Your GP referral went to “Advice & Guidance”? It's not a rejection.

Advice & Guidance (A&G) lets your GP put a question to a hospital specialist without a formal referral. The specialist reads your details and responds — often suggesting a test your GP can arrange, a treatment to try first, or confirming that yes, you need to be seen and should be referred. It happens behind the scenes, usually through the same electronic system GPs use to refer.

The key thing to understand: A&G is a step before a referral, not a decision to refuse one. It exists to get you the right care faster when a full outpatient appointment isn't needed — and to make sure a referral, when it is needed, is the right one.

From April 2026, NHS England made A&G mandatory: GP practices must use it “prior to or in place of a planned care referral where clinically appropriate” across 10 high-volume specialties agreed locally. The goal is to ease pressure on overloaded outpatient clinics — the government has set a target to divert up to one in four (25%) of these referrals by 2027, and to help more patients start treatment within 18 weeks.

That's why more people are hearing “I'm sending an advice request” where, a year ago, they'd have been referred straight away. Sources: NHS England Advice & Guidance enhanced service and the 2026/27 GP contract diversion target.

• It is not a rejection.A&G does not stop a referral that is clinically necessary. If you need to be seen, your GP can still refer you.
• The 18-week clock hasn't started. Your Referral-to-Treatment wait only begins when a formal referral is made — not while an advice request is open. Ask your GP roughly how long a specialist response is expected to take.
• Your Right to Choose is intact.When you are referred, you keep the legal right to choose which hospital or clinic you're sent to in England, including one with a shorter wait.
• You can push back.If your problem is being managed with advice when you feel you need to be seen, say so plainly and ask for a formal referral or a clear explanation of the specialist's reasoning and timeframe.

1. Ask your GP two questions:what did the specialist advise, and how long until a response or referral is expected? A&G responses can take days to weeks.
2. Be specific about symptoms.If things are affecting your daily life or getting worse, describe that clearly — it's the information that turns an advice request into a referral.
3. If you're referred, compare your wait. Waits for the same specialty vary hugely between trusts, and you can legally choose a faster one:

Compare NHS waiting times by specialty and trust

How your Right to Choose works

Advice & Guidance is for routine, planned care. If your symptoms are severe or getting rapidly worse, don't wait on an advice request — contact NHS 111 (or 111 online), and call 999or go to A&E in an emergency. A&G is never a reason to sit on a serious problem.

Is Advice & Guidance the same as my referral being rejected?

No. Advice & Guidance means your GP has asked a hospital specialist for advice before, or instead of, sending a formal referral — not that a referral was refused. The specialist might suggest a test, a treatment your GP can start, or agree that a referral is needed after all. It is a step in the process, not a rejection, and it does not stop a referral that is clinically necessary.

Why did this change in April 2026?

From 1 April 2026, NHS England made Advice & Guidance mandatory for GP practices to use 'prior to or in place of a planned care referral where clinically appropriate' across 10 high-volume specialties agreed locally. The aim is to reduce demand on outpatient clinics — the government has set a target to divert up to one in four (25%) of these referrals by 2027 and help more patients start treatment within 18 weeks.

Can I still be referred if I need to be?

Yes. Advice & Guidance is designed to sit before a referral, not to block one. If your symptoms clinically need a specialist, your GP can and should still refer you. If you feel your problem is being managed with advice when you need to be seen, say so clearly and ask your GP to make a formal referral or to explain the specialist's reasoning and expected timeframe.

How long does an Advice & Guidance response take?

It varies by area and specialty — a specialist reply can take anywhere from a few days to a few weeks, and it is not the same as being on a waiting list. Importantly, the 18-week Referral-to-Treatment clock only starts when a formal referral is made, not while an advice request is open, so ask your GP roughly how long a response is expected to take.

Once I'm referred, can I choose which hospital I go to?

Yes. In England you have a legal Right to Choose which hospital or clinic your GP refers you to for most planned (elective) care, including choosing one with a shorter wait. Advice & Guidance does not change that right — it applies at the point a formal referral is made. You can compare every English trust's waiting time for your specialty on this site first.

What if I disagree with the advice my GP was given?

Ask your GP to talk you through what the specialist advised and why. You can ask for a formal referral, ask for a second opinion, or ask to be referred to a different provider. If a serious condition might be being missed, be specific about your symptoms and their impact — and seek urgent care (111, or 999 for an emergency) if things are getting rapidly worse.

Everything on HospitalWaits comes from published NHS data, with every figure linked to its source. Advice & Guidance itself has no patient-facing waiting-time dataset — it happens between your GP and a specialist. What we can do is explain it honestly and, the moment your referral is made, show you exactly where the shortest wait is.