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Preparing for SPoA: What acute NHS providers need to know
This article is part of our Opinions section, where we invite industry professionals to share their views on the most pressing technology questions of our time.
Reforming elective care is a central focus of the NHS Medium Term Planning Framework – a mission that aims to meet 92% of 18-week referral-to-treatment targets by the end of 2028/29, improve performance against key cancer standards, and accelerate diagnostic waiting times so the rate of those waiting more than six weeks is 1%. Success is naturally multi-layered, but it hinges heavily on reducing delays at the very front of the patient pathway.
Advice & Guidance (A&G) has already done much to give GPs earlier access to specialist input, which, in turn, improves the pace and accuracy of referrals. However, it sits alongside a patchwork of other access routes into secondary care, and with every extra handoff comes increased variability in triage logic and greater risk of delay. Elective single point of access (SPoA) is being introduced to close this gap. The model, which will be rolled out nationally via integrated care boards (ICBs), directs all A&G requests and elective referrals into a single digital entry point per specialty level, ensuring every case receives the same standard of consultant-led clinical review before the most appropriate next step is determined.
Yet, with acute providers expected to have it live in at least 10 priority specialties by October 2026 – and the broadest feasible coverage across the rest by March 2027 – the challenge is delivering such a redesign at pace, against technical updates still being finalised, and just as winter pressures increase.
How elective SPoA will reshape healthcare delivery
Elective SPoA is, in essence, a consolidation exercise. Today, a GP seeking specialist input or wanting to refer a patient must choose between several separate digital pathways within the e-Referral Service (e-RS) – including A&G, Referral Assessment Services (RAS), Clinical Assessment Services (CAS), and Directly Bookable Services (DBS) – each configured differently by each trust and specialty. There is no national standard for how quickly a request is answered and by whom, and no consistent rule for which route a given case should take, which means response times and rejection rates can differ drastically.
With SPoA, NHS England is effectively seeking to turn this piecemeal amalgamation of routes into the same door of secondary care, built up over a decade, into one. GPs can direct enquiries into a given specialty through one channel, reviewed to one consistent, consultant-led standard. So, while the referral decision is not qualified, wherever a referral lands, responsibility for mapping it to the right outcome – be it advice back to primary care, a straight-to-test booking, or a transfer to another SPoA – sits with the system, and not the individual referrer, removing the concept of the ‘wrong door’ and alleviating pressures. And, because the referral to treatment (RTT) clock also moves earlier for accepted referrals or straight-to-test, beginning on the date SPoA receives the request rather than the date it is triaged or booked, waiting-time risks are pulled firmly to the front end of the process.
However, this change arrives at a time when the e-RS platform itself is mid-transition. The e-RS A&G service functionality only reached trusts in a phased rollout between April and July 2026, with further technical improvements built for elective SPoA not expected until October 2026 – the same month by which acute providers must have the model running in at least 10 priority specialties. The challenge is therefore not simply to redesign clinical pathways, but to do so around infrastructure that is still being finalised. Yet, as seasonal pressures compound for acute trusts, operational pressures are no less demanding.
What is required of secondary acute trusts and by when
A&G was the opening move for this transition. From April 2026, providers of RTT consultant-led care were required to prioritise it across at least 10 specialties – selected locally in collaboration with commissioners, GPs, and interface groups based on which locations would deliver the greatest benefit – with all relevant digital A&G channels open and fully live by the end of June.
The move to elective SPoA is the next phase, and is a considerably larger undertaking for three reasons. First, the scope covers every elective referral in each specialty, not just A&G requests in isolation, so trusts must redesign the entire front door rather than one pathway through it. Second, instead of the parallel routes described above, it requires a specialty-level (or, for larger specialties, sub-specialty-level) entry point, with the service types it replaces progressively worked out of use. Third, it requires workforce capacity – change does not exist if it does not have dedicated, job-planned consultant time set aside specifically for review, which needs carving out from other activity.
This particular set of requirements must converge by 1 October 2026, when acute providers are mandated to have consultant-led clinical review running for every A&G request and elective referral (excluding urgent suspected cancer) across their 10 priority specialties, delivered through that single digital entry point. Since July, any A&G request from general practice handled directly within the e-RS user interface has had to go through the e-RS itself, but trusts routing those requests via an integrated third-party platform have had until October to meet the same standard. The whole model must also operate against a new series of national processing standards attached to it by NHS England, including a five-working-day response for A&G requests and routine referrals, and two working days for anything urgent.
October is not the end point either. NHS England expects providers to keep extending elective SPoA beyond those initial 10 specialties by March 2027, reaching the broadest feasible coverage across all specialties and sub-specialties. Within these locations, DBS, RAS, and CAS must also all be decommissioned unless an exception is agreed.
Why it is not enough to rely on the e-RS alone
e-RS is the national referral route and digital front door set to help deliver such a standardised approach, and the platform improvements NHS England has committed to – including integrated search red flags, standardised Directory of Services mapping, and structural clinical intent parameters for A&G – will only prove more useful as they unfold. However, infrastructure is not the same as a robust operating model, and this platform alone will not deliver everything an effective SPoA needs.
Trusts require clear, named ownership of every case as it moves through review, including who holds it and how long it has been waiting, so nothing sits unactioned. They need structured clinical queues that make the two- and five-day standards manageable at a volume that is only growing, ageing and escalation processes for cases at risk of breaching them, consistent capture of the clinician’s decision and rationale, and performance reporting that ties back to demand and capacity planning – plus a way of coordinating with PAS, EPR, and community systems that sit either side of e-RS. And it will not build any of this capability on the trust’s behalf; each element must be configured and owned locally, specialty by specialty.
This is the gap clinical workflow automation is increasingly being asked to fill. It is not a replacement for e-RS, because this remains the nationally mandated referral route and the system of record for referral receipt dates and, in turn, the RTT clock start within the PAS. Instead, it adds a critical operational layer that turns a national mandate into something a trust can see, manage, and evidence day to day. These tools can integrate directly with e-RS to bring referrals and A&G requests into a structured workflow, helping clinical and operational teams prepare cases, manage review queues, track case age against the national standards, and record the clinician’s decision and rationale as each case progresses towards its agreed next step. It doesn’t make clinical decisions – that remains with the reviewing clinician – but it does give trusts the operational visibility that is mandatory yet e-RS, on its own, doesn’t provide.
Getting set for the national SPoA rollout
Elective SPoA doesn’t change the fundamental ambition set out in the Medium Term Planning Framework – an NHS that gets patients the right care, first time, without the delays that have historically accumulated at the front of the pathway. In fact, this is the mechanism through which NHS England hopes to achieve it, providing a clear, consolidated, and standardised route for managing the receipt, triage, and management of specialist advice and referrals.
The news is as positive for acute providers as it is for patients – less ambiguity over where a referral belongs, projected and recognised time for the consultants reviewing them, and fewer of the duplicated, rejected, or misdirected referrals that generate rework. However, success ultimately depends on the operational groundwork trusts build around e-RS infrastructure – work that is considerable, but achievable, with the right partner and technology in place.
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