NHS Digital on Advice & Guidance – the Good and the Bad

Published: 15th March 2017

NHS Digital has published an overview of Advice & Guidance as offered through the NHS e-Referral service. The e-Referral service is an email-based Advice & Guidance system offered by the NHS as part of the same platform used for booking hospital referrals. You can get a copy of the document by clicking on the link at the bottom of this article.

What We Like About the Document

  • The overview is extremely broad, so suited to management and clinicians at CCGs and Trusts. It is also short (3 pages if you don’t include the title and contents pages).
  • The document contains useful examples of how Advice & Guidance can be applied, all of which resonate with our experience of how clinicians use Consultant Connect:
    • “Asking another clinician/specialist for their advice on a treatment plan and/or the ongoing management of a patient
    • Asking for clarification (or advice) regarding a patient’s test results
    • Seeking advice on the appropriateness of a referral for their patient (e.g. whether to refer, or what the most appropriate alternative care pathway might be)
    • Identifying the most clinically appropriate service to refer a patient into (and how to find that service – e.g. what clinical term to search on)”.
  • The summary on benefits to stakeholders (patients, GPs, hospital clinicians, CCGs and Trusts) is excellent and should be required reading for anyone considering Advice & Guidance in their area.

Where the Document Falls Short of Expectations

  • There is no analysis of how effective written Advice & Guidance is – in some areas there is a risk that written Advice & Guidance is a waste of time
  • The document highlights that clinicians can append attachments to email Advice & Guidance but doesn’t give any guidance on what makes a good request – one of the most common complaints we hear about written A&G is “kitchen sinking”, whereby a clinician will include a large number of attachments in their A&G request for the receiving clinician to work through. We would recommend that local guidance on this issue is made available.
  • There is no useful guidance on resourcing hospital clinical teams that will be responsible for replying to Advice & Guidance requests, other than to say teams need resourcing! This sidesteps the main issue with email Advice & Guidance in that, because it is time-intensive, email Advice & Guidance may require changes to job plans or the setting aside of clinical sessions. This point is even more acute if Trusts are hoping to qualify for CQUIN 2017-19, when the mandatory 48 hour response deadline applies.
  • The tariff debate rumbles on! The document states that, whilst there isn’t a nationally agreed tariff for Advice & Guidance, there are areas where a tariff is being paid. Our position is that a tariff makes sense and is important if Trusts are going to commit to Advice & Guidance activity. We have heard on the grapevine that a national tariff is being worked on and will likely be introduced after CQUIN 2017-19 finishes, although there is nothing official on this at the moment.

You can access the full NHS Digital article here: Advice_and_Guidance_Overview_-_February_2017

If you’d like to learn more about setting up and Advice & Guidance project in your area, or if you’d like to see a demonstration of the Consultant Connect telephone A&G system, please email us on info@www.consultantconnect.org.uk or call us on 01865 261467.

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