On 7 January 2019, the NHS Long Term Plan (formerly known as the 10-year plan) was published setting out an ambitious vision of improved care for patients over the next 10 years. At the time we recommended on this blog that local commissioners and Trusts could approach this challenge by looking for the easiest bits of the plan to gain quick, high-impact wins.
One of the most eye-catching ambitions of the plan is to save 30 million outpatient trips to hospital. How can this be achieved? Better support for GPs to avoid the need for a hospital referral is key. We suggested that Advice & Guidance was the best way of achieving better support for GPs, whether through the written e-RS Advice & Guidance system or through Consultant Connect by telephone or photo.
Obviously a lot has happened in the areas we work with since January. So is Enhanced Advice & Guidance still a good idea for delivering the Long Term Plan?
Findings of an independent report
At the start of 2019, audits carried out in SE London indicated that roughly 25% of referrals did not require secondary care level treatment and could be managed in primary care with advice, guidance and support. The audits also found that e-RS was not always a good option for Advice & Guidance, especially when the request was more urgent or complex.
The STP made a decision to supplement their e-RS advice service with Consultant Connect’s immediate Telephone Advice & Guidance. This gave GPs the additional option of an immediate conversation with a specialist, often during the patient consultation. This then led to Photo Advice & Guidance for teledermatology being added to the service.
The STP also decided to use the National Consultant Network as a back-up for answering A&G calls in some specialties. This meant that, if local consultants were not able to answer a call, it was put through to a non-local NHS consultant to give them advice. This ensured answer rates were high, a fact much appreciated by GPs.
The result of all this work was a large increase in usage of advice & guidance, both through e-RS A&G and Consultant Connect. The use of advice & guidance resulted in a reduction in unnecessary referrals. You can read their independent report here.
Benchmarking data shows a significant impact
In July this year we published our annual advice & guidance benchmarking data. This shows that 66% of calls placed via Consultant Connect to elective specialties, such as cardiology, diabetes and gynaecology, result in the patient avoiding a trip to hospital.
It’s also super quick: GPs connect to consultants in 27 seconds (UK average) which means the service gets used a LOT. Telephone advice and Guidance via Consultant Connect is also highly effective in urgent care; 62% of calls to Acute Medicine and 74% of calls to Navigation Advice are not resulting in an immediate admission.
The benchmarking data also shows how Advice & Guidance helps areas tackle the growing demand for mental health support. One in four GP consultations are now mental health related, which is staggering considering GPs have minimal training in this area. Our data shows that telephone is the most helpful channel for GPs requiring mental health advice for their patients. 50% of calls to General Advice lines via Consultant Connect and 89% of calls to Medication Advice lines result in an avoided visit for patients. Watch Greenwich CCG’s video.
Photo Advice & Guidance via the Consultant Connect App is highly effective in reducing pressure on dermatology teams. The benchmarking data shows over 80% of photo message sessions are resulting in an avoided referral. When GPs attach the photos to e-RS 2WW referrals, 28% of requests are resulting in the patient being discharged before their 2WW appointment.
It’s still easy!
The NHS Long Term Plan says; “It’s easy to be cynical about the achievability of these big technology-driven shifts in outpatient care… They are already happening in parts of the NHS, so this is clearly ‘the art of the possible.”
Not only is Advice & Guidance a proven win, it’s also one of the easiest things to get up and running in the whole of the long-term plan. The typical length of time that it takes to launch a Consultant Connect Advice & Guidance project is 6 weeks (we have launched projects in 2-weeks before). And the impact is immediate.
There’s no doubt that implementing the LTP plan in full is going to take years, so a quick-win on a highly-visible, high-impact Advice & Guidance project may be just what the doctor ordered as you continue on your journey.
Hear from a SE London commissioner:
Hear from a GP: