Published 25 April 2026 | NHS Policy & Primary Care Interface
NHS England wrote to GP practices, ICBs and trusts on 22 April 2026 to set out what the elective single point of access (SPoA) model means in practice. For many GPs, the model has felt opaque — and in some areas it has already generated real friction. This article unpacks what the letter says, what it means for your practice, and what you should expect from secondary care.
What Is Elective SPoA?
The SPoA model brings specialist advice requests and outpatient referrals together through a single route, with triage happening at speciality or sub-speciality level. The stated goal is straightforward: patients who don't need a hospital appointment shouldn't wait months for one only to be told that. Where a specialist can provide a clear management plan, a diagnostic pathway, or direct primary care to the right tests, that should happen promptly — without an outpatient slot being consumed unnecessarily.
That principle is difficult to argue with. The problem, as GPs have been pointing out, has been the execution: inconsistent responses, generic advice that ignores clinical context already provided, and the perception that advice and guidance is being used as a gatekeeping mechanism rather than a clinical tool.
Your Clinical Judgement Remains Unchanged
Dr Amanda Doyle is explicit: "A GP’s clinical decision to refer remains unchanged." The model is intended to support decision-making, not override it. This is an important line to hold onto if you find yourself in a local dispute about whether a referral was appropriate.
On the “25% Diversion” Figure
There has been real anxiety about language in the neighbourhood health framework implying a target to divert at least 25% of referrals away from hospital. NHS England is explicit in this letter: there is no national diversion target.
The 25% figure is described as an estimate of the proportion of patients who could clinically be assessed without a hospital appointment — not a quota for secondary care to hit, and not a performance measure that should influence GP referral behaviour.
What You Should Now Expect from Secondary Care
The letter sets out operational standards that trusts are required to meet. These are worth knowing — they give your practice something concrete to reference if the local SPoA is not functioning well.
Response Timescales
5 working days
From receipt of referral to next step actioned
2 working days
From receipt of referral to next step actioned
5 working days
From receipt of request to response
Clear Next Steps Required
Every response from secondary care must include one of the following — vague or non-specific advice does not meet the standard:
✓ Outpatient appointment
Where the patient genuinely needs to be seen
✓ Straight-to-test pathway
Diagnostics organised and acted on by the trust
✓ Primary care diagnostic advice
Where the GP specifically requested guidance on tests
✓ Clear specialist advice
Patient-specific, actionable, and from a named consultant
Named Consultant Accountability
All referrals and specialist advice requests must receive a response from a named consultant with clear accountability. This is a minimum standard. Where local models already provide timely specialist assessment with consultant oversight, those may continue — but the named accountability principle applies regardless.
The Diagnostics Rule — Read This Carefully
One of the most practically significant clarifications in the letter concerns who arranges tests following a specialist assessment:
This directly addresses a persistent frustration: tests being requested via advice and guidance responses but then left for the GP to chase, book, and interpret — often without the specialist context needed to act meaningfully on the result. If it is part of the specialist pathway, it is secondary care’s responsibility.
Co-Design: Your Practice Has a Right to Be Involved
Trusts and ICBs are required to involve local GPs, LMCs and interface groups in the design and ongoing refinement of SPoA pathways. NHS England acknowledges that where this is genuinely happening, outcomes are better for both sides of the interface. Where it is not, the model creates more friction than it solves.
If you are not being meaningfully consulted on pathway design — particularly for high-volume specialties — that is worth raising formally through your LMC or PCN clinical director. The letter gives local GP leadership structures an explicit mandate to push back.
What to Do If Your Local SPoA Isn’t Working
Where concerns arise, NHS England expects them to be resolved through local governance first. Where that fails, NHS England has indicated it will step in to support review. In practice, that means:
Keep a record of responses that are non-specific, refuse appropriate referrals, or return diagnostics to general practice without justification. Specifics are what governance processes need.
This letter gives GP leadership structures a formal mandate. Use established channels rather than absorbing the problem practice by practice.
NHS England is planning a national webinar for general practice co-led by primary and secondary care clinicians. There is also an NHS CEO event on 28 April 2026 at which GP clinical representation will be present.
Final Thoughts
NHS England’s letter contains real reassurances: no diversion targets, unchanged clinical referral thresholds, named consultant accountability as a minimum standard, and a clear rule that secondary care-initiated diagnostics stay in secondary care. Those commitments matter.
But what will determine whether SPoA helps or harms general practice is whether trusts and ICBs implement it faithfully — and whether the GP voice in co-design conversations carries genuine weight, or becomes tokenistic. Engage with the co-design process early, document problems when they arise, and if what you’re experiencing locally doesn’t match what this letter promises, escalate with evidence.
Source: NHS England — Specialist advice and elective single point of access: what this means for you and your patients, Dr Amanda Doyle OBE MRCGP, 22 April 2026.