Patients benefit profoundly when clinicians use rapid Advice & Guidance:
- Instant reassurance, and reduction of stress or worry.
- Avoidance of costs and disruption through unnecessary hospital visits.
- The right care, faster.
- Instant reassurance, and reduction of stress or worry.
- Avoidance of costs and disruption through unnecessary hospital visits.
- The right care, faster.
Real-life patient experiences are re-told by clinicians in our videos and in the examples grouped by hospital specialty below.
Telephone A&G – Mental Health
Photo A&G
Acute Medicine
‘A patient presented with a swollen leg but had previously been to the Emergency Department. The symptoms persisted, and I was concerned that they may have deep vein thrombosis (DVT). I used the Consultant Connect App to contact a GP in the Acute GP Unit Medical Admissions Team at Singleton Hospital. Together, we decided on the best care for the patient, and which is the appropriate clinic or department to send them to. It was agreed that an urgent ultrasound scan was required, which I arranged for the following day. This was a great result for the patient, and the scan was organised for a time when they could easily get to the hospital. Using Telephone Advice & Guidance in this instance meant that the patient’s care was expedited.’
‘A 27-year-old patient presented with a one-week history of flu-like symptoms with a dry cough, vomiting and left-sided chest pain. She was noted to be pyrexial and tachycardic but had a normal-sounding chest and O2 saturations. I suspected it was either community-acquired pneumonia or influenza and wanted to request an urgent CXR. I called Acute Medicine via Consultant Connect and spoke to a local consultant who agreed that if the patient attended hospital, they would look at the CXR on PACS and call the patient with the results. The patient was prescribed antibiotics in case of pneumonia, but the CXR did not show any initial changes, though the radiologist did report signs of possible pneumonia. Using Prof-to-Prof Advice meant the patient was managed in the community, avoiding needing a hospital appointment.’
Cardiology
‘A 62 year-old fit and well lady presented with new breathlessness. A routine ECG conducted as a part of investigations showed some slight irregularities. I was uncertain of the significance in relation to her symptoms of breathlessness so used the Consultant Connect App to take pictures of the ECG with patient consent and request consultant review of the trace.
‘The cardiologist was able to reassure us that this was not a cause for concern and that no further action was required. The patient also felt reassured. Her breathlessness was monitored and “subsequently settled spontaneously”.’
‘I answered a call from a GP about atrial fibrillation and general management for a patient. The GP did not feel that the patient needed anticoagulation medication, at least until all of the tests were in. I informed the GP that the patient was at a very high risk of having a stroke and whatever the tests showed, the patient still needed anticoagulation drugs and these should be started at that time. As the tests could easily take 3-4 months, this protected the patient against a possibly devastating stroke much earlier than originally planned. This was a good outcome and the GP was pleased with the advice.’
‘I saw an elderly patient because she was breathless. She was last seen by her local cardiology team 18 months previously with some narrowing of the aortic valve. I found that she had fluid retention, including swollen ankles, and a heart rhythm disturbance, which was atrial fibrillation. I was aware that atrial fibrillation in an elderly patient with heart problems creates a very high risk of blood clots in the heart, which can cause a stroke. Therefore, I needed to start blood-thinning drugs as soon as possible. Still, I wasn’t sure of the interaction with the patient’s abdominal aortic aneurysm, which would be life-threatening if ruptured. I contacted Dr Davey via the Consultant Connect App and was very grateful for his input in my patient’s case. Dr Davey’s thorough advice was didactic and helped me a great deal in deciding on a management plan and to expedite the referral to the anticoagulant clinic.’
‘I saw a young adult patient who presented with atypical chest pain. I carried out an ECG, showing some unexpected and unexplained features. I wanted to discuss the results with a cardiologist, so I used Telephone Advice & Guidance via Consultant Connect. The cardiologist reviewed the ECG and advised that the patient needed to be referred to the outpatient department for further assessment. On another occasion, I saw an elderly patient who had stents fitted abroad, and their medication had run out. The patient had had two previous myocardial infarctions and reported 4-5 stents being present, but all medical notes provided were not in English. Due to the procedures being carried out abroad and the ongoing medication advice given to the patient not matching the local NHS equivalents, I was uncertain of the next steps. I used Consultant Connect to speak with a cardiologist, and together, we worked out what medication the patient needed to stay safe in Primary Care whilst awaiting their outpatient appointment.’
‘I saw a 72-year-old patient who had bradycardia, presenting with slow atrial fibrillation. The patient had a history of myocardial infarction, and, as their heart rate was at about 50, I was not sure whether they needed pacing. I used the Consultant Connect App to contact a cardiologist for advice on the patient’s ECG. They explained that the patient did not need pacing, which was reassuring as it meant that an urgent referral was not necessary. The cardiologist advised on the management of the atrial fibrillation, which we started in the community.’
