STORY
The King’s Fund has called for urgent action from NHS England after an investigation identified patient safety risks in the use of Advice and Guidance services across the NHS. Advice and Guidance allows GPs to seek advice from hospital specialists before, or instead of, making a formal referral. An interim report from the Health Services Safety Investigations Body found that while the system can improve care when used effectively, poorly designed or inadequately monitored pathways had contributed to delayed or missed diagnoses, delays to treatment and incidents of physical and psychological harm.
The investigation found significant differences between national expectations and the way some local services were operating, including pathways where GPs were required to use Advice and Guidance rather than being able to make a direct referral. HSSIB also identified problems with the NHS electronic referral system which made it more difficult to track patients and share clinical information. The King’s Fund said confusion had been increased by expectations that Advice and Guidance would reduce referrals by 25%, warning that this risked creating the impression that reducing referrals was more important than getting patients to appropriate care quickly.
HSSIB has recommended that NHS England and the Department of Health and Social Care carry out a rapid evaluation of Advice and Guidance services, covering workforce, capacity, training, digital risks and patient safety reporting. It has also called for standardised templates to be developed for requests and responses where they do not already exist. Beccy Baird, Senior Fellow for Primary Care at The King’s Fund, said NHS England should establish how the system was being implemented in different areas and issue clearer guidance to primary and secondary care staff.