A Doctor Writes – What Our Feedback Tells Us

Published: 11th February 2020
In this blog, our Medical Director, Dr David Griffiths, looks at what our regular user surveys can teach us about the use of Advice & Guidance in the NHS.

I have been looking at the feedback from Consultant Connect’s surveys of clinical users to see what we can learn from the reflections of service users. I was interested, and pleased, to see that much of the feedback chimed with my own feelings about the service.

There are several ways in which the ability for primary care clinicians and consultants to communicate in real-time adds significant value for patients and the system as a whole.

The majority of feedback suggested that the phone calls provide useful advice on how to investigate a patient’s condition, including the expected progression; how to manage it, especially regarding the choice and dosing of medication; and how to navigate the system.

Primary care clinicians valued the reassurance of immediate expert advice, appreciating the confidence boost even when it confirmed their initial thoughts. They also described how their patients were comforted by this aspect of the service and there were many references to the advantage of being able to get this type of advice while the patient was still in the consulting room i.e. in real-time. This is supported by other feedback that we have received including the following quote from Dr Andrew Ross, a GP in Lambeth.

“The patient felt put at ease that this was all done whilst he was in the room with me and he did not have to wait or come back. By speaking with the specialist directly in the presence of the patient, I felt that he was more involved directly in his care and decision process and felt comfortable that the advice we were giving was appropriate. From my point of view it felt like a more ‘connected’ approach without the divide between primary and secondary care.” (Read the case study here)

There were many references to improved decision making, where the consultant’s advice had changed the primary care clinician’s mind about which choice to make. This is hardly surprising, after all that is exactly the reason why they use the service: to check their thinking with an expert in a specific field and then use their generalist skills to apply this to the patient’s particular context. The speed with which this can occur and the fact that clinician and consultant can discuss the context, which can often be lost in a letter, has obvious benefits for patients, of course.

The data on the service clearly shows that it reduces both referrals to outpatients and emergency admissions, with different rates across a variety of specialties and there were many comments confirming this. There were also examples where a GP felt that the advice received, while not avoiding referral, had improved the patient’s journey: they had ended up in the right clinic or department first time and often much earlier than they otherwise would have done. Examples of this include the following:

“Housebound lady with PR bleeding, seen in urgent OPC setting within 2 days rather than sent to A&E to wait for hours.” Anonymous

“Consultant arranged to see patient with worsening angina at a clinic the next day rather than her be admitted – which was a huge benefit for the patient.” Anonymous

Clearly this is potentially of great benefit for the patients in question and means that quality care is being delivered but does it mean that consultant advice might make healthcare more expensive? I would argue the opposite. Ensuring that the right thing is done as soon as possible – thanks to streamlined access to an expert opinion – is almost certainly cheaper in the long run for the service as a whole. To read an example of how Telephone Advice & Guidance, resulting in a referral, has benefitted a patient, click here.

One of the most frustrating forms of waste in any system is internally generated work. This might mean repeating a process (rework – this helpful definition from manufacturing if interested) or trying an alternative approach (repair) because the required outcome has not been reached. In general practice this might mean, for example, re-referring a patient to another service after an appointment which has not solved their problem. It might mean repeating tests which should never have been requested in the first place. It could even mean picking up the pieces for patients harmed by their care.

However, as the feedback demonstrates, when a GP has access to rapid and specific advice, this frustrating extra work is much less likely to be required. Given that healthcare interventions can harm as well as heal, this is an ‘everyone wins’ situation.

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