New GP Contract: What the "Advice and Guidance" Changes Mean for Patients
What is "Advice and Guidance"?
Advice and Guidance (A&G) is not a completely new concept — it has existed in the NHS for around a decade. It allows GPs to send an electronic message to a hospital specialist asking for their input on a patient's case, either before making a formal referral or instead of one.
What is new is that from 1 April 2026, GPs are now contractually required to use Advice and Guidance before — or in some cases instead of — making a traditional referral to a hospital consultant, across up to ten agreed specialties. This marks a significant shift from it being an optional tool to being a mandatory part of how your GP is expected to work.
NHS England's stated aim is to reduce outpatient waiting lists and ensure patients are seen in the right place at the right time. The government has backed the new contract with a £485 million funding uplift and says A&G, when used well, can support more joined-up care.
So what does this mean in practice for patients?
Under the new system, rather than your GP directly booking you a hospital appointment, they may first send a digital message to a specialist. That specialist — reviewing your case remotely — will then advise whether a referral is needed, suggest a treatment or test, or ask your GP to manage the situation in primary care instead.
Response times are expected to range between two and five working days.
In some cases, this could genuinely speed things up — a quicker specialist view without waiting months for an outpatient appointment. But there are real and legitimate concerns, which we believe patients deserve to know about.
What are the concerns?
Clinicians and patient organisations have raised serious questions about this change.
More pressure on already stretched GP surgeries. The GP workforce is already under considerable strain — England has lost over 6,000 GP partners since 2015. Adding A&G work to GP caseloads means your GP will need to action advice received from specialists, which in turn requires follow-up appointments. This could make it harder, not easier, to get a GP appointment.
The BMA has rejected the contract. In a March 2026 referendum, 99% of GP members who voted rejected the 2026/27 contract, calling its expectations unrealistic. The BMA is also seeking legal advice on whether the mandatory A&G requirement may unlawfully remove a GP's right to refer directly — a concern shared at the highest levels of the profession.
Patient safety worries around complex and chronic conditions. The Royal College of General Practitioners (RCGP) has raised concerns about the risk of delays — particularly where tests may be required before a referral can be submitted, where messages are lost, or where requests are handled without adequate senior clinical oversight. In areas where hospital waiting lists are longest, there is a risk A&G becomes a mechanism for managing demand rather than delivering better care.
Who may be most at risk?
We want to be clear: this change is not equally likely to affect everyone in the same way. Those with complex, rare, or chronic conditions — who may already struggle to have their symptoms recognised and taken seriously — face the greatest risk.
There is particular concern for:
- Women, especially those with conditions that are historically under-diagnosed or dismissed, such as autoimmune diseases, endometriosis, POTS, MCAS, or EDS
- Black patients and other ethnic minority communities, who face well-documented barriers to equitable care and whose symptoms may be less likely to be escalated
- Trans and non-binary patients, who frequently encounter additional barriers to accessing appropriate healthcare
- People living with long-term or 'medically unexplained' conditions, including Long Covid and chronic fatigue, whose presentations can be complex or inconsistent
Under the new system, a specialist will make decisions based only on the information the GP has submitted electronically. Patients will no longer have the opportunity to speak directly to a specialist or to advocate for themselves. Any assumptions or implicit biases in how a GP describes a case will be passed on as the full picture.
This is a patient voice issue, and it is one we take very seriously.
What can you do?
Know your rights under Jess's Rule. In September 2025, NHS England introduced Jess's Rule — named in memory of Jessica Brady, who died of cancer in December 2020 at the age of 27 after having more than twenty GP appointments without a diagnosis. Jess's Rule asks GP teams to Reflect, Review and Rethink if a patient has presented three or more times with the same or worsening symptoms that remain unresolved. This means considering a face-to-face consultation, ordering further tests, seeking a second opinion, or making a specialist referral.
If you have seen your GP three or more times about the same problem without resolution, you can ask your GP to apply Jess's Rule. This remains in place alongside the new A&G requirements, and NHS England has confirmed that referral pathways under this initiative will continue.
Other steps you can take:
- Ask your GP to explain whether your case is going through Advice and Guidance or a direct referral, and why
- Ask what happens if the specialist declines the referral — who is responsible for your ongoing care?
- If you feel your symptoms are not being taken seriously, consider requesting to speak to a different GP, asking for a face-to-face appointment, or requesting a second opinion
- Keep a record of all your appointments, symptoms, and what you have been told
Tell us your experience - Your stories help us build the evidence that can lead to real change.
Healthwatch Nottingham and Nottinghamshire is here to listen. As an independent patient voice organisation, it is our job to understand how NHS changes are affecting people on the ground — and to make sure decision-makers hear those experiences.
If you are affected by the new referral process — whether you have found it helpful or whether you are concerned about delays or barriers to your care — we want to hear from you.
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