ICBs must develop a delivery plan for advice and guidance (A&G) to ‘accelerate maturity’ of the service and to better standardise care, NHS England guidance has said.
In new operational framework for A&G 2025/26, published yesterday, NHS England set out a series of performance management measures that ICBs must complete over the next year to understand progress on the uptake and quality of A&G.
A&G is a key part of the elective care recovery plan and provides primary care with access to specialist clinical advice.
However, NHS England said that there was ‘considerable variation’ in how A&G is applied, delivered and monitored across England and that ‘a higher degree of rigour and standardisation is needed’.
The measures require ICBs to complete a self-assessment by this month (April 2025), to establish a baseline for the service, and develop a delivery plan that is ‘aligned with effective planning for 2025/26’, as well as implementing actions across ‘relevant sections’.
A self-assessment should then be completed each quarter, using a maturity level classification and the minimum standards set out in the framework to assess progress.
There are seven sections (see box), each with indicators with a set of minimum standards. Each indicator is then scored between 0-3 for maturity level, 0 being little or no evidence of progress against minimum standards, and 3 for all minimum standards met and evidence of improvement.
By March 2026, will ICBs need to complete an evaluation from A&G in 2025/26 and set out a new plan for 2026/27.
Seven sections for A&G
- Leadership and governance
- Use of digital platforms to support Advice and Guidance
- Improving the quality of Advice and Guidance
- Reducing health inequalities
- Patient and staff engagement
- Workforce planning, training and development
- Local commissioning and payment mechanisms
The framework also set out what ICBs were responsible for around the delivery of A&G. This included fostering partnership working at the primary and secondary care interface and providing effective oversight.
Responsibilities of ICBs in A&G
- Provide effective system leadership and oversight of the delivery of Advice and Guidance and triage priorities within the plan for reforming elective care for patients,
- Foster partnership working at the primary and secondary care interface,
- Implement the delivery plan for high quality Advice and Guidance to increase the proportion of patients being treated in the most appropriate care setting,
- Oversee the primary care and elective funding for the delivery of Advice and Guidance, ensuring the distribution of funds in 2025/26 reflects local healthcare needs and supports the reduction of health inequalities,
- Reduce unwarranted variation, using national and local data and insights.
It comes as a contract document last week set out details of an ICB funding cap for the service, which is intended to ensure ‘expenditure stays within the £80m national funding envelope’ while also maximising A&G requests.
This means ICBs will be able to cap the number of A&G requests claimed per GP practice – on a monthly, quarterly or annual basis – and if GPs exceed the cap they will not be able to claim payment.
NHS England clarified to our sister title Pulse: ‘At any point during the year, the ICB may set a cap or change a cap. If a cap is changed in year, it will not be set below the level of delivered activity at that point.
‘Each practice that signs up to this ES will be notified by its ICB of any cap (where applicable) and any in year changes to the cap.’
As previously confirmed by the Government, the £20 Item of Service (IoS) fee is intended to cover a single episode of care, rather than each interaction with hospital specialists.
The specification said: ‘Only one claim can be made per episode of care (i.e. multiple contacts between the practice and specialist for the same clinical issue are counted as one A&G referral).’
It added: ‘For the avoidance of doubt, ongoing communication between the referrer and the respondent regarding the same episode of care will not attract a further IoS fee.’
NHS England also clarified that the enhanced service is not intended to mandate A&G for particular specialties, emphasising that the ‘requests are not limited to specific specialties or clinical conditions’.
It comes as ICBs are set to be graded from July, according to a new performance assessment framework document from NHS England.
