The scheme sees GPs working closely with hospital specialists to get advice quickly and speed up getting patients through the health care system.
The government has expanded its Advice and Guidance scheme in a bid to keep 2 million people off patient waiting lists and get them the medical help they need sooner and closer to home.
Announced on Thursday by the Department for Health and Social Care (DHSC), this enhanced pre-referral service will be expanded with the support of £80 million in funding.
The scheme will see GPs working closely with hospital specialists to get advice quickly and speed up getting patients through the health care system.
This means that patients can be directed straight onto community physiotherapy services or access scans via GPs, rather than being put on long NHS waiting lists for “unnecessary appointments” at hospitals.
The DHSC hopes this will cut waiting lists by 2 million people by the end of 2026.
Originally introduced in 2015 and updated in 2021 to streamline care, Advice and Guidance is now available across the country, ending what the DHSC described as the “postcode lottery for patients.”
660,000 Treatments
The department said that between July and December 2024 around 660,000 treatments were handled in this way.
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The process is said to benefit patients with conditions like irritable bowel syndrome, whereby instead of being stuck on the referral list—which stands at almost 40,000 for digestive problems—people can be referred directly to a dietitian through their GP surgery.
Patients with ear, nose, and throat (ENT) issues can also be managed through out-of-hospital settings, especially for conditions like tinnitus as well as simple ear infections and ear wax removal. As of February, the ENT services waiting list was at 634,000.
Health minister Karin Smyth said that by caring for patients closer to home, “we save time and stop masses of people having to head to hospital for unnecessary appointments in the first place.”
She said: “We are rewiring the NHS so that we are doing things differently, more efficiently and delivering better outcomes for patients. This scheme is a perfect example of how we are saving patients time and reducing pressure on key NHS services in the process.”
GPs can claim £20 every time they make a referral request using the scheme, a figure agreed in February by the British Medical Association as part of the 2025/26 GP contract for England.
Concerns Raised
Medic and patient advocates backed the expansion of the programme, with the Royal College of General Practitioners (RCGP) saying it was encouraged by the government’s commitment to extra support for family doctors in getting patients off of waiting lists and into community care.
However, the RCGP cautioned over the increase in pressure on GP resources.
Professor Kamila Hawthorne, chairwoman of the RCGP, said it’s “crucial that GP services have the capacity to accommodate the shift from hospitals to community care so this funding is a good step in the right direction.”
“In the past, some GPs have reported issues with using [Advice and Guidance] services, including that they shift care into general practice without appropriate resource and that they can be used to reject necessary referrals,” she said.
Similarly, the Patients Association’s Chief Executive Rachel Power welcomed the expansion, but cautioned that for it to work, “we need transparency around how GP capacity challenges will be addressed,” calling for further funding for resources.
A general view of staff on a NHS hospital ward at Ealing Hospital in London, on Jan. 18, 2023. Jeff Moore/PA Wire
Likewise, The King’s Fund supported plans to deliver more care closer to home, but said commissioners “must safeguard against potential unintended consequences.”
The think tank’s Senior Fellow Beccy Baird said, “Financial incentives for GPs based on the number of requests raised could undermine the primary goal of delivering high-quality care and the scheme must avoid introducing unnecessary steps into a patient’s journey.”
She added, “To truly achieve the vision of shifting care from hospitals to the community, the government must reallocate funding to strengthen out-of-hospital services and overhaul existing hospital-focused performance targets.”
NHS Reform
The measures are part of the government’s plan to reform the NHS by creating more access to care in the community, improving GP access, offering more preventative care, and making better use of online services.
One major reform already underway is the dismantling of NHS England, bringing its functions back under direct government control, with ministers expecting savings from the restructure to be redirected to frontline health care services.
According to the RCP, outpatients are subjected to long waits to receive a diagnosis or treatment, poor communication, and difficulty and confusion in trying to navigate services. It also said that follow-up appointments are not always aligned to patients’ needs.