GPs in one area will no longer be funded to process advice and guidance (A&G) after falling short of their ICB’s ‘required targets’.
Following lobbying from the LMC in 2022, North East London (NEL) CCG agreed to pay roughly £19 per A&G request in order to cover the extra work that comes back to GPs as a result of actioning specialist advice.
This funding was carried over for Tower Hamlets, Newham and Waltham Forest when the ICB was established later in the year, and the project developed into ‘advice and refer’ whereby all referrals went through a ‘single point of access’.
Sister title, Pulse, reported last month that GP leaders feared NHS England wants to replace the traditional direct referral system, with ICBs being encouraged to take up the ‘advice and refer’ system across England.
And an NHS document confirming the plans, and setting out details for their recommendations to ICBs, carried no suggestions practices should be paid to carry out the extra work.
According to GPs in East London, the paid advice-and-refer system has worked well, but the ICB has now pulled the funding for this financial year, arguing that it was ‘non-recurrent’.
Local commissioners said that a ‘majority of practices’ had failed to meet targets for the project, which had resulted in ‘mixed achievements’.
Professor Sir Sam Everington, a GP in Tower Hamlets, said that he is ‘busy arguing back’ since he believes the funded advice and referral system has been a ‘fantastic success’.
He said: ‘There are two solutions to the waiting list, one is increased capacity in the acute sector. But secondly, supporting primary care to manage these patients in primary care – and we did that through funding.
‘It was about £100,000. It was non-recurrent funding, but it’s not been continued and I’m taking that up with the ICB at the moment.’
Tower Hamlets LMC chair Dr Jackie Applebee told said that practices have been ‘unfunded’ for nearly three months since the start of the financial year.
‘The LMC has protested to the ICB and also advising practices not to use advice and refer as we aren’t contracted to, and to write in the advice box that we are not asking for advice but referring the patient to be seen,’ she said.
Recent guidance from Londonwide LMCs cited NEL as an area where funding for A&G has been ‘withdrawn’, with the local improvement scheme (LIS) having been discontinued this year.
The guidance added: ‘In areas where it is being withdrawn this is further complicated in that the secondary care trusts have redesigned their referral processes, so that all referrals need to be via A&G and they no longer have appointments on eRS for direct referral.’
According to Tower Hamlets LMC, there have also been issues with GP practices receiving payments for advice that was processed prior to the end of the contract.
The latest newsletter said: ‘The LMC has been pushing for some time to ensure that payments already due under the Advice & Referral LIS are made.
‘The ICB has in response done work to identify payments owed, which are to be checked and then approved – progress was promised very soon.’
NEL ICB said that as of 31 March this year, the contracts for advice and referral across the area ‘expired’.
A spokesperson said: ‘During the lifetime of the contract, the delivery of the scheme resulted in mixed achievements whereby a majority of practices did not meet the required targets.
‘The ICB is planning to work with stakeholders to conduct an independent evaluation of the A&R scheme. The remaining funds from the original non-recurrent funding will be ring-fenced for investment in primary care.’
GPs stopping to engage with the advice and guidance pathway is one of the options on the BMA’s current collective action ballot.
In November, NHS England said there will be no national mandate for GPs to use advice and guidance in a certain number of cases, and that local systems should design their own targets and processes.
Last year, sister title Pulse did an analysis of how A&G is being used across the country found that GPs are concerned about the increased workload it brings, the medicolegal implications, and the lack of resourcing in primary care.
A version of this story was first published on sister title Pulse.
