NHS England has said it wants to ‘maximise opportunity’ in the management of patients in primary care via advice and guidance services rather than referral.
Last month, health secretary Matt Hancock signalled that he wants GPs to continue to consult patients who would typically be seen in secondary care – with specialist help – after the Covid-19 pandemic comes to an end.
And a recent update to the GP standard operating procedures said GP practices should use advice and guidance services to ‘keep patients away from hospital’, despite messages to restart routine care.
These services involve GPs accessing specialist advice by telephone or IT platforms.
In new guidance on ‘high impact interventions’ published today, NHS England said A&G services would give commissioners ‘greater confidence that referrals into secondary care are appropriate’.
Further benefits of the service are that it allows patients to be ‘managed outside the hospital setting for longer’ and provides ‘improved access to services’, the document added.
However, GPs previously warned that this approach amounted to ‘workload dumping’ and could lead to people being ‘turned away from general practice’ because GPs are too busy dealing with complex patients.
The document added: ‘During the NHS response to Covid-19, A&G services are central to supporting the management of patients in primary care, as well as the restoration and recovery of elective services.
‘Changes to current models of A&G delivery may be implemented at organisational or system level, to maximise opportunity in the management of patients outside secondary care.’
Separate guidance specifically for practices said the service allows GPs to ‘access specialist advice before or instead of referral’.
It added: ‘This strengthens shared decision-making, enhances personalised approaches to care and avoids unnecessary outpatient activity.’
The GP guidance added that practices should ‘support system partners in implementing A&G services in their area’.
This could include
- nominating a ‘clinical champion’ across or within PCNs to support the shaping of A&G services
- working with CCGs to ‘regularly’ review ‘demand and availability’
- designing ‘clear governance arrangements’ such as the retention of ‘accessible records’ alongside CCGs and secondary care partners
Meanwhile, commissioners should ‘facilitate collaboration’ between primary and secondary care, it added.
It comes as a report revealed earlier this month that ending inappropriate transfers of workload from secondary care could free up 3m GP appointments across England.
Throughout the Covid-19 pandemic, GPs have warned that they are managing more patients ‘outside their comfort zone’ due to less support from secondary care services.
Since April, NHS England has told GPs to continue referring patients to secondary care despite restrictions on elective care due to Covid-19.
Last month, it outlined that trusts must make their e-referral service ‘fully open’ to GPs.