‘A patient had recently returned from holiday where he had experienced chest pains and had gone to the local hospital, where he was diagnosed with pericarditis. I then saw the patient a few weeks later with ongoing symptoms. I called Dr Davey via Consultant Connect to determine whether the symptoms matched the diagnosis. Dr Davey reassured me that this was the case and that some simple outpatient tests and treatment for the patient’s inflamed pericardium were appropriate. I find Consultant Connect very convenient for getting quick advice when needed from specialist consultants. I was put through quickly and gained the information I needed to manage the patient effectively. The patient felt at ease that this would all be done whilst he was in the clinic with me, and he did not have to wait for an answer or return later. By speaking with Dr Davey directly, the patient was more involved in his care and decision process and felt comfortable that our advice was appropriate. From my point of view, it felt like a more connected approach without the divide between primary and secondary care.’
‘I had a patient with heart palpitations come to see me. These had been proven by ambulatory ECG monitoring to be benign ectopic beats, but due to their history of hospital admissions for asthma, beta-blockers were contraindicated. I used Consultant Connect’s Prof-to-Prof Advice to speak with a consultant cardiologist. This service allowed me to discuss the option of introducing a calcium channel blocker, which I had seen being used for other patients in the past, but I wasn’t confident enough to commence.’
‘I used [cardiology] a few weeks ago after a gentleman who’d had an ECG carried out in a walk-in facility came to see me for review. He had been complaining of dizziness, and after assessing his ECG, it didn’t look normal. It wasn’t myocardial infarction or atrial fibrillation, but something was out of the ordinary. 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. I felt very reassured, and although I’d advised the patient that he might need to attend hospital, I rang him immediately and relayed the consultant’s advice. 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. My patients are more than happy with me using Consultant Connect because they know it means they’ll get answers for their conditions quickly.’
Community Mental Health
‘I received a call last month about an 80-year-old lady who was diagnosed by our memory service with Alzheimer’s disease three years ago, but who was not currently under Secondary Care. Over the past three months, she has become more forgetful and had developed some paranoid symptoms, believing her neighbours had a spare key, were entering her property when she was asleep, and hiding objects around the house. She was quite distressed about this but through discussion we were able to establish that there were no acute risks to herself or others. I reviewed her medication and did not feel she was on any that were likely to be worsening her cognition. Her GP had helpfully carried out some baseline bloods and an MSU (urine test) which I reviewed, and found that no physical factors were causing her deterioration. She was already on donepezil but no other psychiatric medication. I was able to advise that she should start on memantine and I advised on a dose of titration which her GP was happy to monitor. We agreed she did not meet the threshold for prescribing an antipsychotic at this stage or need a referral to the older adult CMHT at this point, but that she could be referred to us if there is no improvement in her symptoms with the memantine or if the risks increase. Her GP was happy with this plan, and said they had thought this would probably be the treatment plan, but they had found it helpful to check the plan was appropriate, and it gave them confidence in managing the patient going forward.’
Dermatology
‘A patient came to see me with a cutaneous horn-type lesion on his upper chest. The patient had a history of fair skin and sun exposure, so I was concerned that the lesion might be an early Squamous Cell Carcinoma (SCC). I sent a photo via the Consultant Connect App, with the patient’s consent, for Dermatology Advice & Guidance. The consultant agreed that it could be an early SCC and advised a two-week wait (2WW) referral. I was able to share the image with the consultant, and I received a response within the hour containing their clinical advice. Putting the patient forward for a 2WW referral was the best result because it fast-tracked the referral and meant that the condition was being managed efficiently.’
‘A patient with a facial rash presented, which was presumed to be seborrheic dermatitis. As the patient wasn’t responding to standard treatment, I used Photo Advice & Guidance to take patient photos to send to the Dermatology Team at Guy’s and St Thomas’ NHS Foundation Trust. I received a response from a consultant dermatologist advising me to try an alternative rosacea treatment. With this alternative treatment, the patient’s condition improved rapidly.’
‘I saw a patient who had been taking Tamoxifen following a mastectomy for breast cancer. She had developed an extensive itchy blanching rash on her limbs and chest. It was so extensive that she called an ambulance, who advised her to stop taking the Tamoxifen and make a GP appointment. She used antihistamines, stopped the medication and saw me after one week with no improvement. I was concerned about a medication reaction and started her on Prednisolone. After two days, the rash had still not improved. I used the Consultant Connect App to send photos of the rash to a dermatologist. Within 24 hours, I had a response saying that there was no evidence of Erythema Multiforme or Toxic Epidermal Necrolysis and that the rash was in keeping with a drug rash with possible mild Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) but without system symptoms. The dermatologist concluded that the Prednisolone treatment could be continued with the addition of a topical steroid and emollient, adding that a referral should be considered if there was no improvement after a week. A week later, the rash had resolved, which avoided a referral for the patient. It was a relief to the patient that the rash had cleared up and reassuring to me, as a GP, that the proposed diagnosis and management were safe.
‘A patient suffering with a rash came to see me. The patient also had coeliac disease, so I wondered if the rash was dermatitis herpetiformis. I took some photos via the app with the patient’s consent and sent them to a local dermatologist for advice. They came back and confirmed that the rash was in fact pompholyx. I then called the patient back within five minutes to confirm the appropriate diagnosis alongside a management plan. I received rapid clarification on the diagnosis which was great for the patient and meant that they received a management plan put together by a specialist without needing to attend hospital. Virtual management plans put together in this way are a brilliant tool, especially during COVID-19, as patients can be managed without needing to visit another healthcare setting.’
