Written questions by Evans.

What assessment he has made of the potential impact of digital case management systems on tackling CVD.

The Government is aware of the need for robust digital case management systems to identify, monitor, and track individuals who are at risk or who are living with cardiovascular disease.As stated in the 10-Year Health Plan, to accelerate progress on the Government’s ambition to reduce premature mortality from heart disease and stroke by 25% in the next 10 years, a new Cardiovascular Disease Modern Service Framework will be published in spring. The framework will support consistent, high quality, and equitable care, whilst fostering innovation across the cardiovascular disease pathway in line with the Government’s three key shifts, from hospital to community, from sickness to prevention, and from analogue to digital.We are engaging with key stakeholders, including National Health Service leaders, on priorities for the modern service framework, such as the role digital case management systems could play to support efforts to tackle cardiovascular disease.

What conversations he is having with NHS leaders about [i] the future of the PASS system and [ii] the role of digital case management system to support efforts to tackle CVD.

We are aware of the need for robust digital case management systems to identify, monitor, and track individuals who are at risk or are living with cardiovascular disease, including opportunities systems such as the Pedigree and Cascade Screening System may present.To accelerate progress on the Government’s ambition to reduce premature mortality from heart disease and stroke by 25% in the next ten years, a new Cardiovascular Disease Modern Service Framework will be published in spring. The framework will support consistent, high quality, and equitable care, whilst fostering innovation across the cardiovascular disease pathway.We are engaging with key stakeholders, including National Health Service leaders, on priorities for the modern service frameworks, to support efforts to tackle cardiovascular disease.

If he will assess the role of digital case management CVD prevention systems in supporting efforts to facilitate trends in [i] moving from hospital to community care and [ii] analogue to digital care.

The Government is aware of the need for robust digital case management systems to identify, monitor, and track individuals who are at risk or who are living with cardiovascular disease.As stated in the 10-Year Health Plan, to accelerate progress on the Government’s ambition to reduce premature mortality from heart disease and stroke by 25% in the next 10 years, a new Cardiovascular Disease Modern Service Framework will be published in spring. The framework will support consistent, high quality, and equitable care, whilst fostering innovation across the cardiovascular disease pathway in line with the Government’s three key shifts, from hospital to community, from sickness to prevention, and from analogue to digital.We are engaging with key stakeholders, including National Health Service leaders, on priorities for the modern service framework, such as the role digital case management systems could play to support efforts to tackle cardiovascular disease.

What assessment he has made of the compatibility of NHS England's policy of mandatory Advice and Guidance and Elective Single Point of Access with NHS England's Patient Choice Guidance published December 2023.

The policy intention for Advice and Guidance (A&G) and the Elective Single Point of Access (SPoA) model is fully compatible with NHS England’s Patient Choice Guidance, published December 2023. Patients must continue to be offered a choice of provider at the appropriate point in the pathway, and local pathways should be designed to ensure that choice rights operate in practice.The purpose of A&G is to support decision‑making, reduce unnecessary referrals, and deliver more care closer to home. SPoA acts as a single ‘front door’ to support clinical triage to the most appropriate service or outcome, meaning timelier, more joined-up care for patients, without altering patients’ statutory right to choice.NHS England has published system guidance The Elective Single Point of Access: Technical Guidance for 2026/27, which specifies that patients must continue to be offered choice of provider and team at the appropriate point in the pathway when they can make an informed choice. An elective SPoA diagram showing touchpoints of choice is included in the technical guidance annex.

What assessment he has made of the trends in the level of (a) staff take-up and (b) trends in staff feedback to the mental health support offered to NHS England staff teams as the closure of NHS England takes place.

In addition to the routine review of mental health services, and specifically the employee assistance and occupational health services which highlight needs of colleagues that are mental health related, the engagement level for both services is tracked. Trends in the level of colleague uptake of services, by type and satisfaction levels, and trends in staff feedback to the mental health support offered to NHS England colleagues is monitored and reviewed through established governance arrangements, including feedback provided from trade union partnerships and staff networks, to ensure that the provision is meeting existing demand and forecast projections.An expert panel has been recently engaged to assess the trends, including the level of colleague uptake and feedback, to make recommendations within the context of the closure of NHS England and potential impact on colleagues. The panel will inform decisions on whether further support for colleagues should be put in place in 2026/27.

