Most people know the NHS e-Referrals Service as a way of booking patients into first hospital or clinic appointments. But it also offers a written Advice & Guidance service, provided that local Trust clinicians have agreed to use it.
The 2017-19 CQUIN gives Trusts aiming to qualify for Advice & Guidance payments a choice between using asynchronous or synchronous Advice & Guidance. Asynchronous A&G means you get your answer some time after you have asked your question – this includes written A&G, such as e-RS. With synchronous A&G you get your answer immediately, as you do on the telephone – Consultant Connect is the only example of synchronous A&G cited in the CQUIN.
There is a problem, though: a tripwire for users of asynchronous (written) Advice & Guidance such as e-RS. The CQUIN requires Trusts to meet quality standards for provision of A&G. For written A&G (including e-RS) the quality standard is mandatory:
- “80% of asynchronous responses are provided within 2 working days”
To the untrained eye that may not look like a big deal, but it is.
To give you an idea, we spoke with a total of 15 CCGs and Trusts from different areas in the past 4 weeks. We asked them 2 questions, first: “How long does it take for a GP to receive written Advice & Guidance in your area?”
The responses were:
- Under 2 days: 0%
- 2 – 5 days: 53%
- 5 days +: 47%
Then we asked “How likely is it that your Trust will be able to respond to 80% of written Advice & Guidance queries within 2 working days?”
- Highly Likely: 7%
- Likely: 27%
- Unlikely: 46%
- Highly Unlikely: 20%
To summarise, 66% of respondents – 10 out of 15 – think that it is unlikely or highly unlikely that their Trust will be able to meet the CQUIN standard for written Advice & Guidance. But the standard is mandated. If they don’t meet the standard, they don’t get CQUIN payments.
With telephone Advice & Guidance, the quality standards are not mandated by CQUIN. Standards have to be agreed locally between commissioners and providers. This means there is an opportunity for a genuine win-win. Providers will aim for targets that are reasonable and achievable based on their local situation. This will enable them to genuinely support the introduction of Advice & Guidance. In turn, commissioners will have a working Advice & Guidance service that saves them money through avoiding unnecessary activity.
We have already started working in some areas to assist with the setting and agreement of quality standards between commissioners and providers. Although the standards are stretching, there is no doubt they can be achieved and the Trusts are behind them. And if they are achieved, the whole healthcare system stands to benefit.
If you would like to discuss CQUIN standards and how a synchronous Advice & Guidance service in your area might work, please get in touch with us on 01865 261467 or email us at firstname.lastname@example.org.