‘I recently saw a child with an itchy body rash and a history of eczema. As I was unsure if this particular rash was eczema, I took photos of the patient using Photo Advice & Guidance to send to the Dermatology Team. I received a written response from a local dermatologist the next day, who diagnosed the rash as chronic eczema with lichenification and follicular morphologies. The consultant had also written a detailed patient management plan. The patient was provided with the correct treatment plan early on. They did not need to wait for a Dermatology hospital appointment, and a potential hospital referral was avoided.’
‘A black male patient in his 50s presented with a very itchy rash. He had no allergies, wasn’t taking any medications, and had no history of skin complaints. I wasn’t sure what the condition could be, so I took his photos using the Consultant Connect App and sent them to a consultant dermatologist on the NCN. The consultant replied and diagnosed the patient with lichen planus, something I’ve never seen before. Receiving this advice allowed us to research the condition and set expectations with the patient regarding how long it might take to improve. This was the patient’s first presentation with this complaint, and his episode of care was concluded in a couple of weeks.’
Diabetes and Endocrinology
‘I recently spoke with a local GP who was seeking advice about a patient with Type 2 diabetes. They wanted rapid advice because the patient’s control had fluctuated rather considerably. The GP explained the patient’s history and asked whether they ought to consider scans for the patient to exclude malignancy. I was able to reassure both the GP and the patient that the fluctuations were likely caused by patient-initiated changes to lifestyle, which the GP subsequently confirmed after reviewing practice nurse notes, and so I didn’t need to consider any scans for the patient.’
‘I had a patient who was referred to Endocrinology for hyperthyroidism and was started on carbimazole in the meantime. I was periodically monitoring her thyroid function tests on the new medication, and her results consistently improved. As she had still not received an outpatient appointment from Endocrinology, I used Consultant Connect to speak with a consultant endocrinologist for advice on the medication dosage and how to reduce it.’
Recently, I saw a patient with type 2 diabetes who needed a GLP1 during Ramadan. Because he was fasting, my initial thought was to delay it until after Ramadan, but I decided to speak with a diabetologist on the NCN to confirm my plan. The consultant advised that introducing the GLP1 would help with fasting because it would reduce the patient’s hunger and increase feelings of fullness. This was invaluable advice, and when I relayed this to the patient, he was very satisfied with the decision.
Care of the Elderly
‘The Recovery at Home Team was concerned about an elderly patient living independently. She was known to have chronic obstructive pulmonary disease but had recently become more breathless. She complained of weight loss and a poor appetite and explained that she had been collapsing at home. She was recently seen in the Emergency Department, but they felt she wasn’t improving. We arranged an urgent outpatient clinic appointment which she attended. We assessed her with access to her medical records and previous investigations. Blood tests, an ECG and lying and standing blood pressure were checked, and advice on medication changes was given. We liaised with other services involved in her care. This enabled the patient to get the assessment and support she needed without an emergency admission.’
‘I saw an elderly patient who was awaiting a hip replacement. The operation was cancelled by the anaesthetist because the patient’s sodium level was low, and they were slightly anaemic. I carried out initial investigations but couldn’t find a cause. I used Telephone Advice & Guidance to speak to an elderly care consultant, who explained that anaemia is not a contraindication and that the patient could be transfused. I arranged further investigations for the cause of the low sodium level or hypernatremia. I could then refer the patient back to orthopaedics for their operation. Getting this type of advice quickly improved the patient’s care. Without the service, it may have taken three months for them to see a consultant, and by that time, the patient could have been presenting with new clinical conditions. Using the service was a good experience for myself and the patient.’
‘I called the Care of the Elderly (COTE) line regarding a patient for whom I wasn’t sure if an admission was in their best interests. It’s all about what is necessary: Do they need a diagnostic right now, or can we operate a “wait and see” approach? The consultant was very helpful and advised that the patient should be seen the same day in hospital for investigations and that they would take things from there.’
Emergency Medicine
‘During a recent weekend shift, I attended to an elderly patient in severe pain due to a large swelling in their groin. After learning the patient’s past medical history and performing an examination, I was concerned that they were suffering from a strangulated hernia. Our current guidelines require us to convey all surgical cases, except abdominal aortic aneurysms, to Perth Royal Infirmary in the first instance of assessment. I used Consultant Connect to obtain telephone Emergency Medicine prof-to-prof advice to speak with a senior consultant. I raised my concerns that it would be detrimental to the patient to have them taken to Perth Royal Infirmary for assessment, only then to be transferred to Ninewells Hospital for the immediate attention his condition required. Through immediate discussion with a senior consultant at Ninewells Hospital, we agreed to bypass Perth Royal Infirmary and transfer the patient directly to Ninewells Hospital, which helped speed up their treatment.’
‘I recently spoke to an A&E consultant via the Emergency Medicine line on Consultant Connect regarding a patient experiencing what had the potential of a stroke mimic. I thought the patient was experiencing Bell’s Palsy, so I decided to use telephone prof-to-prof advice to discuss a few steps to confirm this suspected diagnosis. The advice I received gave me the confidence that the best pathway for the patient would be to refer to their local GP rather than undertaking a journey to hospital. The patient was happy that the outcome resulted in a local appointment with the GP rather than carrying out an 80-mile round trip to hospital.’
