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.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what guidance they have issued to Integrated Care Boards on the allocation of resources towards prevention, primary care, and community services.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

NHS England is responsible for determining allocations of financial resources to integrated care boards (ICBs). NHS England’s allocations policy aims to support equal opportunity of access for equal need, as well as NHS England’s duties to reduce health inequalities that are amenable to healthcare.

The Medium Term Planning Framework sets out the priority deliverables and the reform opportunities that ICBs and providers need to deliver for the next three years and the broader strategic aims that will need to be reflected in five year plans developed by each organisation. This includes expectations on prevention, and on neighbourhood health, including primary and community care. Further guidance on neighbourhood health has also been set out in the subsequent Neighbourhood health framework.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what measures they use to assess whether NHS resource allocation reflects their longstanding commitment to deliver more care closer to home.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

NHS England's allocation methodology takes account of population need, including community health needs and health inequalities, to ensure resources are distributed fairly across integrated care boards. This is being complemented by the development of neighbourhood health services and the associated incentives to support the Government's ambition to shift more care from hospitals into community settings.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what proportion of NHS expenditure has been allocated to (1) acute hospital services, (2) primary medical care (general practice), and (3) community health services, in each financial year since 2015/16.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

The following table sets out the revenue spend categories for the specified services commissioned by NHS England and clinical commissioning groups, now integrated care boards, using audited figures between 2015/16 to 2024/25:

Notes:

1. delegated specialised commissioning has been included within the specialised commissioning line as well as directly commissioned spec comm to remain consistent with previous years; and
2. prescribing and delegated pharmacy/ophthalmology/primary and secondary dental all sit within the ‘other’ category.

Information for 2025/26 is unvalidated and not quality assured. In-year data is not routinely reported on with the breakdown of spend used for this answer and would be subject to material change between plan and outturn as a result.

75% of NHS England commissioned social services are within the community services line.

Found: met in Committee Room 4 Present: Baroness Kennedy of The Shaws (Chair) Baroness Barran Baroness Gerada

Found: The Committee met in Committee Room 2 Present: Baroness Kennedy of The Shaws (Chair) Baroness Gerada

Found: Watch the meeting Members present: Baroness Kennedy of The Shaws (The Chair); Baroness Barran; Baroness Gerada

Found: 18th June The Committee met in Committee Room 3 Present: Baroness Barran (Acting Chair) Baroness Gerada

Found: Apologies and notices Apologies were received from the Lord Bishop of Derby, Baroness Gerada

Found: Apologies and notices Apologies were received from the Lord Bishop of Derby, Baroness Gerada

Found: The Committee met in Committee Room 1 Present: Baroness Kennedy of The Shaws (Chair) Baroness Gerada

Found: Baroness Gerada: I was going to ask a very similar question.

Found: Thursday 18 June 2026 11.40 am Watch the meeting Members present: Baroness Barran (The Chair); Baroness Gerada

Found: Thursday 18 June 2026 10.35 am Watch the meeting Members present: Baroness Barran (The Chair); Baroness Gerada

Found: Can I move to you, Baroness Gerada?

Found: Meeting, held at 10:30am on Thursday, 21st May Present: Baroness Barran (acting as Chair) Baroness Gerada

Found: 2026 11.50 am Watch the meeting Members present: Baroness Kennedy of The Shaws (The Chair); Baroness Gerada

Found: 2026 11.50 am Watch the meeting Members present: Baroness Kennedy of The Shaws (The Chair); Baroness Gerada

Found: 2026 10.30 am Watch the meeting Members present: Baroness Kennedy of The Shaws (The Chair); Baroness Gerada

Found: 2026 10.30 am Watch the meeting Members present: Baroness Kennedy of The Shaws (The Chair); Baroness Gerada

Found: Thursday 21 May 2026 11.40 am Watch the meeting Members present: Baroness Barran (in the Chair); Baroness Gerada

Found: Thursday 21 May 2026 10.40 am Watch the meeting Members present: Baroness Barran (The Chair); Baroness Gerada

Found: 2026 11.45 am Watch the meeting Members present: Baroness Kennedy of The Shaws (The Chair); Baroness Gerada

Found: 2026 10.40 am Watch the meeting Members present: Baroness Kennedy of The Shaws (The Chair); Baroness Gerada

Found: Watch the meeting Members present: Baroness Kennedy of The Shaws (The Chair); Baroness Barran; Baroness Gerada

Found: Watch the meeting Members present: Baroness Kennedy of The Shaws (The Chair); Baroness Barran; Baroness Gerada