Asked by: Helen Morgan (Liberal Democrat - North Shropshire)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what quality assurance arrangements NHS England has put in place for mandatory Single Point of Access triage decisions from 1 April 2026; what monitoring will be conducted of triage outcomes by specialty and provider; and how GPs and patients will be able to escalate concerns about triage decisions that they consider clinically inappropriate.
Answered by Stephen Kinnock - Minister of State (Department of Health and Social Care)
We're setting the Advice and Guidance (A&G) clock start so it's the same as outpatient referrals, ensuring no patient will have to wait longer for an appointment as a result of A&G
As set out in the Medium Term Planning Framework, the National Health Service will move toward delivering care through a ‘Single Point of Access’ (SPoA) for all appropriate requests and referrals, excluding for urgent suspected cancer. Under the new SPoA model, if a patient needs treatment, their Referral to Treatment (RTT) clock start date will be calculated from the date the Advice and Guidance (A&G) request or referral was received by the SPoA. This is instead of the current process for A&G, where the clock start date is the date that the request or referral is converted to a treatment pathway. This will ensure that patients' waiting times are accurately reflected.
In February 2026, NHS England issued The Elective Single Point of Access: Technical Guidance for 2026/27 to integrated care boards. This provides guidance on RTT rules and quality assurance arrangements, and advice on establishing leadership and governance structures that ensure SPoA outcomes are assessed regularly. The SPoA will be supported by improvements to the NHS e-Referral Service, which will enable NHS England to collect data on triage outcomes.
SPoA is designed to promote clinical collaboration between primary care referrers and secondary care clinicians, including by facilitating two-way communication and shared decision making. General practitioners (GPs) can re-submit a referral following a SPoA triage outcome if they have concerns about the clinical decision. Escalation routes for concerns about triage decisions will continue to operate through locally agreed referral pathways and communication processes for GPs and patients, supported by improvements to the NHS e-Referral Service. Where patients have concerns regarding outcomes, local Patient Advice and Liaison Service teams can provide advice and support.
Asked by: Helen Morgan (Liberal Democrat - North Shropshire)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what the referral to treatment clock start date is where a GP resubmits a referral following a Single Point of Access triage outcome with which they disagree; and what guidance NHS England has issued to Integrated Care Boards on the referral to treatment clock start date in these circumstances ahead of mandatory Single Point of Access triage processes taking effect from 1 April 2026.
Answered by Stephen Kinnock - Minister of State (Department of Health and Social Care)
We're setting the Advice and Guidance (A&G) clock start so it's the same as outpatient referrals, ensuring no patient will have to wait longer for an appointment as a result of A&G
As set out in the Medium Term Planning Framework, the National Health Service will move toward delivering care through a ‘Single Point of Access’ (SPoA) for all appropriate requests and referrals, excluding for urgent suspected cancer. Under the new SPoA model, if a patient needs treatment, their Referral to Treatment (RTT) clock start date will be calculated from the date the Advice and Guidance (A&G) request or referral was received by the SPoA. This is instead of the current process for A&G, where the clock start date is the date that the request or referral is converted to a treatment pathway. This will ensure that patients' waiting times are accurately reflected.
In February 2026, NHS England issued The Elective Single Point of Access: Technical Guidance for 2026/27 to integrated care boards. This provides guidance on RTT rules and quality assurance arrangements, and advice on establishing leadership and governance structures that ensure SPoA outcomes are assessed regularly. The SPoA will be supported by improvements to the NHS e-Referral Service, which will enable NHS England to collect data on triage outcomes.
SPoA is designed to promote clinical collaboration between primary care referrers and secondary care clinicians, including by facilitating two-way communication and shared decision making. General practitioners (GPs) can re-submit a referral following a SPoA triage outcome if they have concerns about the clinical decision. Escalation routes for concerns about triage decisions will continue to operate through locally agreed referral pathways and communication processes for GPs and patients, supported by improvements to the NHS e-Referral Service. Where patients have concerns regarding outcomes, local Patient Advice and Liaison Service teams can provide advice and support.
Asked by: Helen Morgan (Liberal Democrat - North Shropshire)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if he will make an assessment of the adequacy of the consistency of the mandatory Single Point of Access triage process with NHS England's Jess's Rule guidance; and what safeguards are in place to ensure that a mandatory Single Point of Access triage process does not return to primary care a patient whom a GP has referred in accordance with that guidance.
Answered by Stephen Kinnock - Minister of State (Department of Health and Social Care)
The Single Point of Access (SPoA) triage process is consistent with Jess’s Rule.