Whether assessments of trends in the level of provision of mental health support for (a) senior NHS England leaders and (b) wider staff teams as the closure of NHS England is taking place.

NHS England has robust people management infrastructure in place. This includes an annual appraisal process which incorporates risk assessments for all colleagues. There is a broad set of provisions for mental health support which includes an independent external Employee Assistance Programme, Occupational Health Services, and the in-house provision of Mental Health First Aiders.This provision is supplemented by a bespoke well-being programme which was developed and implemented in response to the Government’s announcement regarding the closure of NHS England last year and includes webinars and workshops delivered by external and internal mental health experts, the provision of change management, and stress management interventions and toolkits, including Maximum and Able Futures workplace mental health services.Regular reports, including trend data and insights from the providers of mental health services, are regularly reviewed through routine reviews with the providers of the services and established governance arrangements, including the Health and Safety Committee, to ensure that the provision is meeting existing demand and forecast projections.

What data his Department holds on trends in the level of suicides amongst senior leaders in non-clinical roles in the NHS.

The Department does not hold data on the level of suicides amongst the National Health Service workforce.Data relating to numbers of suicides in England and Wales is published regularly by the Office of National Statistics (ONS). ONS occasionally also publishes ad hoc analysis of suicide numbers by standard occupational classifications. Whilst this data does not allow identification of the employer, such as the NHS, it does present suicide numbers by broad occupation categories. The latest ad hoc publication can be found at the following link:https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/adhocs/2726suicidebyoccupationinenglandandwales2023and2024provisionalThere is a wide range of mental health support for all NHS staff. Staff are able to access mental health support through their general practice but can also access support provided by their employer through employee assistance programmes or occupational health. NHS England also offers a range of health and wellbeing resources, including health and wellbeing apps and text support services, and NHS leaders can access the National Staff Mental Health Treatment Service which is available to both clinical and non-clinical staff and is in place to help those with more complex mental health needs. Further information on the National Staff Mental Health Treatment Service is available at the following link:https://www.practitionerhealth.nhs.uk/The service is designed to offer confidential support to NHS professionals, who cannot access confidential support locally.NHS England has also published a national suicide prevention toolkit and postvention toolkit to help organisations introduce prevention strategies and support their workforce, both of which are available, respectively, at the following two links:https://www.england.nhs.uk/publication/working-together-to-prevent-suicide-in-the-nhs/https://www.nhsconfed.org/system/files/2023-03/NHS-employee-suicide-postvention-toolkit.pdf

What assessment he has made of trends in the level of mental health support for senior leaders in non-clinical NHS roles.

The Department does not hold data on the level of suicides amongst the National Health Service workforce.Data relating to numbers of suicides in England and Wales is published regularly by the Office of National Statistics (ONS). ONS occasionally also publishes ad hoc analysis of suicide numbers by standard occupational classifications. Whilst this data does not allow identification of the employer, such as the NHS, it does present suicide numbers by broad occupation categories. The latest ad hoc publication can be found at the following link:https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/adhocs/2726suicidebyoccupationinenglandandwales2023and2024provisionalThere is a wide range of mental health support for all NHS staff. Staff are able to access mental health support through their general practice but can also access support provided by their employer through employee assistance programmes or occupational health. NHS England also offers a range of health and wellbeing resources, including health and wellbeing apps and text support services, and NHS leaders can access the National Staff Mental Health Treatment Service which is available to both clinical and non-clinical staff and is in place to help those with more complex mental health needs. Further information on the National Staff Mental Health Treatment Service is available at the following link:https://www.practitionerhealth.nhs.uk/The service is designed to offer confidential support to NHS professionals, who cannot access confidential support locally.NHS England has also published a national suicide prevention toolkit and postvention toolkit to help organisations introduce prevention strategies and support their workforce, both of which are available, respectively, at the following two links:https://www.england.nhs.uk/publication/working-together-to-prevent-suicide-in-the-nhs/https://www.nhsconfed.org/system/files/2023-03/NHS-employee-suicide-postvention-toolkit.pdf

Pursuant to Question 118267 answered on 13 March on General Practitioners: Contracts, what data will be collected about advice and guidance by NHS England.

