An NHS area in the east of England has shown how in-the-moment conversations between primary and secondary care clinicians support more confident decision-making and sustainable patient management plans.
Enhanced Advice & Guidance (A&G) via Consultant Connect gives healthcare professionals real-time access to specialist expertise, helping inform clinical decisions and guide the next steps in patient care. Clinicians can seek A&G via telephone, where 80% of calls are answered within 30 seconds, or photo messaging, where clinical images and files can be attached, and responses are received within 6 hours on average.
Analysis of A&G cases found that patients were substantially less likely to require an onward referral when clinicians had sought Telephone or Messaging A&G via Consultant Connect than when written A&G was submitted through eRS. The immediacy and depth of a telephone conversation support more detailed discussions and enhanced patient management plans, whilst the ability to share clinical imagery through Messaging A&G provides valuable additional context for visual specialties. Together, these capabilities enable clinicians to develop more informed and holistic plans for patients, potentially reducing the need for subsequent specialist referrals.
A service that has grown with demand
Consultant Connect was first launched in one East England borough in June 2017, before expanding across the wider NHS area in subsequent years. In November 2020, the first local specialist line was introduced, with out-of-area NHS consultants on the National Consultant Network (NCN) providing additional capacity during periods of peak demand and access to specialties unavailable locally.
Just one year on, clinicians had placed more than 10,000 calls. Today, the service supports over one million patients and provides primary care clinicians access to a minimum of 19 specialties, rising to 28 in some localities.
The area’s Planned Care Commissioning Manager said:
‘The service has been well received by GPs, and the timely support provided by the NCN has proven invaluable, making sure our patients are seen in the right place by the right clinicians at the right time.’
Current performance* demonstrates both scale and responsiveness:
87%
connection rate
26%
of acute calls enable patients to be treated outside of hospital
26 seconds
average call answer time
66%
of elective calls avoid hospital attendance, including:
– 64% avoiding a referral
– 2% avoiding an admission
Fewer onward referrals following Telephone A&G
To understand whether referral avoidance achieved through A&G was sustained over time, the NHS area analysed patients whose original A&G outcome was ‘manage within primary care’. The analysis compared matched cohorts of 848 Consultant Connect cases and 660 eRS cases, selected to provide a comparable mix of specialties, and tracked whether patients required an onward referral in the following three months.
The findings showed a clear difference:
- 117 of 660 eRS cases (17.7%) resulted in an onward referral.
- 27 of 848 Consultant Connect cases (3.2%) resulted in an onward referral.
This represents a 14.5 percentage-point difference in onward referral rates.
‘[Speaking to the NCN consultants] was great because we discussed our thoughts and the overall process, rather than simply referring the patient.’
How a telephone conversation can make the difference
Telephone A&G allows clinicians to discuss the complexities of a case in real time, ask follow-up questions, and agree on management plans together. This can support greater confidence in managing patients closer to home and reduce the need for subsequent referrals.
A GP using the service said:
‘[Speaking to the NCN consultants] was great because we discussed our thoughts and the overall process, rather than simply referring the patient. When seeking written A&G, it’s sometimes difficult to reference nuances and subtleties you can mention during a spoken conversation.’
