Paying for Advice and Guidance isn’t a long-term fix

Tackling long waiting lists

More than seven million people are waiting for elective care, and the waits are far longer than they were pre-pandemic. It’s painful for patients, which means it’s a political sore point too.  

Last month, the government announced a plan to shift a large chunk of these cases away from hospitals and towards community providers. So far, so good; hospitals are overwhelmed. Yet consultants also spend a lot of time seeing patients first, before explaining that what they actually need is a physio. To cut this down, the government wants to pay GPs for making Advice and Guidance requests. 

The role of Advice and Guidance

The Advice and Guidance process lets GPs ask consultants for their views ahead of a referral. They may be unsure whether a symptom reaches the bar for a referral or be unclear on which specialism to aim for. 

It’s a process that can help to support high quality care. For example, during the pandemic when outpatient appointments were rare, we helped GPs to securely share high resolution images of skin lesions so consultants could decide which patients were at risk of cancer and should be seen within two weeks. The principle works, so what’s the issue?

Repairing the referral process

Advice and Guidance is useful where there’s uncertainty. Picking the right pathway requires knowledge of the ins and outs of national guidance, as well as the local requirements of the various hospitals it might go to. It’s little wonder that as many as 25% of all referrals are reviewed by consultants and bounced back to the start, taking up time in both primary and secondary care.  

But making Advice and Guidance routine for all referrals is potentially time-consuming on its own, with the BMA describing how it can lead to “lengthy back and forth discussions”.  It doesn’t fix the underlying issue, which is that referring to the right place is hard.  

Integrated Care Boards (ICBs) that use our Rego software have reshaped the referral process to work for all parties. Set up in close collaboration with all relevant care providers, it guides referrers to the right pathway in under two minutes then lets the reviewer see everything they need in one place – like patient data, test results and scans – and triage the request quickly. A&G can be utilised if the patient does not meet the criteria for referral ensuring the referrer has a back up support option. 

Expanding community-based treatments

Our software also enables direct referrals to community providers. For example, the North East London MSK Alliance uses NEC Rego in five area: Therapies, Rheumatology, Neurosurgery, Pain Management and Orthopaedics. Following agreed pathways, GPs use it to refer patients directly to physio practices or hospital consultants as depending on the patient’s symptoms.  

Before, Barking, Redbridge and Havering NHS Trust had been rejecting 3,000 MSK referrals annually because their specialists didn’t have enough information to triage them effectively. Now, patients get to the right place first time, and GPs have saved 3,000 hours of admin. 

Closing the gap between primary and secondary care

When hospitals, GP surgeries, community providers and patients all come together and co-design referral pathways – as they did for the MSK Alliance – the results can be transformative. The government is right to try and improve these pathways and prevent unnecessary referrals, but increasing Advice and Guidance is just a sticking plaster, not a fix. 

Find out more about our work with the MSK Alliance.