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Patient safety incidents (PSIs), defined as unintended or unexpected events that could have or did lead to patient harm, can have profound effects on general practitioners (GPs). Understanding how GPs experience and recover from PSIs is important for workforce wellbeing and patient safety in primary care. The aim of this study was to explore how GPs experience PSIs, how they move on, and how they use available support. Semi-structured interviews were conducted with 22 GPs. Data were analysed using thematic analysis. Three themes were generated: personal and professional consequences, recovery and learning processes, and barriers to healing. GPs described emotional responses, including guilt, self-doubt, and fear of reputational or regulatory consequences. Peer support was valued, but access to structured support was limited. Formal investigations were experienced as distressing and compounded emotional impact. Recovery and learning were facilitated by empathetic, systems-focused cultures, protected time for reflection, and structured opportunities to learn from incidents. Findings highlight importance of compassionate, non-punitive support systems and psychologically safe environments to enable recovery and promote learning.

Partnership working between Consultant Specialists and GPs is front and centre to the Government’s commitment to move patient care closer to home. Pre referral advice and guidance supports integrated care and peer to peer learning as well as service improvement. General Practices across the country already support advice and guidance pathways, which are intended to help to ensure patients receive care in the right place at the right time. However, advice and guidance pathways have workload implications for both general practice and secondary care. This document from NHS England gives more information about General Practice Requests for Advice and Guidance (A&G) pathway.

Medicine is still debating whether artificial intelligence will match or exceed human diagnostic skill. But the most consequential change is already happening elsewhere. It is unfolding quietly in the relationships patients are forming with AI systems, and in the narratives they bring with them before a clinician ever enters the room. If general practice only looks for it inside the consultation, it will be reacting to consequences rather than causes. Adam Phillips is a UK medical student and former IBM technology consultant, and Simon Rudland, visiting professor of integrated digital health at the University of Suffolk, describe these dynamics as post-Turing clinical relationships (PTCRs). In these relationships, patients develop sustained, functionally supportive interactions with AI tools that influence how they interpret symptoms, regulate anxiety, decide when to seek care, and engage with clinicians. The changes are uneven, but they are already reshaping consultations and continuity in ways general practice is only beginning to notice.

Advice and guidance (A&G) enables dialogue between specialists and GPs before a referral is made. The aim is to ensure patients are managed in the right setting and to avoid unnecessary hospital referrals. A&G was first introduced as a formal pathway in 2015, so the concept itself is not new. However, its prominence as a policy lever is. The GP Contract 2026/27 outlines that GPs will be required to use A&G “prior to or in place of a planned care referral where clinically appropriate”. The Neighbourhood Health Framework goes further, stating an aim to achieve a “diversion rate of at least 25 per cent by March 2027 for at least 10 high-volume specialties”. This has not come without debate. Wes Streeting recently published a blog to “set out the facts” following media coverage alleging that A&G targets may lead to rationing of care. Transparency will be critical to evaluate whether increased use of A&G leads to better experiences and outcomes, says William Pett in this HSJ article.

Advice and Guidance (A&G) has been used in the NHS for years. It helps GPs get advice from specialists on a patient’s condition to decide the best course of treatment. The Department of Health and Social Care sets out the facts following media reports with a letter from the Health and Social Care Secretary Wes Streeting, published in the Daily Telegraph on 31 March.

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. 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. 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. A&G should be optional and not mandated. 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. 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. 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.

The government has published its much-awaited Neighbourhood Health Framework. It sets out in new detail what neighbourhood health aims to do and how this will be achieved, building on the 10 Year Health Plan, the Neighbourhood health guidelines 2025/26 and the Medium Term Planning Framework.  The framework describes neighbourhood health as putting the person at the centre of how local services are organised and delivered – including GP and community services, urgent care and outpatients, as well as services commissioned by local authorities such as social care and public health.   The new guidance brings some long-awaited clarity to commissioners and providers about what neighbourhood health should deliver. There is much to welcome. But questions remain around whether targets can ease pressures on the acute sector as well as improve patient care and experience; whether focus can be maintained on long term population health priorities among a plethora of specific shorter term delivery goals; whether permissiveness in designing local services and rigid structures can coexist; and, fundamentally, whether integrated care boards (ICBs) and other organisations have the capacity to action it all.  In this King's Fund article, experts set out their more detailed analysis of the framework. They consider the parts to celebrate, the aspects that raise some concerns, what’s missing, and the questions that remain outstanding.  

