Advice and Guidance: The Next Phase Of NHS Elective Transformation, From Initiative To Expectation
When I first wrote about Advice and Guidance (A&G) earlier this year, it was clear something significant was happening beneath the surface of NHS elective recovery.
The idea that a GP could get specialist advice digitally before referring a patient was quietly reshaping care. It promised quicker decisions, reduced waiting lists and fewer unnecessary outpatient appointments – and it opened an excellent opportunity for pharma, medtech and device companies. Now, that quiet shift has become a structural change. ICBs are being told to identify ten specialties where GPs must use A&G before referring patients and the new Medium Term Planning Framework 2026/29 confirms that A&G is here to stay. Not as a pilot but as a core part of how the NHS manages demand and improves productivity.
The opportunity for pharma, medtech and device companies just got even better.
For general practice, A&G offers quicker access to specialist insight but adds new layers of responsibility. For hospitals, it’s a way to focus outpatient capacity where it’s most needed.
And for pharmaceutical, medtech, and device companies, it’s a strategic inflection point, a chance to become part of the infrastructure that shapes how care is delivered and decisions are made.
A&G – the key to freeing up hospital capacity and consultant time
The government has already invested £80million in A&G, backed by a £20 payment per request for practices. The goal is to increase usage from 2.4million requests in 2023/24 to 4 million by 2025/26, potentially keeping 800,000 patients in primary care each year who might otherwise have been referred to hospital. Now, with ICBs under instruction to select ten mandatory specialties, the focus moves from optional participation to system-wide standardisation.
This policy change reflects NHS England’s intent to make A&G a universal feature of outpatient reform, driving consistency, reducing variation and enabling better use of scarce consultant time. The move aligns directly with the Medium Term Planning Framework, placing A&G firmly within the NHS’s productivity agenda.
NHS England’s plan identifies A&G as a key mechanism to accelerate the shift to a digitally enabled, patient-led outpatient model, one that improves access, reduces follow-up activity and frees hospital capacity for those who truly need it.
As the framework puts it, embracing interoperable technology between acute and primary care will “enhance how we can use Advice and Guidance, providing more appropriate care and reducing waiting times”.
A turning point for general practice
For GPs, A&G offers quicker answers and access to specialist input that can change management plans within days rather than months. It helps GPs feel supported and connected, especially in complex cases like respiratory disease, diabetes or dermatology.
But there’s another side. Every A&G request must still be GP-led, the patient must be informed, the record updated and any advice implemented or followed up. For practices already under intense workload pressure, this represents a significant administrative and clinical responsibility.
With ICBs now setting local rules for which specialties require A&G before referral, practices will face greater scrutiny of their referral patterns. The potential benefit is that GPs receive faster answers and can manage more care locally. The risk is that poorly implemented systems could add complexity and time.
The task ahead is clear – to make A&G a tool that reduces workload, improves patient care and rebuilds confidence in the relationship between primary and secondary care.
The Medium Term Planning Framework – a new context for A&G
The Medium Term Planning Framework 2026/29 is the first NHS document to make A&G part of a national operating model. It ties A&G directly to four strategic priorities:
- Productivity and efficiency – using A&G and digital triage tools to reduce unnecessary outpatient activity and focus resources where they’re most needed.
- Digital by default delivery – embedding A&G within interoperable systems that connect the NHS App, e-RS, and Consultant Connect.
- Neighbourhood health and left shift – supporting care closer to home, reducing demand on hospitals and enabling GPs to manage more patients locally.
- Clinical quality and standardisation – ensuring A&G advice aligns with best practice and national service frameworks to improve outcomes and reduce variation.
In other words, A&G is no longer a bolt-on. It’s part of the NHS’s broader effort to re-engineer outpatient care, strengthen integration and improve productivity.
Opportunities for pharma, medtech and device companies
For industry partners, this evolution of A&G represents one of the most practical and immediate ways to support NHS reform. The opportunity is to align with system priorities, helping GPs and consultants work smarter, not harder. Four specific areas stand out:
1. Education
Pharma and medtech companies can add real value by developing targeted educational content that simplifies decision making and builds confidence in high demand therapy areas. For example, you could offer short, CPD-accredited webinars or digital modules on effective A&G use. Alternatively, provide ready-to-use clinical checklists or templates that streamline A&G submissions and responses.
2. Pathway Alignment and Standardisation
One of the key challenges highlighted by NHS leaders is inconsistency in consultant responses. Industry can help by working with ICBs and hospital teams to create pathway-aligned templates that standardise advice, ensure adherence to NICE guidance and embed best practice.
3. Decision Support and Diagnostics
A&G often hinges on diagnostic clarification. That makes it a natural fit for medtech innovation. Diagnostic manufacturers can integrate testing guidance or remote review functions into A&G platforms, while device companies can demonstrate how their technologies reduce unnecessary referrals by providing real world examples of improved accuracy and triage efficiency.
4. Data and Insight Partnerships
As A&G becomes embedded in ICB performance frameworks, it will generate a rich dataset on patient presentations, clinical queries and referral trends. Companies that can analyse and visualise this data, showing where delays occur or where variation is highest, can become invaluable partners in service redesign.
How Advice & Guidance Is Evolving in the NHS’s Digital-by-Default Future
The NHS’s digital transformation agenda makes A&G even more powerful. From 2026 onwards, the framework commits to expanding the NHS App as the default interface for appointments, referrals and patient communication.
In this model, A&G will become part of a continuous, data driven care journey, one that links primary care, specialist advice and patient initiated follow-up (PIFU).
Three trends now define the A&G landscape:
- ICBs must identify ten mandatory A&G specialties.
- A&G volumes are expected to nearly double by 2025/26.
- The Medium Term Planning Framework formalises A&G as a key element of digital, productivity, and neighbourhood health reform.
For the NHS, this is about efficiency, sustainability and reducing waiting lists. For industry, it’s about becoming an enabler of that transformation, through education, pathway design and partnership.
Industry has a great opportunity to embed their products into a care revolution
A&G has evolved from a helpful idea into a core operating mechanism for the NHS. It is the bridge between general practice and specialist care, where decisions are made, variation is reduced, and patient outcomes are improved. Pharma, medtech, and device companies that engage early, aligning their value propositions with this new model, will be best placed to embed their products, diagnostics, and therapies into real-world NHS decision making. A&G is not just another initiative. It’s part of the new NHS operating model, and for those willing to step forward now, it’s an opportunity to partner with the NHS in reshaping how care is delivered across every Integrated Care System.
At www.scottmckenzieconsultancy.com, we work directly inside the NHS, supporting provider organisations, commissioners and system leaders to implement real change. We then help pharma, medtech and device companies interpret what’s happening, so they can engage the right stakeholders, align with NHS priorities and get their innovations embedded into care pathways.
With 10 years in pharma and more than 20 years working within the NHS, Scott brings a unique dual perspective, now captured in his book Embedded: How Pharma, MedTech, and Device Companies Can Get Their Products into NHS Pathways and Stay There, which distils everything he’s learned into a practical playbook. Whether you’re launching a new product or trying to unlock stalled adoption, Scott’s Embedded Membership Programme offers expert insights, workshops and coaching to show you how to reframe your offer, align with NHS priorities and make change stick.