The Premises Costs Directions (PCDs) are directions to NHS England from my Rt Hon. Friend, the Secretary of State for Health and Social Care, in relation to reimbursements of certain costs, incurred by General Medical Services contractors, relating to their practice premises, principally notional rent or rent reimbursement, and some day-to-day running costs. The regulations set out the conditions of contractors’ eligibility for notional rent reimbursement, including considerations when there have been premises development or improvement.

The PCDs also provide a mechanism to fund and deliver general practice premises improvements, in the form of grants from commissioners to build extensions and carry out renovations, subject to discretion and available budget.

Data on new or extended primary care premises that have been funded by integrated care boards in England in each of the last five financial years is not held centrally.

The Premises Costs Directions (PCDs) are directions to NHS England from my Rt Hon. Friend, the Secretary of State for Health and Social Care, which provide a mechanism for the National Health Service to fund and deliver premises improvements, in the form of grants from commissioners to build extensions and carry out renovations, subject to discretion and available budget. They also allow reimbursements of certain costs incurred by General Medical Services contractors, relating to their practice premises, principally notional rent or rent reimbursement, and some day-to-day running costs.

We're setting the Advice and Guidance (A&G) clock start so it's the same as outpatient referrals, ensuring no patient will have to wait longer for an appointment as a result of A&G

As set out in the Medium Term Planning Framework, the National Health Service will move toward delivering care through a ‘Single Point of Access’ (SPoA) for all appropriate requests and referrals, excluding for urgent suspected cancer. Under the new SPoA model, if a patient needs treatment, their Referral to Treatment (RTT) clock start date will be calculated from the date the Advice and Guidance (A&G) request or referral was received by the SPoA. This is instead of the current process for A&G, where the clock start date is the date that the request or referral is converted to a treatment pathway. This will ensure that patients' waiting times are accurately reflected.

In February 2026, NHS England issued The Elective Single Point of Access: Technical Guidance for 2026/27 to integrated care boards. This provides guidance on RTT rules and quality assurance arrangements, and advice on establishing leadership and governance structures that ensure SPoA outcomes are assessed regularly. The SPoA will be supported by improvements to the NHS e-Referral Service, which will enable NHS England to collect data on triage outcomes.

SPoA is designed to promote clinical collaboration between primary care referrers and secondary care clinicians, including by facilitating two-way communication and shared decision making. General practitioners (GPs) can re-submit a referral following a SPoA triage outcome if they have concerns about the clinical decision. Escalation routes for concerns about triage decisions will continue to operate through locally agreed referral pathways and communication processes for GPs and patients, supported by improvements to the NHS e-Referral Service. Where patients have concerns regarding outcomes, local Patient Advice and Liaison Service teams can provide advice and support.

The Single Point of Access (SPoA) triage process is consistent with Jess’s Rule.

Jess’s Rule is an NHS England patient safety initiative for primary care. It is designed for general practitioners (GPs) and supports them to reconsider a patient’s presentation and/or diagnosis where the patient has attended a GP three or more times and symptoms have escalated, or the diagnosis is uncertain.

Jess’s Rule can be used to support a GP’s decision on an appropriate referral within the SPoA model. SPoA will provide a more efficient approach to triaging patients, with all appropriate requests and referrals, excluding urgent suspect cancer, flowing through a single ‘front door’. SPoA supports clinical triage to the most appropriate service or outcome, meaning timelier, more joined-up care for patients. Patients will still have a choice about where they receive care.

Safeguards within the SPoA model include senior clinical oversight of triage decisions and the ability for primary care clinicians to re‑escalate concerns where symptoms persist, worsen, or remain unexplained. These arrangements aim to ensure patients who require specialist assessment are not inappropriately managed in the community, and that shared clinical judgement remains central to decision‑making.