CEO Blog August - What might come next?
What might come next?
The NHS 10-year plan aspires to move from analogue to digital. What might that mean for patients? On the face of it sharing data, using IT would seem to be a modern approach. But what if it means something else?
The bread and butter of the NHS... hospital referrals, are fast becoming a mess made by NHSE. A Pulse magazine survey of over 700 GPs suggests around 26% of GP referrals are bounced back as unsolicited Advice and Guidance. GP refers a patient. Hospital replies with advice.
Do another test… try another treatment… wait six weeks… … come back if things get worse.
NHSE says A&G is not supposed to be a way of rejecting referrals. GPs increasingly think that is exactly what it has become, and as an LMC we think they are probably right.
The survey is self-selecting. Pulse accepts it is not scientific. The 26% should not be presented as a national NHS statistic, but it’s not the real issue. The real issue is what happens next.
For decades, the referral pathway has been straightforward.
Patient sees GP.
GP wants a specialist opinion.
Patient usually joins the outpatient queue, sees a consultant and either goes home happy, or starts a care pathway and becomes another number on another waiting list.
A&G changes that. The patient may never see the consultant, or the advice may eventually result in a referral, anyway. Either way, there is still a consultant somewhere in the process. With or without the patient sitting in front of them, someone has to review the information and make a clinical judgement, and that time is neither free nor limitless.
A&G may avoid a full outpatient appointment, but human A&G still consumes scarce specialist time which raises an intriguing question. If A&G is becoming the default gateway into hospital care, perhaps the really important development is not A&G at all.
Perhaps it is what comes next… AI&G.
William Greenwood
Chief Executive