Frailty
‘A patient of mine had been admitted to hospital a couple of times and recently discharged, and I felt she had an underlying and deep-seated infection. The patient hadn’t been scanned whilst in hospital, and I felt that a scan without an admission would support my management of her. I called the Acute Frailty line via Consultant Connect, and the consultant geriatrician arranged the scan for the patient as an outpatient without her needing to attend any appointments beforehand. I would have had to admit her if I hadn’t had access to the Acute Frailty line. As a result, this allowed the patient to stay home and avoid an unnecessary admission, improving her care journey and ensuring she got the care she needed fast.’
Gastroenterology
‘A GP called via the service to ask for advice about treatment for H. pylori in a young child. Although not a paediatrician, as an adult gastroenterologist, I was able to discuss whether or not this warranted treatment, rather than discussing specific treatment methods. The GP found this extremely useful and was very pleased to be able to talk it through with a specialist.’
‘In many parts of the country, there are gaps in the communication between Primary and Secondary Care. Patients have had colonoscopies or flexible sigmoidoscopies due to diarrhoea, and consequently, colitis has been diagnosed. The report to Primary Care often indicates that a gastroenterology appointment has been arranged, with no treatment started, but the appointment isn’t for several months. The Primary Care clinician and the patient are then both in limbo and unsure of how to proceed.
Answering A&G queries via Consultant Connect allows me to recommend treatment in the meantime. A lot of treatments for gastroenterology are protocol-led, and therefore straightforward, meaning the patient doesn’t need to attend A&E.’
Shenaz shared how a patient’s blood test showed elevated alanine aminotransferase levels, so she contacted a consultant paediatric gastroenterologist via the Consultant Connect App:
‘The consultant advised me to order an ultrasound scan for the patient and repeat liver function tests. His advice was helpful, truthful, and non-judgemental, which ultimately helped me provide the best care for my patient.’
‘A patient presented with bloody stools and a history of inflammatory bowel disease. The patient was unwell enough to justify a hospital admission, but I didn’t feel they could wait for an “advice only” SCI letter response. Using Prof-to-Prof Advice allowed me to discuss these concerns with a consultant gastroenterologist, who advised on a management plan, which I commenced. The patient was also then allocated an urgent appointment with treatment in situ in the interim. The patient was reassured, and treatment was commenced quickly to relieve their distressing symptoms, and they got the right care faster.’
General Medicine
‘General Medicine is a specialty I use frequently, and recently I sought Advice & Guidance from a consultant via this line regarding a patient whom I suspected had rhabdomyolysis. The patient presented fit and well; he had previously undertaken intense exercise and was passing dark urine. I took his bloods late on a Friday afternoon, but I was worried about the patient not being seen until after the weekend. After speaking with the consultant, they were able to alert the senior housing officer to chase the blood results, and this resulted in the patient being admitted later that evening. It was a really effective way of preventing the patient from being sent to wait in A&E, which relieves pressure on ED. The patient was grateful for this and the fact that the communication between Primary and Secondary Care was positive and cohesive. The conversation was a good example of working together to ensure the smoothest journey for the patient.’
Gynaecology
‘I recently called a consultant gynaecologist via the Consultant Connect App after seeing an 80-year-old patient presenting with lower abdominal pain. She had been referred for an ultrasound scan, which was reported as a distended endometrial cavity; however, the patient had had no per vaginum bleeding or weight loss. The consultant advised making an urgent, but not a two-week wait, referral to gynaecology for the patient to be seen by a specialist. The response was immediate, and I could make a rapid decision about the best care for the patient.’
‘A young female patient came to see me as she was suffering from excessive prolonged bleeding whilst using the progestogen-only pill (POP). The patient could not use the combined oral contraceptive pill (COC), so I used Consultant Connect to obtain rapid advice from a local gynaecologist on the most suitable option. Using Telephone Advice & Guidance in this way resulted in the patient feeling relieved that their problem was being dealt with in a timely and efficient manner.’
‘I recently saw an antenatal patient after her midwife suggested she discuss starting Acyclovir Prophylaxis in the late stages of her pregnancy due to a history of recurrent genital herpes. When I saw the patient, she was well with no symptoms of genital herpes, so I decided to make a Telephone Advice & Guidance call via Consultant Connect to discuss the case with a local consultant gynaecologist. The call was very useful as they advised me that the guidance surrounding this had recently changed. Research had actually shown it is better for patients with recurrent herpes to be on Acyclovir Prophylaxis from 36 weeks. The patient was very satisfied that the recommended management plan, to prescribe the medication, came from a consultant who was aware of the new guidance. The patient felt reassured because of the consultant’s specialist opinion and felt safer taking the medication following this call.’
Haematology
Dr Moldovan recalled receiving a patient’s bloodwork which showed raised haemoglobin and haematocrit levels:
‘I spoke with a consultant haematologist who reassured me that a referral to Secondary Care was not necessary, which I then shared with the patient. They were pleased and relieved that their case was discussed with a specialist promptly.’
