In our interim report published today, we identify patient safety risks linked to how advice and guidance (A&G) services have been implemented across England. A&G services allow clinicians in general practice to seek specialist advice from secondary care, either before or instead of referring a patient to hospital.
The investigation heard strong support for A&G services where they are working well. But it also found evidence that poorly designed or inadequately monitored pathways have contributed to physical harm, delayed and missed diagnoses, and in some cases to delays in cancer care.
What the investigation found
- Where A&G services improved communication between general practice and specialist services, they had positively influenced patient care. However, there was limited data on patient safety outcomes.
- There was evidence that A&G services had contributed to near misses and incidents of patient harm, both physical and psychological, where they had been poorly implemented or monitored. Harm included delayed or missed diagnoses and delays to care and treatment.
- There were significant gaps between how some local A&G and single point of access (SPoA) processes had been implemented and national expectations. This included local pathways that required GPs to use A&G rather than making direct referrals, and referrals for specialist assessment being declined despite persistent clinical concern.
- Issues with the NHS electronic referral service (e-RS), including interoperability problems and delays to planned system upgrades, made it harder to track patients through pathways and share clinical information consistently.
What HSSIB is recommending
We make two safety recommendations. We recommend that NHS England and the Department of Health and Social Care (DHSC) undertake a rapid evaluation of A&G services with the aim of addressing resource and capacity gaps, workforce training needs, e-RS digital risk management, and weaknesses in patient safety incident reporting.
We also recommend that NHS England and DHSC, working with relevant Royal Colleges, commission the development of standardised A&G request and response templates for specialties where these do not currently exist, and support their effective use in practice.
Investigator's view
Dr Nick Woodier, Senior Safety Investigator, said: "A&G services are making a real difference for patients in many parts of the NHS, and we heard genuine enthusiasm for what they can achieve. But we also heard serious concerns, and found evidence of harm where implementation has not been adequately designed or monitored. Our recommendations are about ensuring that expansion happens safely with the right support, standardisation and oversight in place to ensure patient safety is a priority."
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