The Advice and Guidance (A&G) service allows GPs to seek advice from secondary care consultants and enables the management of patients in primary care.This service was implemented in Guildford and Waverley CCG with the intention to reduce the number of GP referrals for first outpatient appointments by supporting GPs to manage patients safely in primary care, and to improve patient experience by reducing waiting times and enabling quicker access to specialist advice.
The A&G requests have included requests for opinions on test results, medication advice as well as general advice on the next steps in a patient's management plan.
The service has now been rolled out in 22 specialties at the Royal Surrey County Hospital (RSCH) and Guildford and Waverley CCG also have an agreement with Ashford and St. Peter's Hospitals (ASPH) for GPs to access the 22 specialties live at ASPH.
This means GPs have access to a total of 26 specialties that are live at one or both hospitals.
Once GPs have submitted their request via the e-Referral system (e-RS), a consultant reviews the advice request and responds to the GP within 5 working days at the RSCH or 7 working days at ASPH.
Since September 2016 - October 2017 a total of 191 Guildford and Waverley GPs have sent 1,593 A&G requests to the RSCH. The average turnaround time at RSCH is 3 working days.
The Senior Commissioning Manager for Planned Care, Genevieve Ryan, supported the roll out of A&G and found: 'The response from GPs and consultants has been really positive overall. GPs feel that they're getting quick access to good quality advice from consultants and consultants have said they've already noticed a positive difference in freeing up clinic space to accommodate the more complex patients who need their input the most'.
Dr Justine Hall, the Clinical Lead for Planned Care said ‘Advice and Guidance is a really useful resource for the GP to get the answer to a question which would otherwise need a referral or the ability to get hold of a consultant on the phone. It also means outpatient appointments can be used for those who really need them and keeps waiting times down.’
From April to September 2017 there have been 729 A&G requests sent to RSCH, after which only 90 patients (12%) needed an outpatient appointment, saving £89k in first outpatient attendances to date.
Further, a 7% reduction in GP referrals for first outpatient attendances has been seen at the RSCH, with a 92% match between the specialties showing a reduction in referrals and the specialties that A&G has been implemented in.Collectively this amounts to a £500k saving predicted for this financial year due to A&G.
Overall, the A&G service delivers cost savings for the NHS, supports GPs to manage patients in primary care and ensures consultant clinic spaces are used for patients with complex health needs.
Fundamentally this means that patients are getting rapid advice and reassurance without needing to wait long periods for a hospital appointment.