New data from the Royal College of Physicians reveals a widening gap between the amount of NHS Advice and Guidance (A&G) work that physicians are being asked to deliver and the time allocated for it in their job plans, with many reporting that they complete this work in the evenings and on weekends.
NHS A&G services enable GPs to seek specialist input from senior doctors before, or instead of, referring a patient. This can reduce unnecessary referrals and help to ensure that patients receive the right care in the right place. However, a new snapshot survey by the RCP suggests that A&G is increasingly being propped up by goodwill rather than planned capacity.
Key findings:
- 67% of physicians surveyed said they deliver A&G.
- Of those, 47% have no dedicated time for it written into their job plan at all.
- Among physicians who do have allocated time, 75% get one programmed activity (PA) or less per week – the equivalent of 4 hours or fewer.
- 66% are spending at least an hour or more each week on the activity outside their agreed job plan.
- 77% of respondents said the volume of A&G requests they receive has increased over the past year.
- 89% of physicians have received no formal training on delivering A&G.
These findings come as NHSE performance statistics released this week (13/08/26) revealed in June 2026, the total number of requests for pre-referral specialist advice was 359,050, up 15% from May. This is also up 38% from when Labour came into government in July 2024. The significant increase in use of A&G emphasises the need for serious consideration of allocated time for physicians to carry out this work deliberately and safely.
The RCP survey responses highlighted concerns about the complexity of requests as well as the volume. Physicians described spending significant time reviewing clinical histories, blood results and imaging in order to provide advice.
One respondent to the RCP survey reported receiving around 15 Advice and Guidance requests per week despite having only 2 hours allocated in their job plan to complete the work. They noted that requests are often complex and require information to be reviewed across multiple systems, making it difficult to respond safely within a short timeframe.
One physician told us:
‘It all takes time. The temptation is to rush but this is dangerous.’
Most GP requests are now sent as an attachment, which not only slows down the system, but also contains a lot of information which needs to be deciphered, and requires more time to look at blood results, imaging reports and past hospital history to answer questions.
The survey also identified concerns about the appropriateness of some requests. Seven in ten physicians (70%) said they sometimes (42%) or often (28%) receive requests they believe are inappropriate for the A&G route, including some that require urgent clinical intervention.
The findings have been published ahead of planned changes to the NHS e-Referral Service (eRS), which will see A&G and referral pathways brought together from October 2026. Respondents expressed concern that any future expansion of the service must be accompanied by sufficient workforce capacity and job-planned time.
RCP clinical lead for outpatients Dr Ash Sharma said:
‘These findings show that A&G is still being delivered without the planning or resourcing physicians needs. Already overstretched doctors are essentially working for free to get the right care for their patients. This is unacceptable and unsustainable.
‘A&G is now a significant part of clinical practice for many physicians, yet almost half of those delivering it have no dedicated time for the work in their job plans. That gap is increasingly being filled by goodwill, but goodwill is not a sustainable workforce strategy. A&G is a vital part of improving access to expert care for our communities, it requires a real depth of training and isn't something to be seen as something that can simply fit around existing clinical commitments.
‘As A&G is expanded and integrated further into referral pathways from October 2026, it is essential that capacity is built in from the start, rather than assuming clinicians will simply absorb the extra workload.’
Others described the work spilling into their personal time:
'A&G takes a minimum of 10 minutes. Our department receives an average of 19 A&G requests per weekday, meaning we need 3 hours per day to complete this work. The vast majority is done in the evenings and in our own time.’
Another respondent said:
‘When I am covering the wards, it takes up between 2 and 4 hours daily, but the nominal PA allowance is 2 hours per week.’
RCP clinical vice president Dr Hilary Williams said:
‘A&G has an important role to play in helping patients receive the right care in the right place, and physicians want to make it work. However, for A&G to be expanded successfully, the time required to deliver it must be properly recognised in senior doctor job plans.
'This is not a simple administrative task or a quick review of a test result. Increasingly, physicians provide advice for patients with multiple long-term conditions and complex needs, requiring senior clinical expertise, professional judgement and time to consider the wider clinical picture.
'Alongside ensuring protected clinical time, the NHS must invest in the digital infrastructure needed to support this model safely and effectively. This does not mean removing administrative support and transferring additional clerical work to doctors. To realise the benefits of A&G, clinicians need systems that enable efficient communication, access to information and coordinated care.
‘Physicians are committed to working more closely with primary care and want to make the model work for their patients – but further expansion of A&G will only succeed if both the time involved and the supporting digital infrastructure are properly recognised.'