Lizzie Tuckey, managing director at Scan.com, explains why NHS reform could be slowing GPs and patients down.
At a time when NHS waiting lists remain under intense scrutiny and pressure to deliver faster care is mounting, Advice & Guidance (A&G) is emerging as one of the system’s most significant – and controversial – interventions.
A&G is now mandatory for GP referrals across ten specialities. Designed to reduce unnecessary referrals and ease waiting lists, on the surface, it seems to be working – around 660,000 treatments were diverted from hospitals and into the community between July and December 2024, a significant increase on the same period the previous year.
The logic is compelling: use specialist insight earlier to close the gap between primary and secondary care and improve patient access. But will mandatory A&G actually lead to better outcomes, or just add more hurdles for patients and already over-stretched GPs?
Extra workload for primary care
The new rules mean that in some areas, GPs can no longer refer directly to specialists – instead, they must submit an A&G request first, wait up to five working days, and only refer if the advice supports it. While intended to lighten the clinical load, this policy will undoubtedly increase the workload absorbed by primary care: more form-filling and triage for GPs, and longer waits for patients.
Specialist triage already happens informally when referrals are rejected or redirected; the difference now is that the same decision is being formalised, slowed down, and handed to a third-party specialist who may never actually see or examine the patient. A bigger question is: why have GPs become the gatekeepers to specialist care when the specialists already provide expert assessment as part of their commissioned services?
This is particularly problematic in specialities such as orthopaedics, where imaging often comes first in the workflow. Applied before diagnostics, A&G risks reversing established pathways and interrupting GP-led investigation plans, rather than supporting faster diagnosis and patient access to the right treatment.
More barriers for patients and clinicians
For patients, the promise of quicker access to care is far from guaranteed. A&G might help some get to the right place, but it also introduces a two-to-five-day wait for a centralised specialist response, followed by the time it takes for the GP to review that advice, act on it, and then communicate the outcome. For patients already anxious about their health, that delay can feel like an eternity.
There are also concerns around how tailored advice will be. Specialists will likely not have the full clinical picture, having never seen or examined the patient directly. This concern is not just theoretical – we have heard directly from patients that A&G advice can feel generic and impersonal, lacking the specificity they need to feel confident about next steps.
The new process also raises an important question about clinical responsibility: who is accountable while a patient waits? The GP who flagged the case, or the specialist service that hasn’t yet responded? That ambiguity matters because, in a system already under strain, further delays and clinical uncertainty introduce additional risks. Although GPs receive £20 per A&G request, this token incentive is unlikely to offset the added administrative, legal, and emotional burden.
Navigating the public-private divide
In a world of on-demand services, a multi-day delay layered on top of existing wait times is hard to swallow, especially when private diagnostic pathways offer immediate appointments and direct specialist access. This disconnect is likely to drive more patients toward private options. In 2024 alone, more than 1.1 million private tests and scans were delivered, reflecting double-digit growth from the previous year.
Patients and clinicians alike increasingly rely on faster, more direct routes to diagnosis. Our analysis of over 12,000 of our own customers shows that 25% of scans were completed within seven days of referral, and 75% within 19 days. Crucially, 20-30% of patients were referred on to specialists – supporting earlier intervention when it matters most. With the majority of these scans requested directly by clinicians, the surge in private imaging demand points to unmet clinical need elsewhere.
Against this backdrop, the NHS A&G model risks adding complexity to referrals at precisely the moment when both patients and clinicians are moving in the opposite direction. Executed ineffectively, A&G risks widening the gap between private and public care – when the real opportunity lies in integrating these pathways to ease waiting lists and reduce clinical pressure.
Making A&G work in practice
The success of mandatory A&G and how significant these barriers prove to be will come down to execution.
As a standalone third-party service separate from the existing clinical relationship, A&G is likely to create additional handoffs, more delays, and reduced continuity of care. By contrast, if it is delivered by the existing pathway specialist as an add-on to their current role, it may simply formalise the informal advice that already happens today, while preserving clinical continuity and working relationships. If specialist input could be brought into the consultation itself – through real-time phone or chat support – it could genuinely improve triage, cut unnecessary referrals, and improve patient outcomes.
The goals of stronger GP-specialist collaboration, fewer unnecessary referrals, and shorter wait lists are the right ones – the question is whether the current A&G model moves us closer to these goals or pushes us further away.
