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.

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.