Leads: Claire Burton and Victoria Welsh
Dates: 01 June 2024 – 31 May 2026
Background:
When a GP needs a specialist’s input with the care of a patient, one option is to use Advice and Guidance (A&G). A&G is an electronic way for a GP to ask a consultant a clinical question and a specialist responds, usually within a few days. The response may be to send an appointment for the patient to see a specialist, try a treatment, or do a test. A&G was introduced to speed up access to a specialist opinion and cut waiting times for outpatient care. A&G became more important during the COVID-19 pandemic as it meant patients did not automatically need to travel to hospital. The use of A&G is now encouraged to help the NHS recover from the pandemic. However, there is little evidence of its effectiveness in reducing pressures and some clinicians are reluctant to use it. Very few studies look at whether A&G has a better or worse effect on patient care than the usual referral system. For example, the potential longer-term risks of harm to patients, such as diagnostic delay, have not been considered.
Aims and Objectives:
We will study whether Advice and Guidance is effective in reducing compound pressures on the NHS, whilst supporting the delivery of high-quality care, that is satisfactory to patients and clinicians. We will focus on the impact of Advice and Guidance on patients, healthcare workers, and the healthcare system, in terms of:
- how often, why and when A&G is used
- views about its impact on the quality of care and patient satisfaction
- impact on how NHS services are used.
Methods:
This is a multi-stage evaluation study comprising mixed methods and using a sequential design, working in partnership with citizen groups within seldom-heard communities throughout. There are four work packages (WP).
WP 1 will describe how A&G is being used in the NHS. We will use a national database of anonymous GP records to find patients who have A&G requests in their notes. We will describe the patterns of A&G use since 2015 to work out whether some patients are more likely to have A&G versus usual traditional referrals (for example, older patients or patients from certain ethnic and socioeconomic backgrounds). We will interview GPs to ask about how they use A&G and if they think it helps patients or not. We will use these interviews and patient data to work out which specialties we should look at in more detail.
WP2 of the study will be informed by the findings of WP1 and focus on how well A&G works. We will use a national database of anonymous GP records and hospital records to work out if there are differences in what happens to patients who see a specialist in hospital through A&G versus usual referrals. What we will measure will be informed by WP1, but may include issues such as time to cancer diagnosis, admissions to hospital, further GP visits, other referrals, and treatments. This will help us to report if, overall, A&G impacts on the quality and use of care.
WP3 of the study will focus on the experience of A&G from the perspectives of patients, specialists and commissioners (health care leaders). The interviews will take place over the course of the study period and use the findings from WPs 1 and 2.
WP4 will involve a series of community conversations, working with professionals who use A&G and members of the public about our key messages and how best to talk about them, with the aim of improving understanding about the use of A&G and overall patient care. Working together with these seldom-heard groups, the study team including our media producers, the Keele Impact Accelerator Unit, public members and our stakeholder group, will co-produce a suite of resources for users and providers of healthcare.
We will include patient views at each stage of the study through a patient and public involvement group and a patient applicant on the study team. We will ask about which specialties to include, what outcomes to look for and other factors we might need to think about in the analysis. Working together with patients, we will produce information about the most important findings from our study that can be shared in ways that will reach patients and the public. .
Protocol:
N/A
Publications:
Research is still ongoing.
Dissemination:
We will provide the evidence required to support primary and secondary care to work together to reduce compound pressures across the system, whilst promoting high quality care. Dissemination will seek to: provide a Policy Brief to the Department of Health and Social Care to facilitate the effective and safe use of A&G; provide professional resources to support best use of A&G; educate and inform seekers of healthcare across diverse communities about A&G.
Study Link:
https://www.keele.ac.uk/research/ourresearch/medicine/researchareas/primarycare/badger