Significant variation in A&G pathways must be addressed: RCGP responds to HSSIB report

Responding to the HSSIB’s interim report into the safety of Advice and Guidance services, Professor Victoria Tzortziou Brown, President of the Royal College of GPs, said: “The aspirations behind Advice and Guidance services are good. When they work well, they can enable GPs and specialist colleagues to have timely clinical discussions, support appropriate referrals and help patients receive the right care while they are waiting for specialist treatment.

“It is encouraging that this report finds that, in many cases, A&G is working well for patients. But it also highlights significant variation in how A&G pathways operate, with some cases where patient care and safety have been compromised. We also know from surveys published in the last week that both GPs and doctors working in secondary care have concerns and frustrations about how A&G services have been implemented.

“We need to be clear that the success of A&G should not be measured simply by the number of referrals avoided or the volume of A&G requests processed. The important question is whether it is helping clinicians make better, safer and more appropriate decisions for individual patients. A reduction in referral numbers is not a success if it results in delays, repeated contacts, additional workload for clinicians, or risks to patient safety.

“We understand the need to develop new ways of working across primary and secondary care, both to improve access to specialist advice and to make the best use of NHS resources. But these systems must be designed around the needs of patients and the realities of clinical practice. Where A&G pathways are not working effectively, or where responsibility for patient care is unclear, this needs to be addressed urgently.

“As such, we agree with HSSIB that A&G services need to be properly evaluated, with a particular focus on their impact on patients and the quality and safety of care. We also support the recommendation for the RCGP to work alongside others, including NHS England and DHSC to develop standardised request and response templates. This would be a sensible step towards reducing variation, but it should sit alongside clear expectations about response times, clinical responsibility, follow-up and escalation, so that clinicians in primary and secondary care can work together safely and effectively.”

Further information

RCGP press office: 0203 188 7659

press@rcgp.org.uk

Notes to editors

The Royal College of General Practitioners is a network of more than 54,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.