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GP ‘advice and guidance’ could make up more than half of increased elective activity



The target to increase elective activity by 10% over the next year will predominantly be achieved through increased GP advice and guidance under NHS England plans.

NHS England planning guidance previously set out ambitious targets for ‘over 10% more’ elective activity in 2022/23 than before the pandemic, and new draft guidance shared by NHS England last month has revealed that more than half of this increase in activity will be through A&G.

It said that the extra 10% will be made up of ‘more pathways completed in primary care with the support of specialist advice’ as well as ‘more completed pathways as per referral to treatment (RTT) rules’.

This follows the Government’s long-awaited elective recovery plan – published last month – which stressed that GPs’ role in tackling the NHS hospital backlog will focus on the use of A&G to try to avoid ‘unnecessary’ referrals to secondary care.

A&G involves GPs accessing specialist advice by telephone or IT platforms, rather than referring patients for a hospital investigation.

The new draft guidelines added that ‘additional elective funding has been allocated to fund 104% of 2019/20 levels of value-based activity’.

The remaining 6% will be achieved through ‘the planned increase in pre-referral advice and guidance’, as well as resources freed through the ‘minimum’ 25% reduction in the following up of outpatients by March next year that could also be redeployed into ‘the use of specialist advice’.

GP A&G ‘could contribute an estimated six percentage points towards the completed pathway activity target’, NHS England said.

It added that where there is a ‘need’ to invest in services such as ‘support to primary care’, trusts must agree this with their integrated care board and ‘resources/contracts adjusted accordingly’.

NHS England last month claimed that GP A&G requests avoided more than one million ‘unnecessary’ hospital attendances in 2020/21.

A&G ‘avoids the need’ for a GP referral to secondary care ‘in most cases’, it said at the time.

Meanwhile, NHS England has set an A&G target across the country in a bid to curb GP referrals to hospitals, which requires GPs to use A&G for 12 out of 100 outpatient attendances by this month.

And by March 2023, integrated care systems (ICSs) must deliver ‘16 specialist advice requests, including advice and guidance (A&G), per 100 outpatient first attendances’ – although it remains unclear how many should be GP A&G requests.

PCNs are due to be incentivised for using A&G through ‘Investment and Impact Fund’ (IIF) points worth £9.9m in 2022/23, however GP leaders have raised concerns about its workload impact in general practice.

A&G: Workload and resourcing concerns

Pulse revealed in November that an LMC has called for GP practices to be paid £12.50 per A&G episode to resource the extra workload.

It followed a major London trial assessing advice and guidance as the single point of access for referrals and a CCG target to cut GP referrals by 65% through A&G.

Meanwhile, GP leaders demanded an end to hospitals being allowed to mandate the use of A&G before accepting GP referrals of patients to secondary care at the LMCs Conference in November.

GP leaders previously warned that any measures leading to GPs facing rejected referrals and therefore more ‘unresourced’ work and greater medicolegal risk are ‘unacceptable’.

They have also previously raised concerns that advice and guidance is yet another form of ‘workload dumping’ from secondary care and cautioned that patient referrals may be declined in error.

Research carried out on behalf of NHS England in 2020 concluded that A&G represents a ‘significant time and resource challenge to primary care’ and that general practice staff ‘do not have additional time to follow up A&G actions’.

READERS' COMMENTS [4]

Bonglim Bong 8 March, 2022 11:12 am

So having targets for a&g requests from GPs just means that GPs will start to do a&g for some things they could manage themselves just to hit the targets.
The hospitals replying to these simple but totally unnecessary a&g requests means they can demonstrate a big increase in outpatient activity.

Everyone can give themselves a big pay on the back as productivity figures increase……
But the system, patients and taxpayer are actually a lot worse off.

Slow handclap for everyone in NHSE.

Darren Tymens 8 March, 2022 12:49 pm

So, hospitals shut down OP during the pandemic but got paid for delivery anyway (and received significant extra funds to cover Covid costs).
They then have been offered an extra £13billion to deliver this work now, so have been paid twice for the work.
They have now been told that they can also be reimbursed for the catchup work using a PBR system – this being paid a third time for the same work.
Now they have been told they can bounce back the actual work into General Practice, but keep all the money.
General Practice will NOT be funded for the extra work.
None of these things make sense, or would be the way that a sensible system would work. This is the future, this is how ICSs will function – and it will push General Practice over the edge.

Patrufini Duffy 8 March, 2022 3:10 pm

Most Consultants I know are working on Mon Thur and Fri up on the private wing of the NHS Trust building. Acting like the dentists – we could see you, but we won’t, only privately on the weekend. I know. Sounds like you’re played like the only fool.

Rogue 1 9 March, 2022 12:30 pm

Perhaps we should all do the same.
Only work one day a week for the NHS, but there will be a service at the surgery (although much reduced).
Then the rest of the time, see patients privately at their convenience and expense!