‘I saw a patient who had recently been diagnosed with an extensive deep vein thrombosis (DVT). She exercised frequently right up until the diagnosis, and during my follow-up appointment with her, she mentioned that she was on her way to an exercise class that day. As the patient had only just started on a direct oral anticoagulant (DOAC), I used Consultant Connect to speak to a haematologist for advice on whether there was a minimum amount of time a person should be on a DOAC before resuming exercise to reduce the risk of thromboembolism. The consultant was really helpful and advised that, although there was very little evidence on this, the consensus opinion was that it was safe to exercise as soon as the DOAC was started, as its primary mechanism of action was to stop clot extension. We concluded that the patient could continue to exercise, assuming it was not causing her any symptoms or pain.’
‘I saw a frail 85-year-old patient in a nursing home with a history of schizophrenia and dementia, who had developed abnormalities in their full blood count. In a younger patient, I would have referred urgently via rapid access but, given the patient’s comorbidities, I wanted to know what investigations would be considered and how invasive they might be. After calling Haematology Advice & Guidance via Consultant Connect, the haematologist reviewed the results and explained that the blood picture looked like Chronic Lymphocytic Leukaemia (CLL). He felt that a bone marrow biopsy would be the investigation of choice but that it might be too traumatic for the patient. We decided that, after discussions about the patient’s current physical health, investigations were not in their best interest. The CLL was likely to be very slow to escalate and, since the patient has a very stable quality of life, it was perfectly reasonable not to investigate further. This reassured me that I had really considered the pros and cons of whether to investigate or not. The haematologist was so helpful, we avoided a referral, and the patient maintained their quality of life. It enabled me to be part of the decision-making process, and this was important given the patient’s health.’
Head & Neck Cancer
‘I saw a patient who had been for a routine ultrasound on a thyroid lump. The report results indicated new nodules, but the grading system is not something I am familiar with interpreting, so I wasn’t sure if the nodules were suspicious. I forwarded the report and scan via the Suspected Head & Neck Cancer messaging line for advice. I received a response from Denise, who advised that I should make a 2WW referral and that she would book the patient in for a fine needle aspiration without needing a clinic appointment first. As a result, the patient’s care was fast-tracked, and they were put on the cancer pathway the same day, ensuring the patient got the care they needed fast. If I had seen the patient before having access to this line, I would have needed to call the hospital switchboard and find a specialist in Head & Neck Oncology or Radiology to review the report. It would’ve been complicated to locate the right person; this streamlines the process and makes it significantly easier
‘I had a patient return to the UK from Cyprus with an ultrasound scan (USS) report, and I wasn’t sure how to proceed. The scan showed some lumps on their thyroid, but they weren’t categorised using the British Thyroid Association’s (BTA) U classification. I thought the scan should be repeated, so I sent the report to the Head & Neck Cancer Team via Consultant Connect. After speaking with a Head & Neck Radiologist, the team replied that they weren’t concerned, so they advised repeating the scan locally and forwarding the new report if there were still questions. In a society where waiting times for specialty input are astronomical across the UK, that saved me from referring a patient to be seen in the clinic in a year just to be told to have a repeat scan, which was really helpful.’
Infectious Diseases
‘A patient presented in the surgery with a fever and feeling unwell after recent travel to Southeast Asia, and I was querying a diagnosis of typhoid. I wasn’t sure whether it was a condition that was managed as an outpatient or inpatient, and therefore, whether she could be a direct admission rather than going via medical assessment. I called the Infectious Diseases line via Consultant Connect, and a specialist answered immediately and advised that she required an admission via medical assessment. Before having access to this service, I would have needed to bleep a specialist via the hospital switchboard, which would’ve prevented me from carrying out other important tasks.’
‘I saw a patient who had recently travelled in an area where they may have caught an infectious disease, and I needed to know quickly whether that was the case so I could advise and treat them accordingly. The patient required a rapid blood test, which can be conducted in general practice. However, because of how the system operates, if we take the patient’s blood in the morning, the sample wouldn’t be collected until the early afternoon. In addition to that, the driver collecting the sample would likely also need to pick up samples from other GP practices before finally delivering the patient’s blood sample at the hospital, which can add another three hours to the timeframe. So, I used the Consultant Connect App to speak with an infectious diseases specialist who told me to send the patient in, and they would conduct the investigation there and then. It was such a quick method of communication and it’s great to connect with experienced colleagues.’
Mental Health
‘I was called by a GP who had a patient with depression. The patient was taking Sertraline but wanted to switch back to Mirtazapine because it helped them to sleep better. However, the GP was unsure how to handle the switching of medications. I spoke to the GP, and together, we formulated a switching regime that was appropriate for the patient. This was a great result as the patient received rapid results and the best possible care. In this case, Telephone Advice & Guidance was important as the GP received rapid support when needed, and the patient remained in the community.’
‘I recently received a call from a patient’s mum who stated that the patient was expressing suicidal thoughts, which had happened previously. Their mum was really worried, and the call came through towards the end of the day, so I needed rapid advice. I called the MHAU line via Consultant Connect and discussed the patient with the specialist, and we quickly devised a patient management plan. The specialist advised me on actions to take in the interim as well as a follow-up plan for later down the line. As a result of this call, I was able to give the patient and their mum a definitive plan which they were happy with, and the prompt response put them at ease.’
