Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether the Department of Health and Social Care or NHS England made or commissioned a clinical or patient safety impact assessment of the duty in paragraph 11C(2) of Schedule 3 to the National Health Service (General Medical Services Contracts) Regulations 2015, inserted by SI 2026/532, before that instrument was laid before Parliament.

The Department and NHS England considered the potential impacts of expanding Advice and Guidance (A&G) as part of the policy development process, including through clinical input, established governance arrangements, and equalities considerations. A&G is intended to support timely clinical decision‑making and ensure patients are directed to the most appropriate care. National guidance is in place to support its safe and consistent use, and the use of A&G does not change existing clinical accountability or patient safety arrangements.

The contract does not change the clinical threshold for referral to specialist care. General practitioner (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 it is needed. GPs retain responsibility for referral decisions, and this model supports, and does not replace, clinical judgement.

The 2026/27 GP Contract embeds the previous A&G enhanced service funding into core practice funding. Following near universal uptake of the A&G 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.