Just over 2 years ago we published an article titled “Who Pays for Advice & Guidance”. It ended up being our most-read article of 2017 and in our top 5 articles of 2018. Why was it so popular?
We think it was down to 2 reasons: firstly, advice & guidance was a new focus of the NHS. It had been included in the 2017-19 CQUIN, which meant that NHS management wanted to understand what its options were in delivering advice & guidance. Understanding what costs what was a key part of those decisions.
The second reason the article was popular was that there were no hard and fast rules about whether a tariff was payable on advice. This led to a lot of controversy at local level. Trusts argued (correctly, in our view) that the extra activity needed to be paid for in addition to the CQUIN payments, and some commissioners agreed with this. But the payment of the CQUIN money clouded the issue.
What’s the situation today?
The CQUIN finished in April this year and that has made the landscape a lot simpler. It looks like this:
It’s now generally accepted that a tariff is paid for advice – but there is no mandatory tariff set, so areas are setting their own levels. We see a range of tariffs between £15 and £35. The most common tariff that we see is a flat rate of £25 per case.
NHSE has also published details of non-mandatory tariffs that are dependent on the speed of response. They recommend £30 for cases turned round in 48 hours or less, £20 for 2 – 7 days and £10 for cases that take longer than 7 days to get a response. It is not clear how widely these tariffs are being adopted, we are aware of a few areas “intention” to use this approach.
The NHS e-RS advice & guidance is a free platform for written advice and we recommend that all areas make use of it. The requirement to reduce outpatient appointments by a third in the Long Term Plan means that many areas are also looking to implement Enhanced Advice & Guidance using Consultant Connect. Telephone Advice & Guidance and Photo-Messaging hugely increase the number of cases that can be dealt with by advice & guidance, as well as giving GPs a choice of how to get their advice.
It remains the case that it is mainly commissioners that pay Consultant Connect’s fees. As before, if we assume a referral costs the CCG £200. When a GP speaks to a consultant using Consultant Connect, we know there is a 66% chance that the patient will avoid an unnecessary trip to hospital. This means that every call to Consultant Connect saves the CCG £132 (£200 x 66%). It doesn’t take many calls for the savings to cover our costs and generate a surplus and, as the CCG is collecting the savings, it often makes sense for them to pay us.
This is not always the case, for example when a Trust is working on a “block contract” basis. The situation is further muddied by the emergence of STPs and ICSs.
Let us know on 01865 261467 or firstname.lastname@example.org if you have an unusual situation you want advice on. With things changing all the time, we’ll doubtless have to publish another update to this article in the not too distant future!