New guidance on onward referral has been published by the GPC. Changes to the contract in 2016 allowed for onward referral of patients by secondary care clinicians, in certain situations, rather than having to always require referral back to the GP. The guidance is designed to support doctors locally in applying the change appropriately.

As a reminder, new guidance was also published recently by the GPC on the responsibility for prescribing and principles for shared care. All guidance can be found on the BMA website, including the Quality First pages with the template letters to support LMCs and practices in reporting contract breaches.

The GPC know that implementation of the contract measures is still very variable and they will continue to press for improvement. The GPC are currently working with NHS England on a contract implementation toolkit for CCGs, who will be encouraged to work with LMCs and providers.

In the meantime, the GPC would encourage you to continue engaging locally, working with the LMC, to push for the changes to be implemented consistently, and to share any specific challenges. This will enable the GPC to continue bringing it to the attention of NHS England, to ensure the national contract changes are realised locally. Equally it would be very helpful to share examples of good practice so that similar practice can be realised and replicated across England.