The new advice and guidance (A&G) enhanced service specification has confirmed that GPs will receive £20 for each ‘episode of care’, which could include several interactions with consultants.
Last week NHS England published full details of the £80m A&G enhanced service as part of the 2025/26 GP contract changes, recently accepted in full by the BMA. The service will start from tomorrow, 1 April.
The specification stipulated that A&G requests are ‘GP led’, meaning that any requests ‘initiated’ by a non-GP member of staff ‘must be reviewed by a GP’ before submission to ‘ensure appropriateness, quality control and relevant content’.
It also set out details for the ICB funding cap, which is intended to ensure ‘expenditure stays within the £80m national funding envelope’ while also maximising A&G requests.
This means ICBs will be able to cap the number of A&G requests claimed per practice – on a monthly, quarterly or annual basis – and if GPs exceed the cap they will not be able to claim payment.
NHS England clarified: ‘At any point during the year, the ICB may set a cap or change a cap. If a cap is changed in year, it will not be set below the level of delivered activity at that point.
‘Each practice that signs up to this ES will be notified by its ICB of any cap (where applicable) and any in year changes to the cap.’
As previously confirmed by the Government, the £20 Item of Service (IoS) fee is intended to cover a single episode of care, rather than each interaction with hospital specialists.
The specification said: ‘Only one claim can be made per episode of care (i.e. multiple contacts between the practice and specialist for the same clinical issue are counted as one A&G referral).’
It added: ‘For the avoidance of doubt, ongoing communication between the referrer and the respondent regarding the same episode of care will not attract a further IoS fee.’
NHS England also clarified that the enhanced service is not intended to mandate A&G for particular specialties, emphasising that the ‘requests are not limited to specific specialties or clinical conditions’.
GP practices wishing to participate must sign up on or before 30 April.
Practices must make manual monthly claims for payment within 12 days of the end of the month when the A&G guidance was requested.
This new £20 per A&G payment was first announced ahead of the 2025/26 contract as part of the Government’s ‘elective reform’ plan to bring down hospital waiting lists.
NHS England is aiming to increase uptake of A&G via this new incentive, bringing the total number of requests up from 2.4 million 2023/25 to 4 million in 2025/26.
The BMA had also said that the impact of the new ES on GPs will be reviewed in the spring, and also that local systems will be required to review the availability of secondary care advice channels.
This article was first published by our sister title Pulse