Jess’s Rule is an NHS England patient safety initiative for primary care. It is designed for general practitioners (GPs) and supports them to reconsider a patient’s presentation and/or diagnosis where the patient has attended a GP three or more times and symptoms have escalated, or the diagnosis is uncertain.
Jess’s Rule can be used to support a GP’s decision on an appropriate referral within the SPoA model. SPoA will provide a more efficient approach to triaging patients, with all appropriate requests and referrals, excluding urgent suspect cancer, flowing through a single ‘front door’. SPoA supports clinical triage to the most appropriate service or outcome, meaning timelier, more joined-up care for patients. Patients will still have a choice about where they receive care.
Safeguards within the SPoA model include senior clinical oversight of triage decisions and the ability for primary care clinicians to re‑escalate concerns where symptoms persist, worsen, or remain unexplained. These arrangements aim to ensure patients who require specialist assessment are not inappropriately managed in the community, and that shared clinical judgement remains central to decision‑making.
Asked by: Helen Morgan (Liberal Democrat - North Shropshire)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what assessment his Department has made of the potential impact of mandatory pre-referral Advice and Guidance requirements from 1 April 2026 on workload transferred to GP practices, including the workload arising from acting on specialist advice responses, requesting and reviewing diagnostic investigations recommended by specialists, and managing patients while awaiting responses; and whether additional funding has been allocated to reflect that workload transfer.
Answered by Stephen Kinnock - Minister of State (Department of Health and Social Care)
Advice and Guidance (A&G) is designed to support quicker, clearer clinical decision making, by enabling general practitioners (GPs) and specialists to discuss and agree on the most appropriate next steps for a patient. The 2026/27 GP Contract does not mandate the use of A&G in all circumstances. Instead, practices are expected to use A&G prior to or in place of a planned care referral, where clinically appropriate, and to follow locally agreed referral pathways.
In 2025/26 we introduced a £20 payment for GPs for each A&G request, allocating up to a total of £80 million of new funding, which has supported significant increases in A&G. For 2026/27, this funding is being incorporated into the GP Contract to provide a consistent, streamlined approach that recognises the vital role of GPs in delivering A&G. Embedding A&G in the GP Contract recognises it as routine clinical practice, removes annual signups, and provides more predictable funding while supporting consistent patient pathways.
We are investing £485 million in GPs in 2026/27, bringing the total spend on the GP Contract to over £13.8 billion. This builds on last year’s £1.1 billion of investment. This uplift represents a 3.6% cash increase, or 1.4% real terms increase, and includes an assumed pay increase of 2.5%. As with previous years, we have asked the independent pay review body for Doctors' and Dentists' Remuneration, for a pay recommendation for 2026/27 for the Government to consider.
Asked by: Helen Morgan (Liberal Democrat - North Shropshire)
Question to the Department for Transport:
To ask the Secretary of State for Transport, whether her Department has made an assessment of the potential impact of reconnecting London to the Marches by rail on the economy.
Answered by Keir Mather - Parliamentary Under-Secretary (Department for Transport)
The Department has not undertaken a specific assessment of the economic impact of reconnecting London to the Marches by rail. Any future proposals would be considered in accordance with established Department appraisal guidance, including analysis of effects on connectivity, regional development and the wider economy. The Department has also responded to the Office of Rail and Road (ORR) on current applications submitted by open access operators.
Asked by: Helen Morgan (Liberal Democrat - North Shropshire)
Question to the Department for Transport:
To ask the Secretary of State for Transport, what steps her Department is taking to improve rail connectivity in North Shropshire.
Answered by Keir Mather - Parliamentary Under-Secretary (Department for Transport)
Services in North Shropshire are provided by Transport for Wales (TfW) in accordance with its Train Service Requirement which is agreed with the Department with respect to services at stations in England. The Department keeps the performance and connectivity of the rail network under continual review including through regular engagement with TfW. There are no active proposals to increase services on this route.
Asked by: Helen Morgan (Liberal Democrat - North Shropshire)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether NHS England has engaged formally with the General Medical Council about the interaction between mandatory pre-referral Advice and Guidance requirements and the professional duty of GPs under General Medical Council guidance to refer patients to specialist care when it is in their best interests to do so; and whether a joint risk assessment or patient safety review has been carried out to ensure GPs are not placed in conflict between their contractual and professional obligations.
Answered by Stephen Kinnock - Minister of State (Department of Health and Social Care)
In early 2026, we concluded the consultation on the changes to the GP Contract for 2026/27. As part of this process, we expanded the consultation to engage with a wider set of primary care stakeholders, these were the British Medical Association’s General Practitioner’s Committee England, the Royal College of General Practitioners, National Voices, the Institute of General Practice Management, Healthwatch England, the NHS Confederation, and the National Association of Primary Care.
