The NHS has an ambition to reduce waiting times at hospital clinics by reducing the number of referrals. The cheapest way is to deal with some cases by a written exchange of information between a general practitioner and a specialist through advice and guidance (A&G) in electronic systems. The GP will write a brief outline of the case, including a clinical question, and the specialist will respond. At a NHS England board meeting in early February, the national director for planned care identified A&G as a cornerstone of "ambulatory transformation". It will become mandatory in the top 10 majors in each region. This has raised concerns about whether A&G will be available in these specialties and whether a specialist will decide whether to offer a patient a test despite a GP recommendation.