Neurology
‘I saw a 45-year-old patient suffering with cluster headaches. He was already on the Neurology waiting list but was struggling to function due to the pain. I used Telephone Advice & Guidance to speak with a specialist colleague in Neurology for immediate advice and to discuss a patient management plan. I was able to call the patient back straight away with an update and a different analgesic option, for which the patient was very appreciative. Using Telephone Advice & Guidance in this way meant that I could get a prompt response and set out a clear management plan whilst the patient waited for his outpatient appointment.’
‘I sent a message via the Consultant Connect App to a consultant neurologist on the NCN after seeing a patient with a neurological concern. The consultant assured me that the patient was suitable for a 40-week referral rather than an urgent one. The response was rapid, and I was able to reassure the anxious patient and put them at ease quickly.’
Recently, I contacted a consultant neurologist on the NCN after seeing a patient with a recent diagnosis of secondary metastatic cancer to the brain. The patient has 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 had had another seizure, so I knew he needed an increased dosage of the medication. However, as these drugs are extremely specialist, it’s best to get advice first before prescribing them. I got through to the consultant neurologist in a few minutes. I had the entire conversation during the patient’s consultation without needing to go through any switchboards or wait on hold indefinitely. The consultant neurologist I spoke with gave me a perfect plan, including what to bridge the medication with. Consultant Connect made it easy for the patient and me to deal with his condition and keep him out of hospital.’
Orthodontics
‘As a dentist with a special interest in orthodontics, I often send Advice & Guidance queries relating to patient treatment plans. I’ll also send through queries for advice relating to the extraction of deciduous teeth, for example.
In these cases, I’ll ask the specialist if they think it is appropriate to take this deciduous tooth out early to try and promote eruption of another.’
Paediatrics
‘I recently saw an unwell baby with low oxygen saturation. He had a slight cold, the patient’s mum was worried, and the examination was largely uninformative, apart from an oxygen saturation of 82%. I tried different oximeters, but the saturations were still low. I used Telephone Advice & Guidance via Consultant Connect to get specialist advice. I discussed my findings with a consultant paediatrician, who immediately advised that the patient be admitted. The patient was in hospital for four days and treated for the infection onsite. Apart from the low saturations, the patient’s presentation was normal. Using Telephone Advice & Guidance that day was crucial. If I hadn’t had the conversation with the specialist, the patient would likely have been admitted due to a 999 call later that day.’
‘I recently answered a call via the outpatient advice line. The patient was a young child who had recently moved from a different country. The child had a rare metabolic disease. The child had been under follow-up in his country of origin, and the GP was wondering how best to get him into follow-up within our services. I was able to point the GP and child to the relevant specialists within our health board who had experience in dealing with these rare metabolic conditions. This enabled the GP to refer the child immediately to the right place, avoiding a referral to a general paediatrician (who may not have experience with this rare condition).’
‘I answered a call from a GP who was worried about a paediatric patient having frequent seizures and possible epilepsy. The patient had an appointment for an EEG test to look for epilepsy, but their appointment wasn’t due for a while. The GP wanted to know if we could expedite the appointment so that the child could be seen by us within a few days of having the test. As a result, the query was answered quickly – they didn’t need to send a letter and await a response from the consultant or administrator. This meant they could advise the patient and their parents quickly and the appointment with the Paediatrics Team was scheduled after the EEG test.’
‘I recently saw a three-year-old child in practice with a urine infection. However, mid-way through the consultation, they became very distressed, complaining of neck pain. I was concerned as to what could be the cause and decided to utilise the Paediatrics Professional-to-Professional Advice line via the Consultant Connect App. A paediatric consultant answered immediately, and agreed that this was unusual and advised the patient and their parent to attend A&E for further assessment. It was so reassuring to have specialist advice and a second opinion so quickly. The consultants are extremely helpful and supportive, which has been a huge help when seeing young patients and their worried parents in the community.’
‘I saw a teenage patient with a firm lump arising from his chest wall costal margin area. I called the Paediatric 2WW Pathway and spoke to Dr Neuling, who saw the patient within two days of making the call. The communication allowed for better patient care and the process of requesting an appointment was much quicker to action via Consultant Connect, and I could easily see the outcome of the referral.’
Palliative Care
‘I recently contacted the Palliative Care Team for advice on managing an end-of-life patient. I spoke with the specialist very quickly to discuss a treatment plan that allowed the patient to remain comfortable at home with their family around them, rather than going to hospital. The Consultant Connect App provided easier access to communicate with specialist teams, and this has been really helpful as the procedures have regularly changed through different stages of the pandemic.
‘A patient presented with deficient levels of vitamin D and a history of ongoing malignant melanoma. Their cancer treatment meant they had to avoid sun exposure completely, and with their low levels, a very high dose of vitamin D was clinically indicated, according to NICE CKS. A loading dose would benefit the patient for a certain length of time. Still, before commencing, especially for oncology patients, this treatment should be discussed with a specialist to determine whether there is additional guidance or therapies to consider. I sent a message to a consultant in palliative care on the NCN outlining my plan and asked if, based on their experience, there was anything they would change. The consultant agreed with my approach, which enabled me to initiate the patient’s treatment the same day, and he avoided a hospital referral.’
