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General Practitioners: Contracts

Answer

The Department and NHS England considered the potential impacts of expanding Advice and Guidance (A&G) as part of the policy development process, including through clinical input, established governance arrangements, and equalities considerations. A&G is intended to support timely clinical decision‑making and ensure patients are directed to the most appropriate care. National guidance is in place to support its safe and consistent use, and the use of A&G does not change existing clinical accountability or patient safety arrangements.

The Department has not held formal discussions with the General Medical Council (GMC) specifically on the impact of A&G on general practitioner (GP) indemnity or patient safety. The GMC’s role is to regulate individual professional standards rather than to co‑design or endorse contractual or service policy. These contractual changes do not alter existing clinical thresholds, professional duties or the central role of clinical judgement.

The Department and NHS England have engaged with the Care Quality Commission (CQC), alongside other system partners, to discuss the implementation of A&G, including in relation to patient safety. This has included multi‑agency discussions involving NHS England, the CQC, and the Health Services Safety Investigations Body. The CQC has identified a number of areas where further clarity and assurance is required, and NHS England is working with system partners to respond to these points. This engagement forms part of ongoing oversight of the safe implementation of A&G.

The contract does not change the clinical threshold for referral to specialist care. GPs should continue to make a clinical decision to refer for specialist care where that is in the patient’s best interests, and to request specialist advice where it is needed. GPs retain responsibility for referral decisions, and this model supports, and does not replace, clinical judgement.

Clinical responsibility remains with appropriately qualified clinicians at each stage of the pathway, supported by established regulatory, indemnity, and local governance arrangements, including patient safety.

While advice is being sought or acted on in primary care, the GP remains responsible for the patient’s overall clinical care and risk. Under this model, requests for specialist advice and referrals are clinically reviewed by a named consultant, with the aim of ensuring patients are directed to the most suitable pathway. The specialist is responsible for the quality and appropriateness of the advice they give, not for ongoing management or follow‑up unless they formally assume responsibility for the patient’s care. Specialists also have clinical responsibility from the point at which a specialist advice request is converted into a referral or if the specialist initiates investigations or treatment directly.

Where a local model is already established, or has been agreed between primary and secondary care, that provides timely specialist clinical assessment with clear accountability, this may continue with oversight from a named consultant.

The 2026/27 GP Contract embeds the previous A&G enhanced service funding into core practice funding. Following near universal uptake of the A&G Enhanced Service in 2025/26, the focus for 2026/27 is on stability and simplicity. Embedding the specialist advice model within the core contract recognises its role in routine clinical practice, removes annual signups, and provides more predictable funding while supporting consistent patient pathways.

Secondary information

Type

Written question

Reference

6695

Session

2026-27

Grouped for answer

Yes

Subjects

Contracts Advisory services General practitioners Safety

Link

View this Written question on www.parliament.uk