Sustainability across the NHS is not achieved through efficiency alone. So the question becomes: how do we capture the opportunity that sits earlier in the pathway?
At its core, this is about delivering the right care, first time—ensuring patients only enter hospital pathways when they genuinely need to, by providing early specialist advice access.
Yet anyone working at the primary–secondary care interface knows this is a complex part of the system to get right.
Sustainable demand management at the front door depends on three things aligning.
1. Financial incentives need to reward the right outcomes
There remains a disconnect between the value created through virtual care and how it is recognised motivationally and financially.
In well developed triage or A&G models, consultants routinely produce detailed management plans for patients who do not require a hospital appointment—often equivalent to what would have been delivered in a first outpatient consultation.
For a significant proportion of patients, this avoids the need for a hospital visit altogether.
Yet this type of activity is not consistently remunerated at the same level as face-to-face care.
Some systems are beginning to address this—introducing local payment mechanisms that recognise both activity and diversion, going beyond the proposed patient-not-present tariffs, which remain more focused on administrative validation and waiting list “hygiene”.
2. Workforce models must reflect real-world pressures
Job planning for Advice & Guidance and triage is becoming more common. However, workforce pressure is not static. Recruitment challenges, unplanned absences, and demand volatility are a constant reality.
This is where more flexible, on-demand workforce models have a role to play if you want to achieve consistent performance. It only takes a couple of struggling services with diminishing response times, and the confidence in the model as a whole is jeopardised.
The ability to bring in additional clinical capacity at short notice—during periods of peak demand—and step it back when pressures ease enables systems to maintain performance without permanently increasing cost.
The demand for our ‘switch-on/switch-off” virtual consultant capacity has grown significantly. Over the past 12 months alone, usage has increased by around 30%.
During the recent Q4 sprint, over 30,000 post-referral triage cases were delivered alongside local teams. More than 30% of patients were managed outside hospital with care plans, with many others redirected to appropriate community services.
3. Front-door services need to be run like core clinical services
Inside hospitals, services such as operating theatres are managed with discipline—clear governance, performance oversight, modern tools, and operational planning.
Front-door services should be no different.
High-performing Advice & Guidance and triage models are actively managed: response times are tracked, access is streamlined, and there is clear accountability for delivery. Clinicians need to be given modern tools to deliver without frustrations about unintuitive and unnecessary steps. Platforms like Consultant Connect have been designed with ‘ease’ in mind, yet they are fully integrated with national tools like eRS to avoid duplication of efforts.
When this level of operational rigour is applied, response times become consistent, which nurtures primary care engagement and confidence—and better patient outcomes follow automatically.
What happens when these elements align?
Where incentives, workforce, and operational management come together, the impact is both measurable and significant.
In Coventry & Warwickshire, a 24/7 frailty service enables ambulance crews to access senior clinical advice in real time with a connection rate of under 30 seconds—resulting in around 79% of patients avoiding emergency department conveyance.
In Greater Manchester, a system-wide Advice & Guidance service launched across more than 20 specialties with support from an out-of-area specialist network. The project has processed over 10,000 cases within six months, with around two-thirds not requiring onward referral into hospital care.
More mature systems, such as South East London, are now operating at scale, handling over 5,000 advice requests per month, with consistently high diversion rates.
These are not isolated examples. They demonstrate what is possible when front-door models are treated as a core part of system design—not an add-on.
If you’d like more information on how our services can support your NHS area, please email info@consultantconnect.org.uk or call 01865 951207.
Related materials:
- What we do | Enhanced Advice & Guidance
- What we do | Referral Triage and Validation
- Frailty Call before Convery supports Warwickshire Trusts’ improved four-hour performance
- Press Release | All Greater Manchester GPs can now connect to specialist advice in seconds
- Case study | How a single conversation helped resolve a patient’s long-standing symptoms in Greater Manchester
- Case study | Same Day Emergency Care in South East London
- Case study | Elderly Care A&G across the NHS
