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Advice and Guidance Best Practice

Checked: 23-03-2023 by Vicky Ryan Next Review: 20-03-2024

Overview

Please see the attached Good Practice for Advice & Guidance v1.4 and Advice & Guidance Update (Oct 2020) which includes a summary of the local progress, the feedback users have given via the survey, and the actions that are underway to keep evolving A&G.

If, following initial Advice and Guidance, the GP wishes to continue the conversation in eRS please see the attached process.

Secondary care teams are asking colleagues to be judicious in the use of advice and guidance during the crisis. The referral team suggest using the following 5 scenarios as appropriate criteria when seeking support in managing patients:

Diagnostic uncertainty that will affect safe / effective management of patient. Please do not use for suspected cancer referrals which should be referred using appropriate 2WW pathways.
Uncertainty around clinical management (once REMEDY pathway guidelines have been checked) that will affect safe / effective management of patient
Support to interpret primary care diagnostics (e.g. ECG) that will affect management
Patients on a follow up pending list who have been deferred and present in primary care with problem that GP cannot manage alone
Clarification of prioritisation between routine and urgent.

It is also suggested that referrers include a contact number eg. practice professional line or mobile telephone number when requesting A and G so that clinicians can contact them directly, if needed, to discuss a patient's care.

To enable the consultants to give the best advice possible please also consider the following points:

Give a clear concise history and examination findings- avoid cutting and pasting long lists of consultation notes that are not relevant to the problem in hand.
Include relevant results, investigations and recent correspondence if appropriate but avoid multiple attachments that can take time to download and make the triage process more cumbersome.
Ask a clear clinical question and avoid ambiguity.
Avoid requests for complex patients known to an individual consultant as they are unlikely to be the consultant giving the advice and may not have easy access to details of previous contacts with the patient. In these cases consider writing or emailing the relevant secretary directly.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.