The NHS has seen a 6 percentage point increase in public satisfaction, the first rise since 2019, according to the latest findings from the gold-standard survey of public attitudes to the NHS and social care, analysed by the Nuffield Trust and The King’s Fund and surveyed by NatCen. Key findings Satisfaction with the NHS In 2025, 26% of British adults were ‘very’ or ‘quite’ satisfied with the way in which the NHS runs – a statistically significant 6 percentage point increase from 2024. Around half of respondents (51%) were dissatisfied with the NHS in 2025, a statistically significant fall of 8 percentage points compared to 2024 when it was 59%. This is the first increase in satisfaction since 2019, and the largest fall in dissatisfaction in more than 25 years. People under 35 (20%), supporters of Reform (20%) and people in Wales (18%) were significantly less satisfied with the NHS than the survey average. Despite the increase in satisfaction only 16% of respondents thought the standard of NHS care would improve in the next 5 years compared to 53% who said they expected care to get worse. Satisfaction with different NHS services Satisfaction with GP services was 35% and dissatisfaction was 45%. Neither was a statistically significant change on the previous year. Just over 1 in 5 respondents (22%) said they were satisfied with NHS dentistry, with 54% saying they were dissatisfied. These are similar results to the previous year. 22% of respondents said they were satisfied with A&E services. Dissatisfaction was 53%. In 2024, 19% said they were satisfied with A&E services, although the change is not statistically significant. 37% of respondents were satisfied with inpatient and outpatient hospital care, an increase of 5 percentage points since 2024, although not statistically significant. 29% were dissatisfied – no change on last year. Attitudes to NHS standards, access and staffing Half of respondents (50%) were satisfied with the quality of NHS care in 2025, and 28% were dissatisfied. There was no statistically significant change since 2024. Only a minority of respondents were satisfied with waiting times for GP appointments (27%), hospital appointments (16%) and in A&E (14%). There were no statistically significant changes compared to last year. Only 12% agreed that ‘there are enough staff in the NHS these days’. 71% disagreed. There was no significant change compared to 2024. Attitudes to NHS financing and efficiency 9% of respondents said that the government spent too much or far too much money on the NHS, 22% said that it spent about the right amount and 66% said that it spent too little or far too little. There were no statistically significant changes compared to 2024. Only 13% of respondents agreed that the NHS spends the money it has efficiently. 55% disagreed with this statement. There was no change compared to 2024. When asked about government choices on tax and spending on the NHS, the public remain closely divided between raising taxes and spending more on the NHS (45%) and keeping taxation and spending at the same level (43%). Only 8% would choose to cut taxes and spend less on the NHS. There was no statistically significant change since 2024. Supporters of the Green party (70%) and the Labour party (57%) were significantly more likely to support higher taxes and higher NHS spending than supporters of Reform (32%) and the Conservative party (30%). NHS priorities and principles On being asked what the top three most important priorities for the NHS should be, both making it easier to get a GP appointment and improving A&E waiting times were selected as top priorities by 46% of respondents, followed by 45% for waiting times for planned operations and 43% for increasing the number of NHS staff. People aged 18–64 were more likely than those aged 65 and over to prioritise A&E waiting times (48% vs 38%) and increasing NHS staff (46% vs 35%) whereas those aged 65 and over prioritised prevention and staying healthy (48% vs 36%). As in previous years, a large majority of respondents agreed that the founding principles of the NHS should ‘definitely’ or ‘probably’ apply in 2025: that the NHS should be free of charge when you need to use it (89%), the NHS should primarily be funded through taxes (81%) and the NHS should be available to everyone (74%). There has been some decrease across the past five years in the proportion who think these principles should ‘definitely’ or ‘probably’ apply since the questions were first asked in 2021. The greatest decrease over time has been support for the principle that ‘the NHS should be available to everyone’. Support for the principle that the NHS should be available to everyone varied significantly by supporters of different political parties, with 68% of Labour supporters agreeing this principle should ‘definitely’ apply compared to 45% of Conservative supporters and 30% of Reform supporters. Social care In 2025, 14% of respondents said they were satisfied with social care. 49% were dissatisfied with social care – a statistically significant decrease from 2024 when this figure was 53%. The top three priorities for social care were helping people stay independent at home for as long as possible (46%), making social care more affordable to those who need it (45%) and improving the quality of social care services (44%). When asked about government choices on tax and spending on social care, 51% said the government should keep taxes and spending on social care at the same level as now. 38% said the government should increase taxes and spend more on social care. 6% said the government should reduce taxes and spend less on social care. Support for increasing taxes and spending more on social care was lower than for the NHS – it was 45% for the NHS. The difference was statistically significant.

