Baroness Gerada

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.

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.

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.

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.

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:

Sources: NHS Workforce Statistics, General Practice Workforce Statistics, and Primary Care Network Workforce Statistics, all published by NHS England.