance ‘adding to backlogs’, say consultants

Many medical consultants report a “mixed” experience with the advice and guidance model, saying it is “under-resourced and adding to existing backlogs”, according to research by an integrated care board.

Cheshire and Merseyside ICB surveyed around 300 GPs and medical consultants about their views on the A&G model, which NHS England has said must be significantly expanded this year.

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

The ramping up of the model in recent months has been controversial among GPs, but the ICB’s survey found 54% said A&G worked “mostly well” or “very well” for them. 36% said their experience was mixed, and 10% “bad”.

However, consultants were more wary: the majority – 51% – said their experience was “mixed”; 18% said it was “bad”; while 31% said it worked “well”.

The ICB’s feedback report says consultants complained about having “no job-planned time” to provide the A&G, as well as “growing volumes, limited admin support, and difficulty accessing GP records”. This was “leaving A&G under-resourced and adding to existing backlogs”.

Consultants also complained of “inappropriate use”, with A&G “sometimes used by [allied health professionals], trainees, and PAs for queries that should go via a GP first”. The findings added: “Many requests lack adequate history or a clear clinical question.”

Although GPs were more positive, they also highlighted problems. They said A&G responses from secondary care could be “brief, contradictory, dismissive, or written by non-consultants, with some specialties slow or unresponsive”.

They also highlighted that “consultants may advise referral but cannot convert A&G directly, forcing GPs to re-refer – sometimes only to be rejected again, creating duplication and patient frustration”.

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Source: HSJ, 1 May 2026