Terrence Frost’s death was verified at 00:26 on 18 July 2024, at the Ipswich Hospital, in Ipswich, Suffolk, although Terrence’s death had occurred earlier at approximately 22:20 on 17th July 2024. On the 11 July 2024 Terrence was admitted to the Ipswich Hospital for an elective surgery (angioplasty) to improve the blood flow to his left leg and foot. Terrence was discharged on the following day 12 July 2024. On the 14 July 2024 Terrence was admitted again to the Ipswich Hospital with abdominal pain and rectal bleeding. No diagnosis was made, and as this settled spontaneously, Terrence was discharged again on the 15 July 2024. On the 16 July 2024, due to concerns raised by his family, a GP’s Paramedic conducted a home visit, and following subsequent concerning blood test results Terrence was told to go back to Ipswich Hospital as a failed discharge. After a prolonged period in the Accident and Emergency department Terrence was readmitted to the Ipswich Hospital. Despite testing, no definitive diagnosis was made during Terrence’s final admission, and Terrence appeared reasonably stable until he suffered a sudden collapse and cardiac arrest at 21:22 on the 17th July 2024. A subsequent postmortem examination identified that Terrence suffered from significant cardiac disease (cardiomegaly and coronary artery disease) and significant vascular disease (systemic atherosclerosis). The pathologist identified that his clinical markers identified that sepsis played a factor in Terrence’s death, although evidence of any infection could not be found. MATTERS OF CONCERN Evidence was heard that prior to his attendance in the Accident and Emergency department on the 16 July 2024, Terrence had been seen at home by a paramedic from his surgery, who was concerned by Terrence’s presentation and wanted to admit him to hospital. However, Terrence was reluctant so it was agreed that urgent blood tests would be taken in the first instance. The results of these tests were seen by a GP, and due to the findings (which indicated a possible serious infection or inflammation) the GP called Terrence and told him to go straight to hospital, and whilst enroute she would speak to the Medical Assessment Unit. In evidence the GP said she then spent 30 minutes on the telephone trying to contact the Medical Assessment Unit as is the required procedure, to discuss Terrence’s admission. After being unable to contact the Medical Assessment Unit, the GP contacted Terrence, via a family member, and told him that as she could not contact the Medical Assessment Unit he should head to the Accident and Emergency department instead. The GP told Terrence she would pre- alert the Accident and Emergency department to his arrival. The GP then spent a further period of time telephoning the Accident and Emergency department but again could not get through. As such upon arrival, a patient who was considered by their GP to be significantly unwell enough to warrant either admission to the Medical Assessment Unit, or that Accident and Emergency should be pre-alerted to their arrival, was unable to speak to either unit prior to the patient’s arrival. Terrence endured a 5 hour wait in Accident and Emergency before being seen. Although observations taken at the time of his subsequent admission suggest he had not developed sepsis at this stage, I am concerned that the inability of a GP to be able to promptly communicate with either the Medical Assessment Unit or Accident and Emergency department may lead to future deaths in cases where suspected sepsis or other life threatening conditions have been differentially diagnosed, especially if those conditions have progressed further than Terrence’s had at the time of his arrival. I am further concerned that evidence was heard from a clinician based at the Ipswich Hospital itself, that they too found contacting the Medical Assessment Unit extremely difficult, with internal hospital telephone calls frequently going unanswered.

Increasing the amount of advice and guidance – where hospital specialists provide advice to GPs so that they can manage the patient without a referral to hospital – is a key part of ambitions to bring down NHS waiting lists. Lucina Rolewicz, Stuti Bagri and Sarah Scobie look at whether the target to increase advice and guidance is likely to be met, and what it might mean for those hopes that it will reduce waiting lists.