Advice & Guidance Services (DRAFT)

Overview

Please also see the Advice and Guidance Best Practice page which can support appropriate use of A & G and give secondary care clinicians the information they need to enable them to give their best advice.

The following table indicates the current advice services which are available. This is subject to change so should be checked whenever submitting a request. Please see the relevant speciality page, via the links in the table, for full details.

Convert to Referral

The eRS platform has a box that can be ticked that can then permit the provider to convert an advice and guidance request into a referral. 

In BNSSG, this option is not widely available and  can only be used for  the following specialties:

• Dermatology
• Rheumatology
• Paediatrics - General
• Paediatric - Allergy

Details on the process involved can be found here.

There have been ongoing discussions with the ICB, local providers and the GPCB regarding the advice and convert model. Although there are some obvious benefits of this model in terms of reducing administration and duplication, at present there are no plans to extend this option in BNSSG beyond the specialties above for the following reasons:

• Choice - if an advice and guidance request is converted to a referral then this means the patient may not have the opportunity to consider a choice of provider. Although it is considered that this choice discussion should happen at the time the advice and guidance request is made, in practice GPs will not usually have time to have a full discussion in this regard. This can also lead to challenge from independent sector providers who do not have advice and guidance provision.
• Funding policies - if a referral is made via this route it will bypass the BNSSG Referral Service. This means that checks against funding policies cannot be made at an early stage in the patient journey. This can lead to difficulties regarding funding at a much later stage with patient expectation raised only to be left disappointed if a treatment or procedure cannot proceed.
• Referral Service review - the referral service not only checks referrals against policy but will also check that referrals have all relevant information attached and can offer advice on alternative pathways of care including community pathways, diagnostics, management options in primary care, etc that would not be available via an advice and conversion route.

You should therefore not tick the convert to referral box other than for those specialties where this has been approved. If the box is ticked when requesting advice and guidance then the provider may decline to convert and ask for a formal referral to be made.

Patients at risk of admission

If you wish to discuss an adult medical patient at risk of admission to hospital, please call the Weekday IUC Professional Line on 0117 2449283 and see the Medical Admissions and Weekday IUC Professional Line page of Remedy.

Clinical responsibilities and medico-legal

Please see advice from NHSE regarding clinical responsibility and medicolegal aspects of specialist advice (such as advice and guidance and RAS):

Specialist Advice is an umbrella term which encompasses Advice & Guidance (A&G) and Referral Assessment Services/triage (RAS) models. Specialist Advice enables the sharing of relevant clinical information prior to or instead of an outpatient appointment. Specialist Advice between referring and providing clinicians is central to outpatient transformation and elective care recovery. Specialist Advice is expanding rapidly due to advances in digital technology across both the NHS e-Referral service and independent (1).

FAQs:

• SA Clinical Responsibility Faqs 231023
• SA Medico Legal Faqs 200623

Updates available via NHS Futures (log in required):

Specialist Advice: Clinical Responsibility and Medicolegal FAQs - Outpatient Recovery and Transformation Platform - FutureNHS Collaboration Platform

Waiting Times for A&G

Please see the Hospital waiting times page.

The waiting time tool for BNSSG GP practices includes a section on A and G waiting times. You will need to download the document and follow the instructions to access the latest information (updated monthly).

Resources

(1) Medicolegal And Clinical Responsibility SA FAQ Executive Summaryv2.4

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.