Are you clear on Advice and Guidance requirements for 2026/27?

At THC Primary Care, we provide resources for primary care network leaders, and the focus of this blog is on Advice and Guidance.

In 2025/26, Advice and Guidance was an Enhanced Service. Practices chose whether to sign up through CQRS, claimed a £20 Item of Service fee for each pre-referral request, and worked within a national envelope of £80 million that ICBs could cap locally.

In 2026/27, that Enhanced Service has been retired and has become a requirement in the core practice contract, and the funding, £82 million, has been incorporated into global sum payments from 1 April 2026 and serves as one of the levers behind the elective reform agenda and the move towards Single Points of Access, where requests for specialist input or referral are triaged at specialty level to find the right next step.

Keep reading for more details.

Advice and Guidance: From optional to obligatory, but not required on every referral

Practices are required to use Advice and Guidance, where clinically appropriate, before or instead of a planned care referral, and to follow locally agreed referral pathways, including Single Point of Access models once introduced.

NHS England has been explicit about what this does not mean.

Advice and Guidance is not

❌ A mandatory step before every referral.

❌ Intended to raise referral thresholds

❌ A route for transferring inappropriate workload into general practice.

✅ The decision to refer remains with the referring clinician (as it always has).

A letter to GP practices and clinical directors on 22 April 2026 made this even plainer. It states that the clinical threshold for a referral remains unchanged, that Single Points of Access are not a way to reject or refuse referrals, and that where specialist advice is given but the GP still believes a referral is clinically appropriate, there must be a clear route to refer, supported by additional clinical context where needed. The model is intended to support your clinical decision, not to override it.

The platform shift: e-RS from July, third-party platforms from October

Alongside the contractual change runs an operational one that has its own timeline.

From July 2026, Advice and Guidance becomes a core, nationally consistent function delivered through the NHS e-Referral Service, e-RS.

In other words, e-RS becomes the standard national route for raising and managing Advice and Guidance requests.

From October 2026, organisations currently using third-party Advice and Guidance platforms will be expected to bring those requests through e-RS as well. The staggered dates exist to give areas on other systems time to migrate.

The practical point for general practice leaders is to find out which platform you are using. If you are using a third-party tool, October 2026 is the date that matters, and migration to e-RS needs planning with your ICB, which is responsible for cascading training and support.

What you should expect from secondary care

The 22 April 2026 letter sets out reciprocal standards on the hospital side.

On timeliness, trusts are expected to respond to a specialist advice request within 5 working days, to action the next step on a routine referral within 5 working days, and to action the next step on an urgent referral within 2 working days. Requests for referral or specialist advice should receive a response from a named consultant, so there is clear accountability rather than an anonymous triage decision.

On diagnostics, the principle matters for workload. Where specialist assessment identifies the need for tests as part of the specialist pathway, those tests should be organised by secondary care, with results reviewed and acted on by the trust.

They should not be returned to general practice to arrange. General practice continues to arrange the diagnostics it would routinely undertake as part of assessment or before referral, as it does now.

There is also a co-design requirement. Trusts and ICBs must involve local GPs and GP leadership, for example, LMCs and interface groups, in designing and refining Single Point of Access pathways. For clinical directors, that is a concrete route to influence how this works locally rather than having it done to your practices.

The 25% figure

Many readers will have seen the neighbourhood health framework reference to a possible diversion rate of at least 25%, and understandably worried that a quarter of referrals would be bounced back.

The 22 April letter makes it explicit that there is no national target to divert a fixed proportion of referrals from hospital care.

The 25% figure is an estimate of the proportion of patients, including those subject to an Advice and Guidance enquiry, who could be appropriately supported by a specialist consultant without a hospital outpatient appointment.

It is not the proportion of referrals to be sent back to general practice. That distinction is worth carrying to any practice that has raised it.

Confirmed, new and open

Confirmed	New for 2026/27	Still to watch
Advice and Guidance remains central to elective reform and care closer to home	The Enhanced Service is retired, and funding (£82m) is embedded in global sum from 1 April 2026	How Single Points of Access are designed locally and how they interact with Advice and Guidance
The decision to refer stays with the referring GP, and the clinical threshold for referral is unchanged	Using Advice and Guidance, where clinically appropriate, is now a core contract requirement	How consistently trusts meet the response standards in practice
Local referral pathways must be followed	e-RS becomes the national route from July 2026; third-party platforms fold in by October 2026	The pace and shape of migration for practices on third-party platforms
There is no national target to divert a fixed share of referrals away from hospital	Operational standards: advice in 5 working days, routine referrals actioned in 5, urgent in 2, response from a named consultant	The forthcoming New Model for Planned Care, due shortly

What to do now

There are a few things worth getting ahead of before the summer.

1. Protect the process. The coding discipline, the GP review before submission, the clear patient communication that Advice and Guidance is not a secondary care appointment, all of this matters more now, not less, because it is a contractual expectation rather than a paid extra.

   
   

2. Understand your platform and put the October 2026 migration on your radar now rather than in the autumn.

   
   

3. Hold the line on appropriate use. As Single Points of Access develop locally, keep testing them against the principle that NHS England has stated: Advice and Guidance supports timely specialist input and should not become a barrier to clinically necessary referrals.

   
   

   Use the co-design requirement to get your GPs, LMC and interface groups around the table when local pathways are being designed, and hold the system to the published standards, the response times, the named consultant, and diagnostics organised by secondary care.

Sources: NHS England, Changes to the GP Contract in 2026/27 (24 February 2026); NHS England, Specialist advice and elective single point of access (22 April 2026); NHS England, Supplementary information to support changes to the 2026/27 GP contract (20 May 2026); NHS England Digital, New Advice and Guidance in the NHS e-Referral Service; NHS England, Enhanced Service specification: GP requests for Advice and Guidance 2025/26 (2025/26).

About us

THC Primary Care is an award-winning healthcare consultancy specialising in Primary Care Network management and the creator of The Business of Healthcare. With over 20 years in the industry, we have supported more than 300 PCNs through interim management, training and consultancy.

Our expertise spans project management and business development across both primary and public sectors. Our work has been published in the London Journal of Primary Care, and we have authored over 250 blog posts sharing insights on primary care networks.