From the Guardian today, the above and:

Cancer diagnoses have been missed or delayed because of a system designed for GPs to seek specialist advice before referring patients to hospital, according to an investigation.

The Health Services Safety Investigations Body (HSSIB) identified patient risks linked to how advice and guidance (A+G) services have been implemented across England.

A+G was brought in to slash unnecessary hospital visits and reduce waiting times, allowing family doctors to seek specialist input before making referrals.

However, the investigation found evidence that A+G had “contributed to near misses and incidents of patient harm, both physical and psychological” where it had been poorly implemented or monitored. https://www.theguardian.com/society/2026/aug/18/gps-advice-service-is-causing-cancer-diagnoses-to-be-missed-inquiry-finds

The English Advice and Guidance (A&G) scheme was introduced primarily to reduce unnecessary hospital referrals and outpatient appointments, ease pressure on secondary care, and help manage growing waiting lists by enabling GPs to obtain specialist input before (or instead of) referring patients. It has faced significant criticism, particularly from GPs, the British Medical Association (BMA), some medical royal colleges, Local Medical Committees (LMCs), and more recently the Health Services Safety Investigations Body (HSSIB).

Main areas of criticism:

• Patient safety and delayed diagnoses: The August 2026 HSSIB interim report found evidence that poorly implemented or monitored A&G contributed to near misses, physical and psychological harm, delayed or missed diagnoses (including in some suspected cancer pathways), and delays to care/treatment. It noted cases where A&G was used even when GPs had requested specialist assessment for suspected cancer. https://www.hssib.org.uk/patient-safety-investigations/electronic-patient-record-systems-electronic-referrals-for-ongoing-care/interim-report/
• GP workload and “workload dump”: Many GPs and LMCs describe it as transferring work from secondary to primary care without adequate resources or time. Surveys (e.g., by Pulse) have reported that roughly a quarter of referrals are returned as unsolicited A&G, and a substantial share of responses ask GPs to undertake work they consider outside their remit. Specialists have also reported completing A&G responses in their own time due to lack of dedicated job-plan capacity. https://www.theguardian.com/society/2026/aug/18/gps-advice-service-is-causing-cancer-diagnoses-to-be-missed-inquiry-finds
• Inconsistent implementation and perceived mandating: Critics argue it has been rolled out unevenly, with some local pathways effectively requiring A&G before (or instead of) direct referrals, referrals being rejected or downgraded despite GP concerns, and variable response times. There have been worries about loss of clinical autonomy, medicolegal accountability, and risks to urgent cases. The BMA and LMCs have repeatedly expressed “deep concern” since its wider introduction and, in some cases, advised practices to limit engagement where it is not clinically helpful. https://www.theguardian.com/society/2026/aug/18/gps-advice-service-is-causing-cancer-diagnoses-to-be-missed-inquiry-finds
• Other concerns: The Royal College of Physicians has warned that over-reliance can lead to diagnostic delays (especially for complex or multimorbid patients) and does not fully address primary–secondary care fragmentation. Parliamentary scrutiny (e.g., Public Accounts Committee) has criticised insufficient tracking of costs, benefits, and outcomes. https://www.pulsetoday.co.uk/news/clinical-areas/dermatology-and-wound-care/reliance-on-ag-risks-diagnosis-delays-and-fragmentation-says-rcp/

The scheme, publicly championed by Wes Streeting was not introduced in Scotland.