Practice Managers respond to plans to fund A&G services

Source: Practicce Index

Earlier this week, the Government laid out its new ‘elective reform plan’, which aims to cut the list of patients waiting more than 18 weeks for NHS treatment in England. One of the measures that has sparked significant debate amongst Practice Managers is the plan to give doctors £20 each time they consult a specialist either by phone or email under the so-called advice and guidance (A&G) scheme, to see if there is an alternative to hospital visits and treatment.

The plan includes a push for GPs to increase the use of A&G, with a target of 4 million advice requests in 2025/26, up from the 2.4 million delivered in 2023/24. This expansion is intended to reduce unnecessary hospital referrals and enable GPs to refer patients directly for diagnostics for conditions like asthma in children, post-menopausal bleeding, and breathlessness. By removing the need for consultant appointments, the Government aims to “end the cycle” of patients being delayed between GP referrals and hospital care.

Financial incentives and resource concerns

The funding for A&G services will come from an £80 million package, split from existing secondary care budgets. Each interaction will be funded at £20, with NHS England supporting Integrated Care Boards (ICBs) to optimise A&G through metrics, dashboards and toolkits. However, the financial model has faced widespread criticism.

“With long waiting lists, patients get sicker, and the impact on GPs and our teams is significant, so it’s in everyone’s best interests to reduce the NHS backlog and A&G is one way of making a difference. However, I would argue that the £20 payment doesn’t come close to reflecting the actual time and resources involved,” a Practice Manager from a south-west London practice told us.

“Preparing and submitting a detailed A&G request, reviewing specialist advice, adjusting care plans, and handling associated administration requires considerable effort. I’ve read that the minimum costing for any hospital outpatient appointment starts at £150, which makes the £20 A&G payment somewhat underwhelming. The initial feedback from the GPs here is that it’s laughable, especially given that the BMA has advised practices to stop engaging with A&G pathways as part of its collective action.”

While the devil is in the detail and this week’s announcement was very much a top-level ‘launch’, Practice Managers have shared their concerns that the introduction of this scheme may well present both operational challenges and opportunities.

A Manchester-based Practice Manager commented: “If we’re to get behind this initiative, we’ll need to scale up our use of A&G significantly. But will that require new systems, processes and additional training for staff? NHS England’s promised metrics and toolkits could help streamline workflows, but the implementation of these tools will likely add to administrative burdens.

“It will be interesting to see how the ICBs implement the various aspects too. Having worked in practices covered by two different ICBs, it’s interesting to see the gulf between how they operate and how they interpret the information cascading down from NHSE.”

Other Practice Managers point to concerns about the potential risk of shifting care to primary settings without adequate safeguards. The Royal College of General Practitioners (RCGP) has also pointed out that A&G services, while beneficial in principle, can sometimes be used to reject necessary referrals or place additional responsibilities on GPs without appropriate resources.

Professor Kamila Hawthorne, RCGP Chair, welcomed the funding and agreed that A&G has the potential to support GPs to “refer appropriately”, but emphasised the need for careful implementation. She stated: “In the past, GPs have reported issues with using A&G services, including that they shift care into general practice without appropriate resource.”

Who will do the work?

Professor Hawthorn’s comments link neatly with the concerns around the ongoing GP and practice staff shortages. The potential for increased workload is a particular concern for practices already struggling with workforce shortages. Recruiting and retaining GPs and practice nurses remains a critical issue, with many practices facing problems with staff and GP burnout.

“The additional demand placed on general practice through this scheme could exacerbate existing pressures, particularly if resources are not adequately allocated to support the expansion,” a Practice Manager commented.

Likewise, the Rebuild General Practice campaign has been critical of the plan, highlighting that it fails to address the root cause of the crisis in primary care: a lack of GPs. Decades of underinvestment have led to a system where practices are closing, GPs are leaving the profession, and patients are left without adequate care.

The campaign stated: “Without a clear focus on addressing resource and funding gaps, this new plan won’t allow Labour to cut waiting times as promised.”

What should Practice Managers do now?

While we wait for the finer details to be released by NHSE and ICBs, Practice Managers are being encouraged to start thinking about how they can navigate the impact of this announcement by taking a proactive approach.

“I think the first step is to assess the workload associated with A&G and identify areas where additional support is needed,” the Manchester-based Practice Manager said.

“Looking forward, I think we’ll need to work with our ICB to implement the new tools and ensure staff are trained to use them efficiently. And then, crucially, I think we’ll need to develop protocols to manage risks associated with delays or rejected referrals and ensure patient safety remains a top priority. I can hear the moaning from certain patients already!”

The Government’s expansion of A&G services is a bold step towards reducing hospital waiting lists and shifting care into the community. However, for general practice, this announcement represents a significant challenge. Without addressing the ongoing workforce crisis and providing adequate resources, the burden on practices could become unsustainable.

Practice Managers will play a crucial role in ensuring this scheme is implemented effectively, but they will need to advocate for the support their practices need to thrive. The success of this plan hinges on whether it will genuinely support primary care or simply add to the growing pressures already faced by the sector.

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