This week, one of our customers shared some data from their CCG on written Advice & Guidance. It was as follows:
WRITTEN ADVICE AND GUIDANCE (mainly email, including Choose & Book)
- Number of requests for Advice & Guidance per month in 2014/15 – 5 – 6 per specialty per month
- Average wait for a response: 10 days
- Referral avoidance rate: 8% of Advice & Guidance requests avoided an onward referral
Compare these figures with the early results from a Consultant Connect telephone Advice & Guidance service in the same area:
CONSULTANT CONNECT (after 2 months)
- Number of requests for Advice & Guidance per month – 15 – 20 per specialty per month
- Average wait for a response: less than 1 minute
- Referral avoidance rate: 65% of Advice & Guidance requests avoided an onward referral
So, does this mean written Advice & Guidance is a waste of time? In this area, the answer seems to be yes. Here’s why:
It’s not worth writing for Advice & Guidance if 92% of patients end up in hospital anyway
Writing and replying to correspondence takes a lot of time, both for the consultant and the GP – even if it’s by email. Add to that the fact that 92% patients will be referred anyway and you can see it is a straightforward decision to refer without going through the written Advice & Guidance process. Yes, there is an 8% chance of sending a patient to hospital unnecessarily but, on the other hand, there is a 92% chance of avoiding a time consuming Advice & Guidance process that will only end in a referral.
No wonder, then, that written Advice & Guidance is not used very much. Most GPs have learned not to go through a process that requires a lot of effort and doesn’t avoid many referrals. What’s more, it’s better for the 92% of patients who won’t have to wait a further 2 weeks before they are referred anyway.
It is worth calling for Advice & Guidance if 65% of patients avoid hospital
Compare this with the performance of the telephone Advice & Guidance system in the same area: 65% of calls result in an onward referral being avoided. Why are the results so much better? Because, during a spoken conversation, large amounts of complex information can be shared with little effort.
A GP calling Consultant Connect waits less than 1 minute to be connected to a consultant and then spends an average of 4 minutes discussing the patient. At the end of that 4 minutes there is a 65% chance of keeping that patient in the community, which saves the busy GP and the consultant the extra workload that comes with a referral.
And GPs are using it too – after only 2 months it is well on its way to our projection of 50 calls per month per specialty in this area. Our customer has told us that they have already identified practices using Consultant Connect that didn’t use written Advice & Guidance.
The GP uses Consultant Connect because it’s better for them, not because somebody else tells them they should be using it. The happy accident is that, by making it easier for the GP, the patient avoids an unnecessary trip to hospital, the hospital manages its demand and the NHS saves money.