Clinical Advice and Guidance services in the NHS in England – what are primary care staff and commissioner perspectives on uptake, outcomes, barriers and opportunities?

Problem

Advice and guidance (A&G) services are central to the vision outlined in the NHS Long Term Plan of 'one click away' specialist advice for general practitioners; use of A&G also formed part of the pandemic response. There was limited evidence as to how A&G had been implemented across England from a primary care perspective, and in the pandemic context. This evaluation aimed to explore primary care and commissioner perspectives on A&G services and associated outcomes, barriers and opportunities, to support development of A&G in a referral optimisation context.

Approach

A mixed methods approach was taken. An online survey was carried out between March-April 2021 to explore primary care staff usage and experience of A&G. Data from 390 complete responses were analysed using descriptive statistics and thematic analysis. Telephone/video interviews were conducted between April-June 2021 with staff working in primary care and commissioning. Interviews were conducted with 34 people purposively sampled from localities across the 7 English regions, and data were analysed thematically.

Findings

On average, 85% of survey respondents agreed the A&G specialties they had used provided a useful service. Satisfaction with the process, response quality, and turnaround time for frequently used services was high. However 34% rated the interoperability of the A&G system with the patient's primary care record as poor/very poor. Barriers to use included: variable/slow response times; availability of A&G services; clunky systems and processes; time and workload pressures and poor quality of responses. Factors which enable/encourage A&G use included: reliable, timely responses; easy-to-use systems; good quality responses; practical support and resource; and trust in the process. Thematic analysis of interview transcripts resulted in identification of five core themes: The system: "Keep it simple"; Access to elective care; Time and resource challenges; Building understanding and collaboration; and Maximising the benefits of A&G.

Consequences

To support primary care staff to use A&G, available A&G services; reliable, timely responses; good quality responses; an intuitive integrated system; practical support and resource; and strong local relationships are important. For decision-makers to implement A&G, it is important to simplify and integrate IT; define A&G in the context of elective care access; plan and resource A&G; build relationships and opportunities to disseminate learning; and make use of reliable comparable data.Based on evaluation results, 46 recommendations were identified across nine areas: Service standards and governance; Systems; Elective care pathways; Widening access; Resourcing; Staff engagement; Patient involvement; Outcome monitoring; and Further evaluation. Results were presented to national stakeholders and this evidence is informing the ongoing development of specialist advice within the referral optimisation agenda.