The elective recovery plan: a view from general practice

This week’s elective recovery plan was published at a very busy time for the NHS, including in general practice, where there will have been strong interest in the plan. Dr Becks Fisher, Director of Research and Policy at the Nuffield Trust and a GP in Oxford, looks at what the plan's impact might be on general practice.

Blog post

Published: 08/01/2025

The elective recovery plan landed on a busy day in general practice. First Mondays of the new year are always hectic, and the NHS is again facing significant winter pressures. But GPs will have taken a keen interest in the plan. Long waits for planned hospital care affect general practice. We care about our patients, too many of whom are waiting too long for care we think they need. We are left trying to manage deteriorating symptoms, offering psychological support to people struggling with uncertainty about what care they might need, and absorbing the oft-vented frustrations of people tangled in dysfunctional administrative systems. How far might the plan go to help?

Advice and guidance

The headline-grabbing announcement for GPs is that we are to be paid for using “advice and guidance” services (A&G). The idea is simple: rather than referring a patient (and so adding them to a waiting list), I can ask a hospital specialist for advice – and hope that the result spares a referral and gets my patient what they need. This is sensible. So sensible in fact that where I work, we’ve been doing it for years. There’s no national evaluation of these services to prove they work, and of course there’s potential for perverse incentives (GPs using them unnecessarily) and for poor outcomes (my experience is that they only work if they’re used judiciously for the right patients, if responses are timely, and the advice is high quality).

The major change is that, until now, hospitals have been paid for providing advice and guidance, not GPs. Now, that tariff is to be split, moving an estimated £80 million from hospital budgets to general practice, and incentivising GPs to make more use of A&G. GPs have previously changed the ways they work in response to financial incentives, so if sufficient specialist capacity is made and services work well, expecting greater uptake seems reasonable. Hospitals will be less pleased – A&G tariffs were generous, and overpayments generated from them were likely being used to fill holes in their other budgets.

The Secretary of State has been clear that he intends to increase the proportion of spend going to general practice – and is mindful of trying to end ongoing collective action from disgruntled GPs. On the heels of a pre-Christmas announcement of a £889 million boost in general practice funding for 2025/26, he seems to be following positive rhetoric with reality.

Improving patient experience

It’s a rare day for me in general practice if a patient doesn’t complain about their experience on a waiting list. Too often, people are left for months without communication, wondering if they’ve made it on a list at all. Too many appointments get cancelled – and rescheduled for months away. Sometimes, appointment letters arrive after appointment dates. GPs and our teams become intermediaries – an inefficient use of our time, but understandable from a patient perspective.

On this too, the plan is positive. It starts by promising to get the basics right – people getting speedy confirmation that their referral is received, being told what will happen next, and how long they can expect to wait. GPs will particularly welcome plans to connect patients with hospital admin services, and will hope this cuts out the go-between role. For many patients, improving digital interfaces, including the NHS App, will help. But the rhetoric in the plan about minimising the risks of digital exclusion is important too.

Other parts of the plan seem more complex though. Few would argue against patients being offered a choice of providers for their referral, and being given information on things like waiting times to help them decide. But I don’t currently have access to that sort of reliable real-time data. GPs in other areas may do, and this is a plan, so it’s not intended to reflect what’s currently happening. But it would be easy to underestimate the complexity of getting this sort of information readily available at the fingertips of referring clinicians, and routinely used in already time-pressured consultations.

This isn’t a plan for everyone

GPs will also be mindful that the elective recovery plan isn’t a plan for everyone waiting for NHS specialist care. Its remit is tackling waiting times for hospital care. But there are over a million referrals on waiting lists for services run by community trusts. Those include many mental health services, community paediatric services, and a myriad of teams – like community nursing, bladder and bowel services and rehabilitation services – who help people stay well at home. The government has made tackling hospital waits a political priority, but GPs and the many people waiting for community care will hope that this doesn’t come at the expense of improvements in other services.

Tackling demand matters too

Rising demand from an ageing population makes reducing the rate of referrals to hospitals seem unrealistic. But taking action to bend the curve matters too. This requires a range of interventions beyond the remit of this plan. Helping people to stay well and active for longer means boosting spend on prevention and on primary care more broadly. It also means tackling health inequalities – and inequity in the distribution of NHS services. This aligns with government plans to shift more care to the community. But NHS finances are exceptionally tight and there are tough trade-offs to be made.

Promisingly, the elective recovery plan starts to link these ambitions – recognising that reducing hospital waiting times can include (and reward) primary care too, and that specific measures to tackle health inequalities should be included in all NHS policy. GPs will welcome attempts to improve patient experience, and free up more GP time to spend with patients. It shouldn’t come at the expense of other much-needed interventions to boost primary care, but if this plan achieves its aims, there will be benefits for patients through general practice too.

Dr Becks Fisher is Director of Research and Policy at the Nuffield Trust, and a GP in Oxford.

Suggested citation

Fisher R (2025) “The elective recovery plan: a view from general practice”, Nuffield Trust blog

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