Advice & Guidance – supporting GP resilience?

Advice & Guidance offers a platform for re-establishing the relationship between primary and secondary care, while improving capacity to manage demand across the NHS. 

“Direct communication by GPs with hospitals has been in slow decline for years; gone are the days where a GP could call a Consultant and ask for advice; email is now the preferred approach, but often it does not lead to the advice required.” (Anonymous GP).

In the past, GPs have benefited from a close relationship with Consultants in their local Trusts.   However, as resources have failed to keep pace with increased demand, the capacity for such requests has diminished. Understanding pressures in general practice, published by The King’s Fund in May of this year, revealed first hand some of the challenges GPs experience in relation to secondary care.

In 2014/15, GPs made more than 13 million referrals to hospital for elective care. We believe that this figure could be significantly reduced were a robust advice & guidance used more widely. In fact, in some specialties, we estimate outpatient referrals could be halved. The key is delivering a service that provides the right advice, in a timely manner, and in a form that is easily accessed by all GPs.

Differing approaches?
The design of an advice & guidance service will depend largely on local contracts.  Fundamentally, however, you would expect it to be delivered in one of two ways; desktop review, or a request via a single-point of access. Desktop review provides GPs with an opportunity to make an instant request, possibly during a consultation to a specialist, who is able to respond within minutes. The advantage of this approach is of course that the patient, and GP, receive specialist advice during their consultation. The challenge is ensuring that appropriate resources are in place to respond.

The alternative approach is for GPs to make a request in much the same way as they would a referral, by sending it to a local referral management service or single-point of access. This request would result in a detailed response, including a management plan where appropriate, in a pre-approved time frame.  In an NHS England publication on good practice for demand management, several examples of this latter approach are cited.  They have achieved positive outcomes for all stakeholders.

Cambridgeshire and Peterborough CCG, for example, has reported that all 105 GP practices are using an advice & guidance service with four providers, as well as community services. The result? A significant reduction in referral rejections, cancelling of outpatient appointments and, GPs have benefited from an additional education resource.  Of the 7,865 requests made in 2015/16 only 30% of patients went on to require an outpatient appointment.

Advice & guidance if properly implemented and administered has the ability to reaffirm the relationship between primary and secondary care. While improving capacity to manage demand right across the NHS.