Advice and Guidance (A&G) has been used in the NHS for years. It helps GPs get advice from specialists on a patient’s condition to decide the best course of treatment.
The below sets out the facts following media reports.
Below is also a letter from the Health and Social Care Secretary Wes Streeting, published in the Daily Telegraph on 31 March, setting the record straight.
Is the government and NHS rationing hospital referrals to meet waiting list targets?
No – there is no truth to these claims. Advice and Guidance has been used in the NHS for years. It allows GPs to get expert input from specialists before referring – it does not block referrals. Clinical decisions remain with GPs, as they always have. If a patient needs a referral, they will get one. This is about making sure patients get the most appropriate care, including faster treatment in the community where appropriate - not adding people to long hospital waiting lists unnecessarily. Advice and Guidance is helping patients: As of November 2025, over 2.2 million requests have been made in 2025/26, with around 1.1 million patients treated without needing to join hospital waiting lists – meaning quicker care in the right setting.Are patients being ‘bounced back’ to GPs to fudge waiting lists?
No - clinical decisions remain with GPs, as they always have. If a patient needs a referral, they will get one. If a GP and specialist doctor decide the most appropriate treatment is available in the community – for example a physiotherapist – patients will be referred to the most appropriate care. This means patients aren’t stuck on hospital waiting lists unnecessarily and they can receive treatment quicker. It also helps free up hospitals to focus on the most urgent or serious cases, saving NHS time and resources.What are the benefits of Advice and Guidance?
Advice and Guidance gives patients faster access to specialist expertise without needing to wait for a hospital appointment. It helps patients avoid long waiting lists, where a referral isn’t necessary. Patients can often receive care closer to home, through their GP or community services. It reduces the need for unnecessary hospital visits, saving time and travel. Patients benefit from earlier reassurance, advice and treatment, which can reduce anxiety. It supports joined-up care, with GPs and specialists working together on the best treatment options for patients. It ensures patients receive the right care, in the right place, at the right time. Overall, Advice and Guidance helps make care quicker, more convenient, and more efficient for patients, while still involving specialist input when needed.Secretary of State Letter to the Editor of the Telegraph
Sir,
Your report suggesting the NHS is “rationing” hospital referrals is wrong. There is no 1-in-4 target for GPs, and Advice and Guidance (A&G) is not a mandatory hurdle designed to block patients from care.
A&G enables GPs to seek rapid input from specialist colleagues before referring, helping ensure patients receive the right care, first time. Clinical judgment remains unchanged: if a patient needs a hospital referral, they will get one.
What this means for patients is simple. If you need to see a specialist, you will. But if you do not, you should not have to join a hospital waiting list, only to be bounced back to community services after months of waiting. This policy is helping millions of patients skip the wait and receive faster care closer to home.
If the NHS doesn’t reform, it won’t recover. It is therefore disappointing to see the Telegraph and the BMA join forces to oppose reform, when GPs and Telegraph readers are crying out for it.
This government is getting the NHS to do things differently– that is why waiting lists are down and patient satisfaction is up.
Wes Streeting
Secretary of State for Health and Social Care
seen at 18:54, 31 March in Department of Health and Social Care Media Centre.