Asked by: Baroness Gerada (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of the clinical and patient safety implications of mandating general practitioners to use Advice and Guidance prior to referral to specialist care within the 2026–27 GP contract and in what clinical circumstances they intend such a mandate to apply; and how they will ensure that any such mandate does not adversely affect access to specialist care or clear clinical accountability for patient care.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The purpose of Advice and Guidance and an elective Single Point of Access is to ensure patients and practices receive rapid specialist assessment and a clear next step, using modern referral and triage approaches. It is important to emphasise that the clinical threshold for a referral remains unchanged.
Where there is clear clinical evidence, the intention is to avoid adding patients to outpatient waiting lists when they can receive timely diagnosis, advice, or management in a more appropriate setting. General practitioners (GPs) should continue to make a clinical decision to refer for specialist care where that is in the patient’s best interests, and to request specialist advice where that is needed. GPs retain responsibility for referral decisions, and this model supports and does not replace or override clinical judgement.
GPs, and other primary care referrers, remain professionally and legally accountable for their clinical decisions, including referring patients to specialist care where this is in the patient’s best interests. Requests for referral or specialist advice will receive a response from a named consultant with clear accountability and oversight.
The 2026/27 GP Contract embeds the previous Advice and Guidance enhanced service funding into core practice funding. Following near universal uptake of the Advice and Guidance Enhanced Service in 2025/26, the focus for 2026/27 is on stability and simplicity. Embedding the specialist advice model within the core contract recognises its role in routine clinical practice, removes annual signups, and provides more predictable funding while supporting consistent patient pathways.
Asked by: Baroness Gerada (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what proportion of fully-qualified equivalent NHS doctors employed in England were (1) fully qualified general practitioners, (2) consultants in hospital and community health services, and (3) specialty and associate specialists doctors in hospital and community health services, in each year since 2015.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The following table shows the full time equivalent (FTE) number of doctors working across general practice, primary care networks, and hospital and community health services in England, and the proportion of these who were fully qualified general practitioners, consultants, or specialty and associate specialist doctors:
| Total doctors employed across general practice, primary care networks, National Health Service provider trusts and other core organisations | Percentage of total which are general practitioners | Percentage of total which are consultants | Percentage of total which are specialty and associate specialist doctors |
September 2015 | 138,890 | 21% | 31% | 6% |
September 2016 | 141,337 | 21% | 31% | 6% |
September 2017 | 143,639 | 20% | 32% | 6% |
September 2018 | 145,615 | 20% | 32% | 6% |
September 2019 | 150,808 | 19% | 32% | 6% |
September 2020 | 157,550 | 18% | 32% | 6% |
September 2021 | 163,814 | 17% | 32% | 6% |
September 2022 | 168,331 | 16% | 32% | 6% |
September 2023 | 176,084 | 16% | 32% | 6% |
September 2024 | 184,883 | 15% | 31% | 7% |
September 2025 | 192,732 | 15% | 31% | 7% |
Sources: NHS Workforce Statistics, General Practice Workforce Statistics, and Primary Care Network Workforce Statistics, all published by NHS England.