GPs in England will be paid £20 each time they decide not to send a patient to hospital under a government scheme to help reduce the NHS waiting list.
Family doctors will be able to claim the money if they instead seek advice from a hospital doctor or specialist before a decision is taken about referring patients for tests and treatment in an out-of-hospital setting, such as a health clinic, or to see a community-based specialist.
An estimated 2 million patients a year, many with common conditions such as ear wax, tinnitus and irritable bowel syndrome (IBS), could get faster care because of the initiative, ministers say.
It could also help women with menopausal symptoms avoid joining the already 580,000-strong waiting list for care from overloaded NHS gynaecological services.
NHS England has allocated £80m to fund an expansion of the existing “advice and guidance” scheme so that it covers all of England from this month onwards.
Ministers hope that it will help reduce the size of the waiting list for planned hospital care – under which 6.24 million patients are waiting for 7.4m appointments, tests or operations – by diverting many of those who would usually join that list to get their care elsewhere.
Over time that should help reduce the headline size of the “referral to treatment” queue for hospital-based care by increasing the number of patients treated elsewhere, as they will therefore not be added to the waiting list total.
If family doctors start liaising much more frequently with hospital consultants about what form care should take then it should also help the government fulfil one of the “three big shifts” in healthcare it has promised – moving a lot of care out of hospitals into community settings.
From now on GPs will be able to claim a £20 payment for their surgery if, for example, after an initial consultation and then speaking to a hospital doctor, they refer someone with IBS to a community-based dietician instead of their local hospital for an investigation and treatment.
At the moment almost 400,000 people of the 7.4 million on the waiting list are waiting to be seen by a hospital specialist because they have a problem with their digestive system.
Karin Smyth, the minister for NHS reform at the Department of Health and Social Care, said: “By caring for patients closer to home, we save time and stop masses of people having to head to hospital for unnecessary appointments in the first place.
“We are rewiring the NHS so that we are doing things differently, more efficiently and delivering better outcomes for patients. The scheme is a perfect example of how we are saving patients time and reducing pressure on key NHS services in the process.”
Women going through menopause would also be able to get advice on the best form of hormone replacement therapy in a community facility, as would those with ear, nose and throat conditions – such as ear wax and ear infections – who make up 30% of all referrals to hospital.
The British Medical Association, the doctors’ union, negotiated the £20-a-head deal with ministers. It said the plan would reward GPs better for taking more responsibility for their patients’ health.
After years of lack of investment in general practice, “this is an important small step in acknowledging the important role of the GP and supporting practices to deliver enhanced care to patients in the community”, said Dr Katie Bramall-Stainer, the chair of the BMA’s GPs committee in England.
However, Beccy Baird, a senior fellow at the King’s Fund thinktank, said the approach could have some “unintended consequences” affecting patients and GPs.
“Unintended consequences of advice and guidance include potential delays in referral for patients and increased administrative burden for both general practice and secondary [hospital] care,” she said.
It could also lengthen the time it takes a patient who needs hospital care finally getting it, if they are first diverted to another service, she added.
“For some there is a possibility [that] it is just adding an extra step in the process and therefore delaying their treatment in secondary care”.
• The headline and text of this article was amended on 17 April 2025 to clarify the basis on which GPs can claim the £20.
