Mandating second opinions has angered UK GPs. But is the heart of the policy in the right place?

Do doctors need more help, more scrutiny or both?

NHS England is facing a GP uproar after essentially mandating that GPs seek a second opinion from a non-GP specialist before referring patients to a hospital by using its digital Advice and Guidance (A&G) system.

A&G has existed as a voluntary system for 10 years, with GPs receiving about $38 per use.

Since the backlash, the NHS has dropped a goal to slash referrals by 25%. But the A&G mandate remains.

Similar but voluntary systems operate in the Netherlands, parts of Canada and one Australian state: Queensland.

The eConsultant program at Mater Health in Brisbane lets GPs lodge clinical questions and receive an answer generally within a day.

Founded in 2018, it received $6 million in taxpayer funding in 2025 to cover the whole state until 2028.

Founder Professor Claire Jackson, a GP, said the service was taking 60 questions a week and growing fast.

“I think there was a real urgency here in Queensland, because we are such a large state,” she told AusDoc.

“Face-to-face outpatient department referrals have lots of costs — acceptance criteria, reviewing time, triage, admin, booking, appointments and rebooking — and removing all that can take out an enormous amount of spending from any system and improve access.”

According to its own reserch from 2021, the team says an e-consult costs about $226 compared with $587 for a standard specialist appointment.

Professor Jackson, a former RACGP president, said their were early concerns about GPs overusing the service as a “phone-a-friend” option rather than its goal of “outpatient substitution”.

“But I have been floored at how appropriate GPs are at observing that,” she said.

“Only 8% of requests for advice move to an OPD face-to-face. That’s because GPs aren’t making requests when the patient clearly needs a face-to-face assessment, which would just waste time.

“I think we understand in general practice that these services are enormously helpful. We want to make sure that we don’t overwhelm them.”

That Queensland GPs have picked the right cases shows that mandating A&G is the wrong move, Professor Jackson said.

“It indicates flawed thinking … the patient and the GP should be the ones to decide whether advice alone will assist them in solving a clinical dilemma.”

Outside of Queensland, a handful of public and private hospital networks have similar systems.

Victoria has now announced it is joining in, with its government revealing in yesterday’s budget that it would set up a program called “Specialist Advice Now.”

The WA Government also announced in February 2025 that it was planning to pilot its own system, but details have no been released since.

A company called Consultmed has launched systems at the Sydney Children’s Hospitals Network and the South Western Sydney Local Health District.

Founder Associate Professor Vikram Palit told AusDoc that it was modelled on A&G.

The Melbourne respiratory paediatrician said governments were interested because of the capacity to reduce the costs of specialist care.

“There are lots of commonsense options that it brings,” he said.

“Something that stuck out to me during my time in England was simply a specialist being able to say, ‘I’ve accepted the referral and here’s what the patient could do in the community until I see them in a month.'”

He said it was too early to discuss a mandatory system.

“What I think we should look to England for is incentives for GPs to request advice,” he said.

“Paying them for their time makes a lot of sense and will help.”

Some experts believe A&G should be mandatory — but not for GPs.

Dr Luke Slawomirski, a health economist and former clinician, suggests a mandatory system for non-GP specialists planning risky or potentially unnecessary procedures.

Allegations that Victorian gynaecologist Dr Simon Gordon carried out unnecessary procedures that left patients infertile demonstrated the need for double-checks, said Dr Slawomirski, from the progressive think tank The Australia Institute.

“High risk, high-cost procedures — certain gynaecological procedures, spinal surgery, and any elective interventions that require a surgeon, anaesthetist and long rehabilitation where viable alternatives exist — would benefit from a review process,” he said.

To avoid US-style insurance company gatekeeping, an independent specialist should provide the second opinion, he said.

Rather than prior authorisation, he said it should be considered peer review.

“Doctors respect each other, and I think the best way to do this is to have this interprofessional level rather than dealing with an insurer or Medicare,” he said.

“We are already importing the bad things from the US which has terrible outcomes despite the money spent — like outsized spending on acute care, compared to prevention and primary care.”