Advice and guidance for referrers and referring clinician teams

Examples of typical patient journeys using advice and guidance are detailed below. 

Request for advice/without authorisation to convert

1. The patient visits their GP and the GP creates an advice and guidance request. Patient images or other attachments can be added as required.
2. Authorisation is not given for the provider to convert the request into a referral.
3. The provider clinician reviews the advice and guidance content and responds, giving advice on diagnosis and management, or requests further information. 
4. The GP receives the response and acts accordingly, such as organises appropriate tests, prescribes recommended treatments, follows suggested management pathway, or sends additional information if required by provider clinician. If referral is recommended the responsibility for referring remains with the GP.

Watch our short film about how Dr Michelle Durham uses advice and guidance within her GP practice. Note: this was filmed prior to the conversion functionality and referrer worklist changes being available.

Request for advice/with authorisation to convert

1. The patient visits their GP and the GP creates an advice and guidance request. Patient images or other attachments can be added as required.
2. Authorisation is given for the provider to convert the request into a referral
3. The provider clinician reviews the advice and guidance content and refers the patient. A response is returned to the referrer providing management information. For example, detailing if any treatment should be undertaken before the patient’s appointment.

To use the advice and guidance worklist:

• log onto e-RS and click on the worklists tab (review the advice and guidance reference guide for referrers for more in-depth information)

• a referring clinician user will see additional options at the top of worklist tiles to view either their own worklist only or that of the organisation.
• select the ‘Advice and guidance’ tile to see all active advice and guidance requests and responses in one place
• to add more information to a request select the UBRN and enter free text or attach advice request letter
• use the Microsoft copy and paste function to copy information from GP systems into an advice and guidance request (and vice-versa); highlight the text to copy and press Ctrl C (copy) and move to the place you want to insert the copied text and press Ctrl V (Paste)

When creating an advice and guidance request consider:

• whether enough clinical information and history is included for the provider clinician to be able to return advice or convert the request to a referral, where authorised

• including attachments such as clinical photos or ECGs where appropriate, with relevant consent 

• ensuring the patient does not have an exclusion criteria for advice and guidance as specified in the provider’s e-RS directory of services (specialist teams will specify exclusions for both advice and guidance and face-to-face clinic services in the directory of services available on e-RS)

In general, advice and guidance should not be used to ask questions about:

• emergency patient care
• patients already under hospital follow-up
• clinical questions where accessible local or national guidance already exists

Reviewing an advice and guidance response

Monitor the advice and guidance worklist regularly to keep on top of advice and guidance requests and responses.

The advice and guidance worklist can be used by:

• logging onto e-RS and clicking on the worklists tab
• a referring clinician user will have additional options present at the top of their worklist tiles for viewing either their own worklist only or that of the organisation they have logged in under
• selecting the ‘Advice and guidance’ tile to see all active advice and guidance requests and responses in one place

If onward referral is recommended by the provider clinician:

• convert the advice and guidance to referral by opening the UBRN
• select the refer now button
• an advice and guidance request/response does not initiate the referral to treatment (RTT) clock,  however at the point at which a request is converted by a provider, the RTT clock will then start

If a provider does not respond to your request within an appropriate timeframe, referrers can update existing advice and guidance requests. This will put the request back at the top of the provider’s advice and guidance worklist. You can contact your commissioning organisation and ask them to raise the issue with the provider in question if necessary. Recommended response times should be agreed with the providers and commissioning teams, and often range from 2-5 working days.

Searching for a previous advice and guidance response

There are two enquiries in e-RS that allow you to see historic advice and guidance requests and responses information, including attachments, from the past 18 months:

Select the enquiries tab at the top of the screen

From the dropdown list select either:

• patient enquiry – enter the advice and guidance UBRN or NHS number to search for an individual patient
• advice and guidance enquiry

For advice and guidance enquiry:

• select your speciality and time period to search for all advice and guidance responses within a defined time frame (maximum 90 day window)
• click the patient name header to arrange advice and guidance responses into alphabetical order by name if required

For access to historical advice and guidance requests and responses completed over 18 months ago review our guidance on archived referrals. 

Read our quick guide on how to log on to e-RS.

Visit our training and support section for referrers and e-RS help files (N3/HSCN connection required).

Attachments for advice and guidance can be added in the same way as they can for referrals. They are a beneficial way of enhancing the information you are sending to the clinician, for example - clinical photos, ECGs. Attachments can be:

• added using web-based to a maximum of 5MB per file and there is no limit to the amount of files for each referral
• added using GP integrated systems to a maximum of 5MB in total for each referral

Important: when reviewing attachments, for example patient images, letters, ECGs, ensure that you have closed the attachment completely before you close the advice and guidance response and move on to the next patient. If the attachment viewing screen is minimized and not closed then the attachment will remain open.

Read the advice and guidance quick reference guide for referrers  and e-RS help files (N3/HSCN connection required), for more information on attachments.

For information on adding attachments using GP clinical systems please refer to the appropriate local GP system training materials. 

Refer to national guidance regarding attachments from relevant organisations, for example the British Association of Dermatologists dermatology guidance for information about patient images and consent for image storage, transfer and teaching use. 

The AG01 (advice and guidance activity report) report and extracts available in the system gives access to data regarding advice and guidance for referring organisations.

These are available using the information analyst (B1130) role, which can be assigned by your Registration Authority (RA). The RA are based at your local commissioning organisation or commissioning support unit (CSU).

Find out more information about business roles.

GPs and referring organisations may want to seek support for data analysis from their local commissioning organisations or CSU. 

Advice and guidance can be used in GP clinical systems. Please contact your local commissioning organisation's primary care trainer, or your GP system supplier for further information on processing advice and guidance requests using GP clinical systems.

We have created a guide to using advice and guidance for referrers.  

Learn more about the benefits of using advice and guidance. 

Further resources including videos can be found at the support information page