London GPs told to alert ICB if trusts don’t respond to A&G requests on time
GPs in North Central London have been asked to alert the ICB if trusts don’t respond to advice and guidance (A&G) requests on time.
The new system put in place by the ICB can also be used to ‘bounce back’ any inappropriate workload from secondary care, and to report patient safety incidents.
Haringey LMC said 570 alerts were sent in the first five weeks of the new system and that they are ‘already seeing a significant improvement in trust responses’.
The alerts are sent through EMIS and the system provides a ‘single, improved way for GPs to raise concerns to secondary care without chasing’, the ICB said.
It comes as NHS England said that there should be pathways for GPs to report trusts to their ICBs if they are experiencing delays or if A&G standard response times are not being met.
GP practices are contractually required to use A&G across specialities ‘prior to or in place of a planned care referral where clinically appropriate’, with ‘single point of access’ routes to be finalised locally by 1 October.
And under recent NHS England guidance trusts are required to respond to GP A&G requests within five working days.
The LMC said: ‘This is your opportunity to bounce back all that inappropriate work from secondary care – examples include being asked to request tests (or chase results from tests requested in secondary care), to do referrals which should be done directly or to do fit notes on behalf of secondary care.
‘You can also submit one if advice and guidance (A&G) advice isn’t clear or doesn’t come quickly or at all, if a trust refuses to take A&G and directs you to consultant connect instead, if there is poor communication or if a patient is inappropriately discharged after a single DNA.’
The ICB said that practice staff can also submit concerns through the system, but GPs are ‘responsible for ensuring the content is clear and clinically appropriate’.
The form is saved in EMIS so patients may be able to see it in the NHS App, but if the practice prefers this not to be visible, they can save the document using their usual ‘not visible to patient’ workflow.
How do GPs decide whether to submit feedback, alert or patient safety event?
This will involve clinical judgement but:
Default → Feedback
• Inappropriate or non-contractual requests (eg. onward referral for related/urgent condition, transfer of care, no fit note)
• Likely awareness / training issue
• No immediate risk of harm
Consider GP Alert if:
• Problem is recurring
• Multiple patients affected
• Issue occurring across multiple specialties
• Actual or risk of low-level harm
Choose patient safety event if:
• Potential or actual moderate/severe harm
• A formal investigation is required
• A delay or action has materially affected patient safety
Source: ICB guidance
NHS England previously clarified that the maximum number of working days to process an A&G request should be five days, and that trusts are required to implement processes to ensure open and outstanding A&G requests are addressed ‘in a timely manner’.
By October, trusts are to have implemented ‘consultant-led clinical review’ of all A&G requests and elective referrals within the 10 specialties prioritised for A&G.
It comes as the CQC, GMC and HSSIB asked NHS England for ‘clarity’ on 11 areas related to A&G including a clearer articulation of A&G, GP indemnity, and patient safety implications.
And Pulse revealed that a group of hospital trusts in North West London have decided to pause plans for a ‘single point of access’ for referrals, following concerns that this would prevent GPs from sending referrals without seeking advice first.
