In June 2020, The Nuffield Trust produced a chart showing the drop in GP referrals during the COVID-19 outbreak. The Nuffield Trust suggested this drop was partly down to efforts to scale back routine hospital care, in anticipation of the increased demand COVID-19 would have on hospitals.

Health Secretary Matt Hancock has signalled that as we move out of the pandemic, there will be an expectation for GPs to use Advice & Guidance (A&G) services in order to treat patients who would normally be seen in secondary care.

Now more than ever, there is pressure on MDU members working in general practice to avoid unnecessary outpatient activity and keep patients away from hospital settings, unless a referral is necessary.

However, it's recognised that A&G services are not just about reducing demand on secondary care services. A&G services can help MDU members working in general practice to make sure patients are seen and treated appropriately in a timely manner. Data from NHS Digital shows that where GPs asked for and subsequently received specialist A&G, only 23% of patients went on to be referred to secondary care.

MDU advice

MDU members working in general practice may find the following tips helpful:

• In line with the GMC's Good medical practice, doctors should continue to refer a patient to another practitioner when this serves the patient's needs.
• When you are involving another healthcare professional in a patient's care, they should be provided with all of the relevant information. Attaching computerised patient summaries can be helpful, but make sure the information included is relevant to your request or referral. Be as clear as you can be about the question you're asking.
• As well as seeking advice on a particular condition and/or treatment plan, A&G services can be used to discuss abnormal test results, the appropriateness of a referral or to find out the most clinically appropriate service to refer to.
• If you intend to use an A&G service, make sure the patient understands what this will entail. The patient should know who is responsible for their overall care and who to contact if they have questions or concerns.
• Responsibility for the patient remains with the healthcare professional using the A&G service unless a decision to refer is made.
• Familiarise yourself with the process at your place of work for checking a response has been received from the A&G service. If you submit an A&G request and anticipate you will not be available to view the response in a timely manner, ensure there is a system in place whereby a colleague will receive the response and take any necessary action.
• If you do make a referral, discuss with the patient the possibility they may be offered a non-face-to-face consultation with the hospital specialist and there may be delays in restarting routine elective activity at the hospital.