The RCGP has ‘voiced concerns’ with NHS England about any proposal to mandate that GPs use advice and guidance (A&G) in all cases instead of direct referrals.
The college said it is among a number of stakeholders NHS England has involved in advising on a new outpatient strategy, which is under development.
While in some areas the A&G has been a ‘helpful tool’, in others it seems to be a ‘barrier to artificially protect waiting lists’, RCGP has told NHS England.
Yesterday, it was reported that NHSE is working on a national outpatient strategy, due by December, which would aim to increase the use of A&G pathways.
The Royal College of Physicians (RCP) is working with the national commissioner on this strategy, and their outpatients lead Dr Theresa Barnes has said there should be a ‘push’ to use A&G ‘in preference to direct referrals’.
To develop these plans, NHS England has held four stakeholder events which included primary care representation, but Pulse understands that no decisions have yet been made.
The RCGP has told Pulse that during ‘ongoing discussions’ with NHSE on the strategy, they have raised concerns about GPs being obliged to use A&G for all referrals.
Chair Professor Kamila Hawthorne said: ‘We’ve seen disparities by region, with some of our GPs saying that, when resourced appropriately and implemented well, it is a helpful tool to increase communications with their colleagues in the rest of the system.
‘In others it seems to be used as a barrier to artificially protect waiting lists and prevent patients getting the care they need.
‘This can have significant impact on already overworked GPs dealing with the spillover of a greater number of referrals that are delayed or rejected.’
She added: ‘We fully support a closer relationship between primary and secondary care, along with any measures to ensure a smoother referral process for patients.
‘However, A&G should only be used to do what its name suggests – provide advice and guidance rather than act as a barrier to timely patient referrals.’
The A&G pathway involves GPs managing patients whilst accessing specialist advice by telephone or IT platforms, rather than referring patients for a hospital investigation.
A&G has been used since 2015, however NHS England formalised the pathway in 2021 when it introduced a target stipulating that GPs use it for 12 out of 100 outpatient attendances.
In January 2022, as part of plans to tackle the elective backlog, NHS England increased this target to 16 specialist advice requests, including via A&G, per 100 outpatient first attendances.
Chair of the BMA’s GPC England Dr Katie Bramall-Stainer said expanding A&G is ‘not a viable solution’ given the ‘current constraints of an overstretched and under resourced system’.
She said: ‘GPs appreciate every day the impact of millions of their patients waiting for specialist treatment – keeping those patients safe as their symptoms progress is in turn putting surgeries under significant pressure.’
‘Greater investment in general practice with a focus on retaining the GPs we have and recruiting more back into the profession is ultimately what is needed to make headway into managing the growing unsustainable pressures that the NHS is facing,’ Dr Bramall-Stainer added.
Earlier this year, a think tank report warned that mandatory A&G pathways could be storing up a ‘hidden backlog’ of patients ‘by allowing treatable conditions to deteriorate’.