NHS England collects and publishes national data on total Advice and Guidance (A&G) activity through the existing system elective recovery outpatient collection, published and available at the following link:https://www.england.nhs.uk/statistics/statistical-work-areas/outpatient-transformation/specialist-advice/This includes total A&G requests sent, processed requests, where a specialist has returned the advice and diversions, where the outcome of A&G is that a referral is not required. This data is also available at provider and integrated care board levels.NHS England also collects data on the above by treatment function, or specialty, and on turnaround times of A&G. These are not published but available to National Health Service providers through the Model Health System. During 2026/27, NHS England will review and expand what measures are published as and when additional data becomes available through the expansion and improvements to the electronic referral system platform.Between April 2025 and November 2025, there were 2,394,266 pre-referral advice and guidance requests, of which 2,210,443 were processed and 1,095,172 have been diverted, which is 45.7% of total requests. Diverted patients may otherwise have had to wait for an unnecessary appointment and instead are expected to receive more timely care with earlier specialist input.

Pursuant to Question118267 answered on 13 March on General Practitioners: Contracts, what evidence is there to support the statement that the changes made to advice and guidance will reduce the number of unnecessary appointments.

NHS England collects and publishes national data on total Advice and Guidance (A&G) activity through the existing system elective recovery outpatient collection, published and available at the following link:https://www.england.nhs.uk/statistics/statistical-work-areas/outpatient-transformation/specialist-advice/This includes total A&G requests sent, processed requests, where a specialist has returned the advice and diversions, where the outcome of A&G is that a referral is not required. This data is also available at provider and integrated care board levels.NHS England also collects data on the above by treatment function, or specialty, and on turnaround times of A&G. These are not published but available to National Health Service providers through the Model Health System. During 2026/27, NHS England will review and expand what measures are published as and when additional data becomes available through the expansion and improvements to the electronic referral system platform.Between April 2025 and November 2025, there were 2,394,266 pre-referral advice and guidance requests, of which 2,210,443 were processed and 1,095,172 have been diverted, which is 45.7% of total requests. Diverted patients may otherwise have had to wait for an unnecessary appointment and instead are expected to receive more timely care with earlier specialist input.

With reference to his Department's publication entitled Changes to the GP contract in 2026/27, updated on 4 March 2025, when will the exact requirements for advice and guidance be published.

As part of the 2026/27 GP Contract, we are embedding the current Advice and Guidance enhanced service funding within core practice funding. The core expectations for general practices (GPs) broadly remain unchanged, and practices will be required to use Advice and Guidance prior to or in place of a planned care referral, where clinically appropriate, and to follow locally agreed referral pathways. As part of the usual annual cycle, NHS England will refresh the operational delivery framework to ensure it remains aligned with the updated contractual requirements. The GP Contract changes for 2026/27 are underpinned by regulations, which will be laid before Parliament in the usual way, alongside an explanatory memorandum. Framework updates will happen in line with, or prior to, regulations coming into force. NHS England will continue to ensure that operational delivery frameworks remain clear, robust, and supportive as the use of Advice and Guidance expands. A draft technical guidance is already available to ICBs to support preparation for implementation.

With reference to his Department's publication entitled Changes to the GP contract in 2026/27, updated on 4 March 2025, at what point during the process of advice and guidance will his Department add a patient to an official NHS waiting list.

Currently, a patient is added to an official waiting list when an Advice and Guidance request is converted into a referral. This will remain the case through part of 2026/27. From October 2026, expanded Advice and Guidance will be routed through a new Elective Single Point of Access (SPoA), in line with the Medium Term Planning Framework. From this point, while a patient will still be added onto a waiting list at the point of the referral being accepted, their waiting time will be calculated from the date the Advice and Guidance request or referral was received by the SpoA.While advice is being sought and acted on in primary care, the general practitioner remains responsible for the patient’s overall clinical care and risk. The specialist is responsible for the quality and appropriateness of the advice they give, not for ongoing management or follow‑up unless they formally take the patient on. Specialist also have clinical responsibility from the point an Advice and Guidance request is converted into a referral or if the specialist initiates investigations or treatment directly.

Pursuant to Question 118267 answered on 13 March on General Practitioners: Contracts, who is clinically responsible for the patient while advice and guidance is being sought; and at what point does that responsibility transfer to secondary care.

