Using out-of-area NHS consultants to support Advice & Guidance

Published: 2nd January 2020

One of the biggest challenges for hospitals delivering an Advice & Guidance service is staffing it. Whether the requests come in from GPs by phone or in writing, most clinicians are expected to respond whilst also doing their day job. This can mean using consultant admin time, for example, to squeeze in advice & guidance […]

One of the biggest challenges for hospitals delivering an Advice & Guidance service is staffing it – particularly during winter. Whether the requests come in from GPs by phone or in writing, most clinicians are expected to respond whilst also doing their day job.

This can mean using consultant admin time, for example, to squeeze in advice & guidance alongside essential paperwork. Planning to take incoming phone calls can be shared amongst teams (“on-call” consultants, answering rotas), but answering calls alongside other duties requires careful management.

Setting time aside specifically for advice by job-planning is a good way of making sure advice is prioritised. The disadvantages are that it stops clinicians from seeing as many patients and that the advice may only be available for small amounts of time, such as 1–2pm or only on certain days.

At the end of the day, the problem can be solved by more staff. And, for many specialties, those staff don’t have to be based at your hospital. This allows consultants from other areas who have availability to take advice calls and written requests from your GPs.

That is why we created the National Network of specialists over a year ago to support your GPs both in Elective Care and Mental Health. Our National Consultant Network (NCN) options help to solve any staffing issues. The network consists of NHS specialists who are able to answer calls for advice. For example, they may work part time and be willing to take calls on their days off. The NCN is very flexible and can be ‘switched on’ (within 48 hours) as a back up whenever your hospital needs it. For example, you may decide to use the NCN during a short peak period e.g November – February.

Many areas across the UK are already using the National Consultant Network – currently 74% of all calls to the NCN result in an admission or referral being avoided.

Elective Care

In Elective Care, these specialists are also able to answer written requests for advice.

They are able to:

Support your local consultants, acting as a backstop when they can’t respond to requests; and
Provide specialties that are not available locally, e.g. neurology

We are currently able to cover most specialties for phone and written advice & guidance requests, including:

Cardiology
Dermatology
Diabetes and Endocrinology
Elderly Care
ENT
Gastroenterology
General Medicine
Gynaecology

The NCN for Elective Care operates

Mon-Fri, 9am-8pm.

Haematology
Neurology
Mental Health
Paediatrics
Renal Medicine
Respiratory Medicine
Rheumatology
Urology

Mental Health

In Mental Health, we offer two national telephone-based advice and guidance services to support GPs with prescribing in primary care: one is for children and young people with mental health problems, and one is for working age adults with mental health problems.

We understand the importance of keeping young people and adults managed in primary care where it is clinically appropriate to do so and reducing the number of people unnecessarily added to long waiting lists in secondary care.

Specifically, our medication advice line supports with:

Medication reviews
Potential interactions between drugs and side effects
Supporting primary care prescribing
Confirming NICE guidance

Our telephone advice lines are staffed by a national network of NHS fully trained and accredited Psychiatrists, Pharmacists and Nurse Prescribers. We offer this service to support GPs with managing a range of conditions in primary care including anxiety, depression, Attention Deficit Hyperactivity Disorder, Autism and Psychosis.

The NCN for Mental Health operates

Mon-Fri, 9am-5pm.

The NCN in practice:

Area using ONLY NCN to answer calls:

“In our area we decided to provide GPs with a service staffed only by the National Consultant Network. In just eight weeks we have seen a significant impact – 71% of all calls have resulted in hospital visits being avoided. GP feedback is also very positive – the specialists answer calls quickly and are very helpful.” NHS Heywood, Middleton and Rochdale CCG. Click here to read a blog post about this project.

Area using NCN in addition to local specialists:

“The service has provided excellent advice and guidance (to GPs) and enabled them to manage their patients. They were supported to utilise alternative prescribing and managed the patients in primary care effectively.” Pam Green, Chief Operating Officer, NHS North East Essex CCG. Click here to read a blog post about this project.

Area using NCN across the STP:

“We have the National Consultant Network back-up in place in some specialties, which has boosted answer rates, and has been well received by GPs. We’re looking to back-up more lines with the National Consultant Network.” South East London STP. Click here to read the full report.

NCN Consultant experiences:

Consultant prevents possible stroke for patient:

“There is no doubt in my mind that it prevents unnecessary referrals. Perhaps just as importantly, it does significantly increase the quality of medicine being practiced in primary care.” Click here to find out how the advice Dr Davey gave to a GP prevented a possible stroke for a patient.

Consultant avoids unnecessary referral for 75-year-old patient:

Dr Sahebjalal says the benefits, of answering Phone Advice & Guidance calls from GPs, to him, include: “Getting to talk to a number of GPs based in different practices. It also helps to understand what the main or recurring issues and concerns are in the community.” Click here to read a recent example of how the advice Dr Sahebjalal gave to a GP avoided an unnecessary referral for a 75-year-old patient.

Consultant avoids referral for patient with long history of body pain:

“It’s a good way for them [consultants] to keep up their regular practice of clinical advice – in addition to the benefits it brings to patients and their local departments by helping to avoid unnecessary referrals.” Click here to find out how the advice Dr Kaur gave to a GP avoided an unnecessary referral for a patient with a long history of body pain.

If you have any questions about our National Consultant Network for Elective Care or Mental Health, visit our National Network webpage, contact us on 018656 261467 or hello@consultantconnect.org.uk.