Does Advice & Guidance work better in the North or the South?

Published: 25th February 2016

shutterstock_71656546One of the benefits of running a lot of telephone Advice & Guidance projects spread across the country is that we get to compare how different areas perform with respect to one another. And, as it happens, at the end of January we reported on three projects in three different parts of England – one in the North, one in the Midlands and one in the South.

The three areas share a number of characteristics:

  • they have similar numbers of patients;
  • they make similar amounts of calls to Consultant Connect;
  • Consultants answer the phone in each of the areas on average after a 50s wait; and
  • Conversations are, on average, about 3m 40s long.

So you might expect Consultant Connect to perform similarly in these areas. This is what we found:

  1. GPs in the Midlands area got through to local hospital consultants the most often – their call pickup rate was >90%, followed by 85% in the North and 80% in the South.
  2. Calls to Consultant Connect in the Midlands and the South areas were equally likely to result in the patient avoiding a trip to hospital (70% of total calls resulted in a trip to hospital being avoided); in the North the hospital avoidance rate was 55%.

So what does this tell us? Do these results prove that Advice & Guidance works best in our project in the Midlands?

In short, no – the situation is complex, but there are lessons to learn.

The pickup rate is critical to making it worthwhile for the GP to invest the time in trying to contact an Advice & Guidance service. We’ve said before that the reason a lot of existing ad-hoc Advice & Guidance arrangements are doomed from the outset is that they are setup in a way that means pickup rates will be low (in our experience they rarely achieve more than 30% pickup).

The high pickup rates achieved here by the North, South and Midlands are partly down to Consultant Connect’s “hunt group” system (consultants on a rota are called in turn until one of them answers) but are also a function of some other factors – there are differences across the areas, including how many consultants are on a rota, how engaged they are with telephone Advice & Guidance, how they organise their rota, do they use their own phones or baton phones, are they recognised for answering calls and more. Achieving a call pickup rate of 80% or over is the gold standard and is the product of great planning in all three areas. The Midlands project’s achievement of >90% is the highest we have seen.

The second measure, the hospital avoidance rate, is a function of which hospital specialties are available: each area has a different mix of specialties on Consultant Connect. Some specialties lend themselves to hospital avoidance. For example, a Haematologist was telling us this week that it is very difficult for GPs to recognise whether a test result that is slightly out of the ideal range is a problem against the background of a whole load of other test results, so her service is proving very effective at reassuring GPs and helping patients to avoid hospital (in over 80% of calls).

By contrast, a Paediatrics department deals with a wider range of problems and tends to operate on an “if in doubt, send them in” approach – which all parents will be grateful for. This means that the hospital avoidance rate tends to be on the lower end of the spectrum at around 50% and leads us to be asked if it is a good specialty to include on the Consultant Connect system. Our answer is very straightforward – although the percentage of calls resulting in hospital trips being avoided isn’t as good as some other specialties, you get a LOT of calls. This means that it’s both a hugely useful service for GPs and, in absolute terms, it still avoids a lot of hospital referrals, which is great for patients. So Paediatrics is one of our first choice specialties.

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