Patient Connect
An elderly female patient in a nursing home had a fall, which resulted in a scalp wound. The wound had been managed by a staff nurse on site with steristrips but the wound needed further treatment. The nurse had phoned NHS 111 and been directed to the Flow Navigation Hub and told to wait for a call via Patient Connect. Dr Andrew Russell, an A&E consultant at University Hospital Monklands then phoned the nurse to discuss via Patient Connect. The patient would have required ambulance transfer both to and from hospital, so Dr Russell phoned the out-of-hours hub to get the number for the area district nurse.
Radiology
‘A female patient who had recently suffered weight loss came to visit me. I examined the patient and found an enlarged liver. Urgent blood tests showed deranged liver function and raised ovarian tumour markers. The patient had a history of breast cancer and had been discharged a year ago. Clinically, the patient had suspected metastases from an unknown primary, and I was worried about the potential delay that could happen to her investigations during COVID-19. I used Consultant Connect to speak to a local radiologist to discuss the patient’s symptoms and arranged for her to get an urgent CT TAP scan in the same week. The scan results showed multiple metastases secondary to breast cancer. I was able to promptly refer the patient to the oncology team, where the patient was assessed for palliative chemotherapy within two weeks of being seen in primary care. The patient was very grateful for the speedy way in which she was managed.’
‘After sending a patient for an X-ray, the report came back suggesting possible cancer metastases and 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 my surgery’s Consultant Connect Dial-In Number to call the radiologist and got straight through. He reviewed the X-ray and said it was definitely cancer metastases, and the patient did not require an MRI scan. Instead, he advised I investigate the cancer’s primary and then refer to that specialty.’
Respiratory Medicine
‘On another occasion, I saw a patient with troubling asthma. The patient was having repeated exacerbations, which were not improving. I used Consultant Connect to speak with a respiratory consultant to receive advice on the correct treatment plan for the patient. I received a rapid response from the specialist. The consultant I spoke to offered immediate treatment advice and the next steps for the patient if the treatment was unsuccessful.’
‘A patient experiencing rapidly worsening shortness of breath over the last few months came to see me, and I initially diagnosed pulmonary fibrosis. The patient didn’t require an 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 the University Hospitals of 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 happy they were being seen by a specialist urgently.’
‘I recently saw a patient who had been under the care of specialists for many months with chest infections and breathing problems, and she had tried various medications and antibiotics. When I saw this patient, she had already been referred to the Respiratory Team at Medway NHS Foundation Trust, but she was experiencing the same symptoms so booked a GP appointment. The patient was off sick from work, fed up that she couldn’t sleep or walk due to breathing issues, and frustrated that the medical interventions were not having any effect on her condition. She was advised that there was currently an eight-month wait to be seen by the Respiratory Team but wanted to know if there was anything else that could be done in the meantime. I used Consultant Connect to call a local respiratory consultant who was extremely helpful. He looked at her previous history and scans, and suggested a steroid and different inhaler that could be prescribed in the interim. He also advised that he would ask the secretary to expedite the patient’s appointment as she was most likely suffering from long Covid. After prescribing the steroid and inhaler, I followed up with the patient two weeks later. She was like a completely different person. Her life had changed dramatically; she was going for walks, sleeping better, and considering going back to work. Although her appointment with the Respiratory Team had been expedited, she wasn’t as concerned as before because she felt such a difference. She was so thankful for the specialist advice, which allowed her to get the care she needed fast, and I found it a truly rewarding experience.’
Rheumatology
‘I saw a patient whose blood tests came back showing very high levels of transaminases as part of his liver function blood test monitoring on methotrexate. The level of transaminases was just above the level at which specialist advice was recommended in order to decide if methotrexate should be temporarily stopped. Previously, I would have had to call the hospital. However, I was able to get through to a rheumatologist via Consultant Connect, who confirmed that it was best to omit the dose for that week and repeat the liver function blood test the following week. This was especially helpful as the patient was very reluctant to stop his methotrexate, so being able to provide timely specialist advice and reassurance was particularly important for him. She also discussed the best ongoing management with respect to the repeat transaminase levels, which was very useful.’
‘A patient presented with intermittent random swelling to her fingers for the past 15 years, which she noticed started happening after the birth of her youngest child. At the time, she was seen by a vascular specialist who conducted scans, which were reported as unremarkable. She came to see us last week because her finger had swelled four times in 24 hours, which was even more unusual. She was understandably worried because it was blue in colour and throbbed. With the patient’s consent, I used Consultant Connect to take and send her photos and clinical history to a rheumatology specialist. The consultant replied, saying that she suffered from the same condition, known as Achenbach’s syndrome, and that the patient didn’t need any treatment. I had never heard of this condition before, but I was so surprised at the quickness of the reply, which came through within an hour of the initial message. For the patient, it was reassuring that it was nothing sinister and she was so grateful.’
