So where do you head if you want advice and guidance? The pub? Your chosen deity? The Samaritans? Well, obviously, we all have the latter on speed dial for those Monday morning surgeries. But wait. These days, ‘Advice and Guidance’ means something else: that increasingly widespread resource whereby we email consultants for, yes, advice and guidance – before, or instead of, a referral.
The idea is to ‘improve communication’ and ‘smooth the patient journey’ yada yada, which sound great. But then so did the Titanic. Consider a simple A&G request recently sent to a local endocrinologist. The response advised and guided me towards a ‘GP to do’ list, which might save an outpatient appointment but only at the cost of tying me up in investigative knots for weeks. After which I’ll probably refer anyway.
And this is not an isolated incident. In practice, Advice and Guidance increasingly seems to translate as Diktat and Dump, with predictable effects on our workload and sanity.
Which is not quite how NHSE sees it. According to them, this is a win-win-win innovation – opening the lines of primary/secondary care communication GPs are always complaining about, facilitating high-quality care for patients and unclogging packed hospital clinics. What’s not to like?
Well, this. There is one final step down that A&G pathway that sooner or later must surely – and terrifyingly – be implemented. And what the NHS bureaucrats will do when that penny finally drops is breathtakingly simple. They will make A&G mandatory before every single non-two-week-wait referral.
Result? Referrals either blocked as ‘unnecessary’ or deferred until we’ve done the hospital’s donkey work. Genius. And the NHS suits could innocently and persuasively justify it thus: a) the queues for access to secondary care have to be sorted, and they stretch all the way back to your practice anyway; and b) as A&G is the kind of service GPs have always wanted and is self-evidently a Good Idea, we’re just making it universal and mandating its use.
Not only would this be a cynical way of dumping a massive amount of hospital work onto general practice while pretending to do the exact opposite, it would also formalise the current approach of hospitals viewing us as their unpaid community housemen.
Even worse, it will deal us GPs a massive and possibly fatal psychological blow. The ability to refer a patient is one of the few trump cards we have left. When we reach the end of our ability to manage a clinical situation, for whatever reason, a referral may well end up helping the patient – but the temporary relinquishing of responsibility certainly helps us. Not any more, if the A&G juggernaut thunders on towards its inevitable conclusion.
Imagine a world in which we cannot refer, and thereby make the patient Someone Else’s Problem. Yes, GPs are notorious for assuming the sky is going to fall on their heads, but on this one I’m with Dr Chicken Licken as it will be absolutely clucking awful. Don’t know how to cope? You could always ask Advice and Guidance. Actually, don’t bother.
Dr Tony Copperfield is a GP in Essex. Click here to read more of his blogs