Dr Stewart Hale argues that advice and guidance can be transformational when it comes to boosting clinical capacity and tackling patient wait lists
Advice and guidance (A&G) is a hotly contested issue – and for good reason. As a key feature in most of the recent targets set by NHS England around elective recovery, it’s frequently top of the agenda.
Although its implementation is patchy, with varied outcomes as a result, we shouldn’t be too eager to dismiss A&G altogether because when implemented well, its impact can be transformational.
Like any new measure that is parachuted in, A&G can cause more problems than it solves. It can unintentionally shift responsibility from one set of clinicians to another, often adding additional workload to already overburdened GPs. As a result, wait lists and elective recovery targets are pushed even further out of reach.
But this isn’t always the case. When accompanied by structured support, onboarding and the right tools and resources, A&G can increase collaboration, streamline wait lists and boost GP capacity.
To ensure these results are achieved all the time, we need to highlight the success stories and share best practice between individual trusts and ICSs, creating a blueprint for successful implementation.
I’ve seen this work incredibly well within my ICS, NHS Cheshire and Merseyside, and the introduction of A&G to more than 100 GP practices in the region as part of a collaborative teledermatology project has already had a significant impact on helping tackle patient wait lists.
In Liverpool, where the project began, use of A&G in dermatology is enabling at least half of cases submitted via the platform to be managed with A&G alone. Building on the success of this, it’s now being rolled out in other areas across the region. Working in close partnership with digital advice and guidance specialists Cinapsis, we’ve been able to introduce A&G into daily practice with minimal friction – and it is already having a notable impact.
As I’ve started to work with other GPs in my area to support them with successful A&G adoption, I’ve found the following three considerations to be essential when it comes to introducing A&G in a sustainable, effective way:
It might seem counterproductive but moving slowly when rolling out A&G can lead to faster results in the long-term. Starting with a pilot site, where comprehensive support can be focused and the infrastructure can be tailored to account for nuance, will help provide a solid foundation for incorporating A&G in a way that works for your individual trust or ICS. Results can be carefully analysed, and any necessary adaptations or adjustments made to the process before it is rolled out more widely across the region.
Comprehensive onboarding support
Onboarding support can genuinely make or break the success of an A&G programme. Clinicians don’t have time to grapple with fiddly new systems or upskill on to new platforms alongside their daily workload. So, choosing a provider that can offer sustained, comprehensive onboarding support is absolutely crucial. This has been a huge factor in the success of the A&G rollout in Cheshire and Merseyside. External support, available from implementation and beyond, is enabling clinicians to swiftly adopt and benefit from the use of A&G, without adding any additional burden to their already full plates.
A&G can truly unlock invaluable levels of collaboration across primary and secondary care. But if the system underpinning it is not interoperable and can’t directly share information or data with the other digital systems already in use, it will fail to deliver any meaningful improvement. Streamlining communication between primary and secondary care is key for A&G to successfully reduce workload and benefit clinicians and patients alike. So, ensuring the platform or tools you’re introducing to enable A&G are fully interoperable is essential.
By pooling experience and best practice on A&G implementation, it can help to raise standards in primary care, rather than lower them. With the right support, infrastructure and roll-out in place, A&G can deliver significant results in terms of boosting clinical capacity and tackling patient wait lists.
It’s not yet time to wave A&G goodbye; we must instead work collaboratively to ensure it can be successfully accessed and implemented in primary care services across the board.
Dr Stewart Hale is a GP and clinical lead in Liverpool, who has been using the teledermatology pathway on the Cinapsis SmartReferrals platform to secure specialist advice on skin lesion cases