SDEC
‘I had a gentleman who had been back and forth to see me with very vague symptoms: a fever, rash, pain and feeling generally unwell. His bloods weren’t matching a pattern that was consistent with his presentation. I treated him on a few occasions, and he would improve slightly and then decline. It was very strange and had continued for weeks. I called the medical SDEC line via Consultant Connect and discussed the patient with a consultant. I explained that the patient’s ferritin level was raised, and his hands were swollen; it looked rheumatological, but I didn’t have an answer. The consultant suggested I take some swabs, repeat the patient’s bloods, prescribe another course of antibiotics, and, in the meantime, send an urgent referral to infectious diseases. Within 20 minutes of that call, the consultant had phoned back to say he had spoken with a colleague, and they thought it could be stills disease. This is a rare condition, similar to adult-onset juvenile arthritis, and this diagnosis fit with the patient’s previous blood tests. The consultant advised that he had booked the patient for an urgent appointment with a practitioner specialising in diagnostic uncertainty the following day. The patient had an Echocardiogram, CT, blood cultures and an appointment, all within 48 hours of the phone call. At the patient’s outpatient appointment, they ruled out a lot of very serious disorders, such as sepsis, endocarditis, and other autoimmune conditions, and he was then referred to rheumatology. The patient wrote to me within a week to give me a complete update and to advise that he was exceptionally happy with his level of care.’
Stroke
‘I saw a patient who had had a stroke and was taking apixaban and statin. They recently had their bloods taken, and their liver function test (LFT) was grossly abnormal, which was a new finding. I sent a message to a haematology consultant, who reassured me that the patient could be managed locally and that a referral was unnecessary. This was excellent for the patient as they didn’t need to travel to the hospital and wait to speak to a clinician in Secondary Care.’
Tissue Viability
‘We had a patient with a complex wound admitted a few months ago to our rehab hospital, which is on another site, after the traumatic wounds she had sustained were slow to heal. Staff used the Consultant Connect App to send the Tissue Viability Team frequent updates so that we could provide dressing advice and monitor her progress. She has now recovered and been discharged, which is a huge achievement. The staff who managed her care did extraordinarily well, but the additional support of the photos via Consultant Connect was a contributing factor and positively impacted the patient’s healing.’
‘We recently triaged a patient via Consultant Connect where the primary clinician had indicated that he needed to be assessed as soon as possible, and we saw him within 24 hours of receiving the images. The gentleman had been admitted as a long lie after falling the night before. He had a septic chest infection and extensive deep-tissue injuries. The epidermis on his buttocks had already started to break down, and he had bilateral DTIs to his heels, as well as hyperkeratosis to his lower limbs. On arrival, the patient was agitated and in a lot of pain, so the benefit of us reviewing him quickly meant we could organise a specialist mattress for him and speak to his family.
‘The patient had been fit and well before the incident and, understandably, the family was shocked and anxious. We had a candid conversation about his pressure damage and the associated expectations. Unfortunately, the patient passed away, but the family were grateful for the honest conversation about his care, which is something that they might not have received had the pathway not been available. If we’d had a referral for this patient without the imagery, it would have been labelled “DTI to buttocks and heels”, and we might not have been able to assess and provide treatment for him as quickly as he needed. As a result, the family might have assumed that the pressure damage caused or contributed to his death, so speedier and enhanced engagement with the family is an obvious plus.’
Trauma and Orthopaedics
‘I received a call from a GP regarding an elderly patient with a soft tissue swelling in the thigh and a history of minor trauma, which the patient had assumed was a muscle sprain. The lump was getting bigger despite rest. This was a typical but rare case of soft tissue/muscle sarcoma. I advised the GP to urgently refer the patient via their local two-week-wait pathway (2WW) to the Musculoskeletal (MSK) Tumour Service. This meant the patient’s care was expedited, and they got the correct care faster.’
‘Over the last 12 months, a patient from our practice attended the emergency department due to foot pain. The patient had an x-ray, which confirmed that the bone was not broken and was discharged. A short time later, the patient returned to the practice with the same issue. The x-ray report identified the possibility of a foreign body in the foot, and rather than sending the patient back to the emergency department, I used Consultant Connect to speak directly with a specialist. The specialist reviewed the x-ray images and quickly organised a repeat scan and follow-up appointment for the patient. Without Consultant Connect, the patient would have needed to return to the emergency department and would have waited a long time to be seen. Going directly to a pre-arranged appointment with a specialist made the best use of both patient and hospital time. This meant the patient received the care and treatment they needed in a more streamlined and effective way.’
Vascular Surgery
‘A patient attended the podiatry clinic in the community for a review but was found to have deteriorated significantly. The podiatrist securely uploaded clinical photographs with the patient’s consent and added a brief history. The images were reviewed, and the patient was transferred urgently to the Vascular Team at UHCW. This was all done via Consultant Connect. Without this service, the patient would have likely been sent to South Warwickshire NHS Foundation Trust for an assessment and then transferred to UHCW, but by sending the images for analysis, we bypassed that completely. The fact that the patient was seen so quickly and efficiently is particularly important as they had an ischaemic foot, which is a vascular emergency.’
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