The UK government has confirmed the expansion of a GP scheme to shift care from hospital to community.
The Advice and Guidance scheme sees GPs working more closely with hospital specialists to access expert advice quickly and speed their patients through the system, so they get care in the right place as soon as possible.
This means patients are being directed to more appropriate care – such as being prescribed medication, accessing blood tests or scans through their GP, or receiving care in a local women’s health hub or community physio service – rather than being put on long NHS waiting lists.
While the Royal College of Physicians has welcomed the expansion of the scheme, Beccy Baird, a senior fellow the King’s Fund, said the approach could have some “unintended consequences affecting both patients and GPs.”
Here’s what you had to say.
Charlotte Harpin, Partner in the health and life sciences team at UK and Ireland law firm Browne Jacobson:
Expansion of the Advice and Guidance scheme will contribute to a more streamlined patient experience, with integrated primary and secondary care delivered in the community via the GP.
In turn, this should lead to reduced waiting times and unnecessary hospital visits, while enhancing integrated, multi-disciplinary working between primary and secondary care providers.
However, success will depend on clear communication between these providers, ideally supported by integrated records – perhaps held on an individual’s GP record – to ensure all treatment, decision-making and clinical advice is incorporated in one place.
Clarification is needed on how this way of working interacts with patient choice.
For instance, if the ‘advice and guidance’ would previously have resulted in a qualifying referral, patients may wish to know whether they still have a choice as to who their GP seeks advice and guidance from.”
Dr Todd Green, GP Lead at Livi:
While GPs have had access to Advice and Guidance (A&G) schemes for years, this incentivised expansion will increase administrative workloads for primary and secondary care.
A portion of clinical workload will get pushed from secondary care (prevented referrals) to primary care (implementing clinical advice received), consistent with current government priorities for the NHS.
Health technology companies are positioned to support primary care to utilise the scheme through, for example, facilitating submission, receipt and processing of A&G referrals and outcomes.
For patients, delayed responses to A&Gs due to increased volume and demands on finite pools of specialists and GPs to process them may cause frustration.
More direct and convenient communication with patients, as provided to several NHS partners by Livi’s leading digital consultation infrastructure, will reduce the burden on GP practices and more efficiently convert advice into progression of patient care.
Dr Sonia Szamocki is a former NHS doctor and CEO of British collaborative healthcare startup 32Co:
Sharing expert knowledge across the NHS is essential to helping it do more with less.
The culture of sharing advice and guidance within healthcare is strong at hospital-level, but when you go down the pyramid to general practitioner-level, the support network and direct line to specialist help is just not there.
Our GPs do a phenomenal job at helping patients with a whole host of medical problems, but there is a point at which they are no longer best fit to diagnose and treat these issues on their own.
Collaborative healthcare is not a new concept.
But a support network that allows GPs to communicate directly with a specialist, even for sake of mind, will no doubt drastically improve GP confidence and hopefully reduce hospital referrals, as the practitioner will feel more empowered in their decision making.
