‘Unintended consequences is what I’m scared of’ – that was the feedback from a senior ICB source this week when asked what they thought of the new NHSE Advice & Guidance (A&G) specification last month. Well, too late – it started Tuesday, 1st April 2025 and lasts for exactly 12 months.
Here’s a reminder of what it includes:
- Target is to INCREASE A&G requests from GPs 2.4 million in 23/24 to 4 million in 25/26, a 66% increase
- GPs will receive £20 for each advice request
- ICBs can introduce local caps on the number of requests GPs can claim
On the face of it, this looks like a great initiative. At Consultant Connect, 70% of advice requests result in patients avoiding an unnecessary trip to hospital and getting the care they need immediately from their GP. It’s better for everyone: patients get the right care quicker, and hospitals only see patients who need to be there.
So why would you cap activity?
Well, NHSE has talked about an “advice first” model for a while now, and this financial incentive means that is what it is going to get. A £20 bounty for a phone call or advice message is good business for GPs. The risk is that GPs now put far more referrals through as A&G, knowing that they can be converted directly into a referral. This could, in the worst case, catch “slam dunk” referrals. So, the challenge for ICBs is to balance the benefits of A&G with a greatly increased appetite to use it.
We think that ICBs can strike this balance if they:
- Predict and monitor “optimal” A&G volume;
- Choose the “best” specialties; and
- Monitor usage over time
Predicting optimal A&G
This will vary from area to area, but the key to estimating an optimal amount of advice is understanding how many referrals are being made that could be dealt with in the community. Clinicians comment that 20-25% of referrals could be dealt with elsewhere, and the percentage is higher in some specialties (such as neurology and routine dermatology).
Once you have an estimated percentage of referrals that can be dealt with elsewhere, you can calculate the number of A&G requests that would result in all of those cases being diverted away from hospital. We find that 60-70% of A&G requests result in a referral being avoided. So, if you want to avoid 1,000 referrals (for example), using a “referral avoidance rate” of 60% would mean that 1,666 cases of A&G would result in 1,000 referrals being avoided.
Spotting those GP practices where the avoidance rate is markedly lower than this (for example, if it falls below 45%) may be an opportunity to check that practices are choosing the right cases for A&G. There is no hard and fast rule to this, but our experience is that a conversation with users of A&G is always useful, especially to get feedback on how effective a service is.
Choosing the best specialties
Your budget for the £20 tariff may mean that you don’t have enough money to do this across all specialties, so you can choose the specialties A&G is most effective for – this link to our annual benchmarks has our data.
Our “magnificent 5” specialties with the highest rates of referral avoidance are:
- Haematology (78% of calls avoid an unnecessary referral)
- Diabetes and Endocrinology (75% of calls avoid an unnecessary referral)
- Cardiology (75% of calls avoid an unnecessary referral)
- Gastroenterology (74% of calls avoid an unnecessary referral)
- Respiratory Medicine (72% of calls avoid an unnecessary referral)
Using data to monitor usage
One of Consultant Connect’s key benefits is the ability to deliver real-time, in-depth data analysis across all A&G channels, including e-RS, written A&G, Telephone A&G, and hotlines. These rich reports can help you identify local specialty trends and provide valuable insights into referral volumes and any discrepancies across your system.
Contact us:
Whether you already use Consultant Connect or not we’re here to help. If you have any questions or would like to find out more, please email hello@consultantconnect.org.uk or call us on 01865 261 467.
Related materials:
- How to make A&G work for your practice
- How do consultants manage increased A&G workload?
- “Reforming Elective Care” – your questions answered
- How will “Reforming Elective Care” affect you?
- e-RS Connect A&G worklist
- Clinical resource for A&G
- Clinical capacity for referrals
- Rich reporting already supports areas to unlock the ERF
