How Enhanced Advice & Guidance can help provide the best care this Men’s Health Week

An NHS Consultant Cardiologist on the National Consultant Network (NCN) reviewed pre-referral A&G for a patient in his early 30s. An Echo scan showed a mild increase in the aorta’s size, which worried him because the patient was so young:

‘Although observations suggested acquired disease, I suspected a possible genetic aortic condition. I contacted a local cardiologist specialising in genetic aortic disease. The patient was seen within a week and, during the appointment, was diagnosed with a genetic disease. He then went on to have early and very successful surgery. The rest of the family received a genetic workup.’

– Dr Patrick Davey.

An Advanced Paramedic Practitioner in NHS Lanarkshire provided Prof-to-Prof Advice via ‘call before convey’ after an ambulance crew saw a patient experiencing breathlessness with ongoing heart failure:

‘After carrying out observations, the crew found that the patient’s symptoms had settled, and they phoned the Flow Navigation Centre via Consultant Connect because they weren’t sure of the most suitable pathway. After a conversation, we decided that the preferred action was to refer the patient to the Hospital at Home Team, with a contingency plan to refer him to the medics at the hospital if needed. The Hospital at Home Team confirmed that the patient was suitable for this pathway and visited him shortly after. If Consultant Connect had not facilitated this conversation, the patient would have been conveyed to the hospital. Even if, on arrival, the Hospital at Home Team decided he would be better cared for in the hospital, he would have been a direct admission.’

– Sharleen Anderson.

A GP in Medway and Swale used Messaging Advice & Guidance via Consultant Connect after seeing a patient who’d had an ECG carried out in a walk-in facility:

‘He had been complaining of dizziness, and after assessing his ECG, it didn’t look normal. I took a picture of the patient’s ECG and forwarded it to a consultant cardiologist on the NCN. The consultant cardiologist responded within the hour, advising that it wasn’t a complete heart block and that referring the patient on a routine pathway would be appropriate. The patient was immediately comforted by this and was very happy that it was nothing to worry about and had saved him a trip to A&E.’

– Dr Modupe Martins.

A GP in NHS Forth Valley used Telephone Prof-to-Prof Advice* after sending a patient for an X-ray, and the report suggested possible cancer metastases:

‘The report suggested that the patient should undergo an urgent MRI scan. Booking an MRI scan – even on an urgent request – can take many weeks or months, so I used Consultant Connect to call the radiologist. He reviewed the X-ray and said it was definitely cancer metastases, and the patient did not require an MRI scan. The benefit was that we didn’t waste time getting an urgent MRI, and I got the patient back into surgery that same day. I took his bloods, we identified the following day that prostate cancer was the source, and I referred him urgently to urology.’

– Dr David Herron.

* Known as Advice & Guidance in England and Wales

A GP Trainee in Barnet, North Central London ICB, contacted a consultant neurologist on the NCN after seeing a patient with a recent diagnosis of secondary metastatic cancer to the brain:

‘The patient had an unknown primary, but the secondary cancer was causing seizures. He’d already been seen in hospital and had commenced anti-epileptic medication, but since then, he’d had another seizure, so I knew he needed an increased dosage of the medication. I got through to the consultant neurologist in a few minutes and had the entire conversation during the patient’s consultation. The consultant gave me a perfect plan, including what to bridge the medication with, and made it easy for the patient and me to deal with his condition and keep him out of hospital.’

– Dr Fahad Iqbal.

A GP in Dorset utilised Telephone Advice & Guidance via Consultant Connect after a patient experiencing rapidly worsening shortness of breath presented in the clinic:

‘When the patient came to see me, I initially diagnosed pulmonary fibrosis. The patient didn’t require admission, but could not have waited months to be seen in a respiratory clinic. I used Consultant Connect to rapidly speak to a local respiratory specialist at University Hospitals Dorset NHS Foundation Trust. By speaking to a specialist, the patient avoided an acute admission, as the specialist arranged an outpatient appointment within a few weeks, with necessary investigations carried out beforehand. The patient was very happy to be seen urgently by a specialist. The service avoids unnecessary referrals and patients coming to harm by waiting a long time for appointments. It provides safer patient care and bridges the gap between Primary and Secondary Care.’

– Dr Rachel Smith.