Currently, a patient is added to an official waiting list when an Advice and Guidance request is converted into a referral. This will remain the case through part of 2026/27. From October 2026, expanded Advice and Guidance will be routed through a new Elective Single Point of Access (SPoA), in line with the Medium Term Planning Framework. From this point, while a patient will still be added onto a waiting list at the point of the referral being accepted, their waiting time will be calculated from the date the Advice and Guidance request or referral was received by the SpoA.While advice is being sought and acted on in primary care, the general practitioner remains responsible for the patient’s overall clinical care and risk. The specialist is responsible for the quality and appropriateness of the advice they give, not for ongoing management or follow‑up unless they formally take the patient on. Specialist also have clinical responsibility from the point an Advice and Guidance request is converted into a referral or if the specialist initiates investigations or treatment directly.

With reference to his Department's publication entitled Changes to the GP contract in 2026/27, updated on 4 March 2025, whether he has made an assessment of the impact of removing the cap on online requests that can be submitted during core hours on (a) patient safety and (b) GP workload.

The Department has not made a specific assessment of the impact of removing the caps on online requests on patient safety and general practice (GP) workload. Data on online consultation submissions is collected, monitored, and published.This is because there is no change to clinical responsibility, triage processes, or same‑day requirements for clinically urgent care as a result of this clarification. Practices retain flexibility over how requests are prioritised and responded to, including the use of triage models and appropriate response times for non‑urgent requests. Evidence from practices shows that spreading demand more evenly across the day can support smoother workflows and reduce pressure on telephone access, rather than increasing overall workload.The clarification on online access is being implemented alongside wider GP Contract changes for 2026/27, including £485 million in additional core funding and reforms intended to support practice capacity.

What his planned timetable is for publishing operational guidance for the use of Advice and Guidance in the context of the GP contract 2026/27.

As part of the usual annual cycle, NHS England will refresh the operational delivery framework to ensure it remains aligned with the updated contractual requirements. The GP Contract changes for 2026/27 are underpinned by regulations, which will be laid before Parliament in the usual way, alongside an explanatory memorandum. Framework updates will happen in line with, or prior to, regulations coming into force. NHS England will continue to ensure that operational delivery frameworks remain clear, robust, and supportive as the use of Advice and Guidance expands.

If he will ask NHS England to set out the definition of ‘clinically urgent’ for patients who need to be dealt with on the same day in the context of the the GP contract 2026/27.

As part of the 2026/27 GP Contract, we are amending the core contract to explicitly require that requests identified as clinically urgent must be dealt with on the same day. It is for practices to use their clinical judgement to determine which requests are clinically urgent.

With reference to his Department's publication entitled Changes to the GP contract in 2026/27, updated on 4 March 2025, whether the money to fund the practice-level GP reimbursement scheme will be new funding.

Following feedback from the 2026/27 GP Contract consultation, we are introducing a practice-level general practice reimbursement scheme using £292 million of repurposed funding from the current Capacity and Access Payment. This funding will be available to practices to hire additional general practitioners (GPs) or to fund additional sessions with existing GPs to improve access in GPs. This aims to strengthen capacity, access, and improve patient satisfaction, whilst also addressing GP unemployment and underemployment. This is good value for the taxpayer and guarantees the money is spent on GPs.

Whether Advice and Guidance will be mandatory for GPs to use in the context of the GP contract 2026/27.

As part of the 2026/27 GP Contract, we are embedding the current Advice and Guidance (A&G) enhanced service funding within core practice funding. Practices will be required to use A&G prior to or in place of a planned care referral, where clinically appropriate, and to follow locally agreed referral pathways.A&G has shown clear value in supporting timely specialist input, reducing unnecessary referrals, and ensuring patients receive timely care in the most appropriate setting.Between April 2025 and December 2025, A&G has avoided 1.3 million patients being added to waiting lists.

With reference to the GP contract 2026/27, whether every non-cancer referral will need to go through Advice and Guidance.

As part of the 2026/27 GP Contract, we are embedding the current Advice and Guidance (A&G) enhanced service funding within core practice funding. Practices will be required to use A&G prior to or in place of a planned care referral, where clinically appropriate, and to follow locally agreed referral pathways.A&G has shown clear value in supporting timely specialist input, reducing unnecessary referrals, and ensuring patients receive timely care in the most appropriate setting.Between April 2025 and December 2025, A&G has avoided 1.3 million patients being added to waiting lists.

What his planned timetable is for informing children’s hospices of their individual allocations from recent funding announcements.

Children and young people’s hospices have been informed of their allocations for 2026/27 by NHS England. Communications regarding future allocations, for 2027/28 and 2028/29, will be sent once the 2026/27 process is complete.