We’ve been working with NHS England to look at how to improve GP referrals of patients to hospital. The goal was to look at ways specialists could support GPs so they could reduce the number of outpatient appointments patients have to attend, without compromising care.

When a GP is thinking about whether or not to refer a patient to hospital to see a specialist, they can get specialist advice and guidance to help them make a decision. NHS England would like more GPs to use this service because its research suggests when GPs use this service it results in quicker diagnoses and treatment, identification of the most appropriate plan for the patient at an earlier stage, and a reduction in unnecessary referrals to hospital.

But before expanding the service’s use, NHS England asked us to help it understand how patients experience the specialist advice and guidance service, how to increase patient awareness about the service, and learn from patients how they believe the service could work better for them.

We brought together a group of patients, whose recommendations for specialist advice and guidance are:

1. Establish a three-way dialogue between the patient, GP, and the specialist to ensure patient partnership and shared decision making
2. Streamline the referral process for GPs to get the advice
3. Include pharmacists into the advice and guidance process.

The group also suggested ways to better engage patients in the service:

1. Consider the individual’s care and communication needs
2. Allow patients to add information to the e-referral system and increase patient access to their medical records
3. What matters most to the patient should guide the referral
4. Provide information to patients on how to manage their health while they wait for the referral or outcome of the advice and guidance request.

To raise awareness of the service among patients, the group suggested that two type of resources: one to raise awareness, and one to provide guidance about the actual service and how it works.

The group also said that since it’s patients who benefit from the specialist advice and guidance service, any evaluation of the service should be patient-focused and provide information on how the service is working for patients and opportunities for making improvements.

The group’s suggestions for evaluating the service are:

1. Impact of specialist advice on patient experience, access, and patient journey
2. Impact of specialist advice on supporting greater patient engagement, shared decision making, patient choice, and self-care
3. Patient awareness and knowledge of specialist advice
4. Effective communication and information-sharing during the specialist advice/referral process
5. Impact of specialist advice on equality and health inequalities and ensuring ease and equity of access to care
6. Availability and access to advocacy and assistance services during the specialist advice process.

NHS England commissioned this report to better understand the experience of patients who have gone through the process of Specialist Advice, from the start of their journey in Primary Care to the outcome of the Specialist Advice request. NHS England welcome the recommendations in this report and are committed to improving the patient experience. They are already taking action on some of the recommendations and are planning to work closely with the Patients Association to build on others. Their next Action on Outpatients series will focus on improving engagement and understanding of Specialist Advice with GPs and wider stakeholders.

Read the report here

22nd November 2022

How you can support the transformation of outpatient services

• Use the social media buttons below to share the report to help raise awareness of referral optimisation services.
• If you've had experience of specialist advice and guidance services, why not share your story with us? Email us on [email protected].
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