The 2 rules for guaranteed success with Advice & Guidance

Published: 15th July 2020
The 2 rules for guaranteed success with Advice & Guidance - Consultant Connect

You may not know this, but all our projects sit alongside e-RS written advice. Why? Because if you give clinicians a choice of telephone or written advice, they will ask for advice far more often than if they only had one option. As it happens, the factors that make a Consultant Connect project a success are the same for e-RS. In fact, there are 2 golden rules for success:


1. Clinicians should use the service a lot
To make the clinicians (GPs, paramedics, nurses etc) want to use the service, there are two conditions that have to be satisfied:

a. The advice service includes useful specialties – specialties that GPs have a high demand for. A popular addition to local services has been a COVID / Acute Medicine line. Specialties impacted by COVID such as Diabetes / Endocrinology, Cardiology and Respiratory Medicine have also proved popular.

b. The “asker” is going to find out something that they do not already know – either “what should I do with my patient?” or “where should I send them?” This means making sure that the right type of clinician is responding to the request – for example, a sufficiently senior specialist or a clinical navigator.

In addition to these conditions, explicitly including advice & guidance in the pathway for certain specialties / conditions is a good strategy for reinforcing the value of the high quality advice that your asking clinicians will receive.
2. The responding clinicians need to answer
This may sound obvious, but no amount of encouraging clinicians to use advice & guidance can overcome an unreliable service. If your calls and written requests get answered reliably, though, you are setup for success. See rule 1 above!

For Consultant Connect, ensuring calls get answered is a large part of our day job. We make sure there are enough specialists on the rota, so that if one or more are unavailable to take a call, there are others backing them up. We make sure that teams are engaged, so that this is how they want to work and we feed back performance data regularly. We also survey callers – there is nothing like good GP feedback to fire up a specialty team!

Local advice from a local clinician is always the best option, but, if a local clinician is not available, advice from an out-of-area NHS specialist is the next best option. Over 70% of calls to National Consultant Network clinicians result in the patient avoiding hospital, which is the quickest and best care for the patient. Where hospital is necessary they do always prompt GPs to consider local options (eg. “If there is a community clinic for …”), making the most of the GP’s pathway knowledge.

With e-RS the challenge is slightly different – although clinicians don’t have to respond immediately, they do have to respond in a timely fashion. Long, unpredictable response times mean that the GP is not certain they will receive the advice when they need it, which means they won’t ask for it in the first place. The 48-hour response time mandated in 2018 by CQUIN seems to be the reasonable limit, and we encourage areas to try and hit that.



Adhering to the 2 rules above is a big challenge. If you achieve them, though, they will guarantee the success of your Advice & Guidance project, whether it’s e-RS written advice, Consultant Connect telephone advice or both. The impact on patient care and system efficiency is worth the effort.


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