The 25/26 GP Advice and Guidance Enhanced Service Explained

At THC Primary Care, we provide resources to primary care network leaders. This blog focuses on the 25/26 Enhanced Advice and Guidance Service.

We cover:

• What it is: A clear explanation of the Enhanced Service that compensates practices for pre-referral advice and guidance

• Why it matters: The rationale behind this service and how it supports moving care closer to home

• Who can participate: Details on practice eligibility and sign-up requirements

• When it takes effect: Key dates for implementation and registration

• How it works: The practical aspects of making and documenting A&G requests

• How much funding: Information on the £20 per request payment and national funding envelope

• The opportunities: Benefits this Enhanced Service brings to practices and patients

• The challenges: Potential hurdles to consider in implementation

• Key questions: In the form of a interactive guide to help your practice prepare for successful implementation

  
  

Whether you're a Practice Manager, GP Partner, salaried GP, or employed through the Additional Roles Reimbursement Scheme, this overview will help you understand what this Enhanced Service means for you and your practice.

Let's jump in!

Why has this Advice and Guidance been introduced?

This enhanced service supports the Government's commitment to move patient care closer to home through a partnership between Consultant Specialists and GPs. The NHS aims to increase pre-referral advice requests from GPs to up to four million in 2025/26 (up from 2.4 million in 2023/24).

The ES aims to:

1. Compensate GPs for the additional workload of seeking pre-referral advice

2. Support patients and GP teams through specialist guidance

3. Ensure referrals to secondary care are appropriate and high-quality

Who is eligible?

All General Medical Services (GMS), Personal Medical Services (PMS), and Alternative Provider Medical Services (APMS) contract holders can participate.

Participation is optional, but practices must sign up through CQRS by May 27, 2025, unless otherwise agreed with the Commissioner.

Practices that sign up will be eligible to claim payment for pre-referral A&G requests made since April 1, 2025.

When will this be implemented?

How does it work?

Participating GP practices must:

• Develop protocols for the appropriate use of pre-referral advice

• Ensure patients understand that A&G is being sought (not a secondary care appointment)

• Make GP-led requests that are reviewed by a GP before submission

• Record all requests appropriately

• Follow relevant guidance for pre-referral requests

The pre-referral advice may come from specialists in secondary care, community settings, primary care providers, interface services, or referral management systems. Integrated Care Boards (ICBs) will monitor the quality of both GP requests and the specialist advice provided.

How much funding is available?

Practices will receive a £20 Item of Service fee per request for pre-referral advice and guidance. Only one claim can be made per episode of care, regardless of how many subsequent interactions occur for the same clinical issue.

The national funding envelope for 2025/26 is £80 million. To manage this budget, ICBs may cap the number of advice and guidance requests that can be claimed per practice. Practices will be notified of any caps and may continue to make requests above the cap, but will not receive payment for those additional requests.

The opportunity

This Enhanced Service offers practices:

• Financial recognition for work that may already be happening

• Improved patient care through faster specialist input

• Enhanced clinical knowledge through specialist guidance

• Reduced unnecessary referrals

• Support for shifting appropriate care from hospitals to community settings

By participating, practices can contribute to more integrated care while ensuring patients receive care in the right place at the right time.

The challenge

Several challenges exist:

• Practices must develop effective protocols

• GPs must ensure patients understand what advice and guidance means for their care

• There is additional administrative work in recording and claiming

• ICB-imposed caps may limit financial benefits for high-volume practices

• Claims must be submitted within 12 days of the month end

For success, GP practices should establish efficient processes for identifying appropriate cases, requesting advice, informing patients, and claiming payments, while maintaining high-quality clinical interactions.

The Process

Below is a high-level process as a starting point.

Questions for Consideration

Click on each title to view the questions.

Getting ahead with retrospective claims

While the guidance highlights that practices will be able to claim for A&G from April 1st, it's worth thinking about how to be proactive:

Practices could consider identifying relevant SNOMED CT codes for advice and guidance activity. While the exact code(s) may vary depending on national or local guidance, early and consistent use will support future and retrospective claims.

This can also be helped by setting up templates, searches and a 'referral log'. Further coding guidance is expected from Commissioners soon.

Some LMCs and practices are already agreeing practice-level protocols with suggested SNOMED codes. It's not yet clear whether claims will be submitted via national CQRS (through GPES extraction), local CQRS, or manually direct to the commissioner(s), but ICBs are working to provide practices with these finer details.

We hope this helps.

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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 Podcast. With over 20 years in the industry, we've supported more than 200 PCNs through interim management, training, and consultancy.

Our expertise spans project management and business development across both private and public sectors. Our work has been published in the London Journal of Primary Care, and we've authored over 250 blogs sharing insights about primary care networks.