Senior doctors could face rising  demand under planned care advice reforms without dedicated time in job plans, warns  the RCP

The Royal College of Physicians (RCP) has responded to new NHS England figures showing a rapidly growing number of Advice and Guidance requests reiterating calls for dedicated time in senior doctor job plans.

NHS England figures released last week show that demand for Advice and Guidance (A&G) continues to grow. In February 2026, the total number of requests for pre-referral specialist advice stood at 305,000, an increase of 26% from the same period last year. Across all types of specialist advice, total requests reached 1.1 million, nearly a two-fold increase since records began in April 2022.

From this month, as a result of changes being introduced in the 2026/27 GP contract, GPs will be required to use A&G ahead of most planned care referrals where clinically appropriate. This means A&G will be an increasingly key part of many referral decisions and is expected to increase demand for specialist input.

The RCP is warning that without dedicated time in job plans, these changes risk increasing demand on specialist services at a time of intense system pressure.

Evidence from the RCP’s February 2025 snapshot survey found that many senior doctors lack the capacity, time and resources to take on A&G work:

• 80% of respondents delivered A&G, yet half (50.2%) said they have no time in their job plan allocated for this work.

• Of those who said they had job-planned time, only 52.2% felt the time was adequate, while 47.8% said it was not.

Dr Hilary Williams, clinical vice president at the Royal College of Physicians, said:

'Senior doctors recognise the benefits of A&G to support better triage of patients. However, every request takes time away from direct clinical care, adding to an already heavy workload and raising the risk of burnout.

'Government needs to make clear how they plan to manage the increased pressures on senior doctors in secondary care who will be expected to respond to these requests.Dedicated time in senior doctor job plans and adequate administrative support is vital to ensure that these reforms do not place even greater pressure on teams already struggling to meet the demands of delivering safe, timely, planned specialist care.'

As requests for A&G increase, some patients may face longer waits for specialist assessment. This is because the same workforce is expected to maintain direct clinical services while absorbing growing volumes of A&G activity, a challenge that will likely be especially seen in more deprived areas already facing significant staffing gaps. This can allow conditions to worsen and potentially increase presentations to the health service elsewhere, such as A&E.

The RCP responded to figures last week showing that March 2026 was the busiest month ever A&E attendances in England.

Professor Mumtaz Patel, president of the Royal College of Physicians said:

'Our concern is that if patients face delays in accessing specialist input, conditions may worsen before the right care is provided. When that happens, people can end up seeking help in emergency care because they feel they have nowhere else to turn. These reforms must not create new barriers to timely specialist care or inadvertently push more patients into an already overstretched urgent and emergency care system.'

The RCP says that the UK government and NHS England must ensure that the 10 Year Workforce Plan fully accounts for the impact of growing A&G activity on medical specialist capacity.

Professor Patel added:

'If A&G is to remain a central part of the government’s reform agenda, modelling in the 10 Year Workforce Plan must reflect the reality of the time senior doctors spend reviewing and responding to these requests. It must also consider flexible job planning so that senior doctors have dedicated, protected time for A&G built into their roles. Without this, rising A&G demand risks further stretching a workforce that is already under immense pressure.'