GPonline has highlighted that there are growing warnings from general practitioners regarding the impact of the NHS’s reforms, specifically the mandatory rollout of Advice and Guidance (A&G) and Single Point of Access (SPoA) used to triage and assess patients.

What happens under the new system?

As I understand the position, historically, if you visited your GP and needed to be seen by someone else, their clinical judgement would often result in a direct referral to a hospital specialist for an outpatient appointment.

However, under the new Advice and Guidance and Single Point of Access (SPoA) pathways, this process has altered. The roll out (which was formally announced by NHS England on 24 February 2026, subsequently taking effect on 1 April 2026) advises GPs to seek remote advice from a hospital consultant before a formal referral can be made.

The GP submits a digital request detailing the patient’s symptoms, which is then reviewed by a consultant remotely, who decides on the best course of action. They may accept the referral, or they may return the request with written advice for the GP on how to manage the condition within the community.

The reforms had the intention to steamline referrals, make them efficient and reduce hospital attendance if it wasn’t required. However, concerns have been raised that this picture isn’t the one that is universally developing.

The impact on patient safety

Some GPs have highlighted that some appropriate referrals are being rejected or downgraded to advice and guidance. GPonline’s own survey highlights that 73% of the 181 GPs who responded, said they had seen a referral rejected inappropriately since April this year.

The BMA has rightly advised GPs to formally document instances where secondary care rejects a referral inappropriately, and to record these instances carefully in the patient's notes. Clear communication and collaborative care between GPs and hospital specialists are essential, but the current implementation of A&G risks adopting a system of obstruction and increasing red tape, rather than reducing it, if these trends are mirrored, and also putting the strain back on already stretched GP surgeries.

The BMA stated that the system was "unrealistic" and represented a "rationing of healthcare."

What can patients do

If referrals are wrongly rejected, I should imagine that it is incredibly frustrating for the GP, and it may well be that matters are escalated by them to ensure you get the treatment or investigations you need. However, there may be some practical steps that you can take as a patient, such as:

• Utilise the NHS App: The NHS App is a valuable tool. It allows you to view your medical records, check test results, and often see correspondence between your GP and hospital specialists. You can use it to track the status of your referral and any advice given.
• Keep a diary: document your symptoms, noting any changes, increased severity, or new developments. This provides your GP with clear, chronological evidence if you need to return to the surgery.
• Take action: if an A&G request is made and you are told your GP will manage your condition, but your symptoms worsen or fail to improve, book another appointment to talk through your concerns with the GP.

While the intention behind referral reforms may be to improve efficiency, although some of the GPs surveyed did highlight some positive changes, the concerns raised by GPonline and the BMA are worrying and the impact on patient safety cannot be ignored.