How do I choose which specialties to include?

Published: 30th November 2016

shutterstock_344824256How many specialties does a typical hospital offer? I’m looking at the lists of specialties offered by three different Acute Trusts as I write this: one offers 51 specialties, one offers 53 and one offers 54. So, from this very limited sample, we can guess that a typical Acute Trust offers about 50 specialties.

The question, then, is which specialties should a Trust offer Advice & Guidance for? Although the idea of a GP being able to call every specialty is nice in principle, this is unlikely to work in practice. For example, some departments may have insufficient personnel to be able to offer the service; others may not be worth the economic and organisational cost required to offer the service.

That being the case, how do you decide how many and which specialties should offer Advice & Guidance? The following is how we recommend our customers prioritise specialties on Consultant Connect.

1. Referral Volume – First Referral AND Follow-Up Referral

Although this is an obvious approach – you want to focus your efforts on where the results will be biggest – there are a couple of additional points worth making:

Firstly, the CQUIN 2017 – 19 offers Trusts significant sums of money based on the volume of referrals covered by Advice & Guidance. The target is for specialties accounting for 75% of referrals by volume to offer Advice & Guidance. This sounds like a lot until you analyse the figures: over 80% of referral volumes are covered by the top 20 specialties. Of these top 20 specialties, some can be further condensed – eg. Gynaecology and Obstetrics can be combined into one specialty.

The second point worth making is not to only focus on first outpatient appointment but also to consider follow-ups. For example, in the Trusts analysed here, for every Cardiology first appointment at a Trust there are 3 – 4 times as many follow up referrals. By contrast, for every Gastroenterology first appointment there is a much smaller number of follow ups (between less than 1 and 1.5 times as many follow up referrals). Naturally, if Cardiology and Gastroenterology had similar numbers of first outpatient appointments, Cardiology would offer a larger opportunity to reduce referrals with Advice & Guidance.

2. Proven suitability for Advice & Guidance

We have gathered data on the performance of telephone Advice & Guidance for a wide variety of hospital specialties – specifically:

  • how much demand there is for each specialty relative to others; and
  • what percentage of calls result in patients avoiding unnecessary trips to hospital.

Our performance benchmarking analysis published in October gives this information across 8 of the most popular specialties on our system. If you would like information on a specialty not included in the analysis, please get in touch with us.

3. Local “Pain Points”

Including a specialty that is under severe pressure locally is a great way to strengthen relationships between clinicians, Trusts and commissioners in an area. Firstly, it shows a serious, coordinated attempt across primary and secondary care to address a problem for patients.

Secondly, although Advice & Guidance will have an impact on a problem, it will probably not solve the problem altogether. Through working together to deliver an Advice & Guidance service, though, stakeholders can gain an understanding about the specialty in the “whole system” context – and work to tackle it together.

If you would like to discuss how to choose specialties for a local telephone Advice & Guidance system in your area, please call us on 01865 261467 or email

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For more information about how we work with commissioners, hospitals & mental health trusts to improve patient care, please get in touch.

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