The Department has not engaged formally with the General Medical Council (GMC) regarding the interaction between the 2026/27 contractual changes and the professional duties set out in GMC guidance. No formal joint risk assessment or joint patient safety review has been undertaken. However, the Department and NHS England considered the potential risks, benefits, and wider impact of the policy changes as part of standard policy-development processes.
The 2026/27 GP Contract embeds the current Advice and Guidance (A&G) enhanced service funding into core practice funding. The contract does not mandate the use of A&G in all circumstances. Instead, practices are expected to use A&G prior to or in place of a planned care referral, where clinically appropriate, and to follow locally agreed referral pathways. This reflects longstanding planned‑care referral practice and does not alter existing legal or professional accountability frameworks for general practitioners (GPs).
GPs, and other primary care referrers, remain professionally accountable for making appropriate clinical decisions, including referring patients to specialist care when it is in the patient’s best interests. The use of A&G does not override those responsibilities or place GPs in conflict between contractual and professional obligations. NHS England continues to support clinicians through guidance, pathway design, and local governance arrangements to ensure A&G is used safely, proportionately, and in a way that preserves clear clinical accountability.
Asked by: Helen Morgan (Liberal Democrat - North Shropshire)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what discussions his Department has had with the Health Services Safety Investigations Body, Care Quality Commission, Healthwatch and Royal College of GPs on changes to the GP contract regarding Advice and Guidance.
Answered by Stephen Kinnock - Minister of State (Department of Health and Social Care)
In early 2026, we concluded the 2026/27 GP Contract consultation. This year, we expanded the consultation to engage with wider stakeholders, which were the General Practitioners Committee England, the Royal College of General Practitioners, National Voices, the Institute of General Practice Management, Healthwatch England, the NHS Confederation, and the National Association of Primary Care. The feedback we received from stakeholders across the system has been constructive and comprehensive, enabling us to refine proposals and address concerns while developing the final contract package.
Embedding Advice and Guidance in the contract is about ensuring general practitioners and specialists can work together earlier and more consistently, so patients are directed to the most appropriate next step without unnecessary delay, whether that is a referral, diagnostics, or supported care in the community.
Last year, we invested £80 million in Advice and Guidance. We are now embedding this money in core contract funding. As a result, since April 2025, we have avoided 1.3 million patients ending up on a waiting list.
The Department has not discussed the changes to the GP Contract regarding Advice and Guidance with the Health Services Safety Investigations Body, and the Care Quality Commission.
Asked by: Helen Morgan (Liberal Democrat - North Shropshire)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether his Department has undertaken a risk assessment for changes to the GP contract regarding Advice and Guidance due to be implemented from 1 April 2026.
Answered by Stephen Kinnock - Minister of State (Department of Health and Social Care)
The Department has not undertaken a formal risk assessment for the changes made to the GP Contract regarding Advice and Guidance (A&G) due to be implemented from 1 April 2026. However, in developing this policy, the Department and NHS England have carefully considered the potential risks, benefits, and wider impact as part of the standard policy-development process.
As part of the 2026/27 GP Contract, we are embedding the current A&G enhanced service funding within core practice funding. Practices will be required to use A&G prior to or in place of a planned care referral where clinically appropriate and to follow locally agreed referral pathways.
Between April 2025 and December 2025, A&G has avoided 1.3 million patients being unnecessarily added to hospital waiting lists by providing them with expert advice in their community.
Asked by: Helen Morgan (Liberal Democrat - North Shropshire)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what arrangements NHS England has made to ensure that patients retain the statutory right to choose a provider where a mandatory Single Point of Access triage process operates; and what guidance has been issued to Integrated Care Boards on preserving patient choice rights within mandatory Single Point of Access pathways from 1 April 2026.
Answered by Karin Smyth - Minister of State (Department of Health and Social Care)
The policy intention for Advice and Guidance (A&G) and the Elective Single Point of Access (SPoA) model is fully compatible with NHS England’s Patient Choice Guidance, published December 2023. Patients must continue to be offered a choice of provider at the appropriate point in the pathway, and local pathways should be designed to ensure that choice rights operate in practice.
The purpose of A&G is to support decision‑making, reduce unnecessary referrals, and deliver more care closer to home. SPoA acts as a single ‘front door’ to support clinical triage to the most appropriate service or outcome, meaning timelier, more joined-up care for patients, without altering patients’ statutory right to choice.
NHS England has published system guidance The Elective Single Point of Access: Technical Guidance for 2026/27, which specifies that patients must continue to be offered choice of provider and team at the appropriate point in the pathway when they can make an informed choice. An elective SPoA diagram showing touchpoints of choice is included in the technical guidance annex.