National guidance for NHS e-Referral Service (e-RS) advice and guidance

BMA guidance includes direction on how primary and secondary care clinicians can implement and use advice and guidance in e-RS. 

Further BMA guidance for e-RS is available for:

• primary care clinicians - read the e-RS guide for GPs 
• secondary care clinicians - read the BMA guidance document: an e-RS guide for secondary care doctors

NHS England's advice and guidance aims:

• to reduce unnecessary hospital referrals (outpatient and admission)
• to ensure patients referred to hospitals are seen in the right place at the right time by the right person
• to improve patient care by optimising digital communication between consultant and GPs, strengthening the relationship between primary and secondary care

The elective care and transformation programme supports advice and guidance as a best practice solution to supporting improved patient care. 

The standard contract 2019-2020 refers to advice and guidance in section 6.2.3, stating:

The provider must offer clinical advice and guidance to GPs and other primary care referrers:

• 6.2.3.1 on potential referrals, through the e-RS; and/or
• 6.2.3.2 on potential referrals and on the care of service users generally, as otherwise set out in the service specifications

Local prices payable by the commissioners for such advice and guidance will be as set out in Schedule 3A (Local Prices), whether this leads to a referral being made or not.

In addition, the 2017/2019 CQUIN requires acute providers to offer advice and guidance in specialties covering 75% of all GP referrals.

Non-mandatory tariffs for advice and guidance have been introduced in the 2019/20 national payment system (benchmark - advice and guidance tab). This reduces the mixed provision of advice and guidance, enabling GPs to make a better and more informed decisions on the most appropriate course of action for their patients. There is a greater focus on delivering the agreed national quality standards. 

The tariffs are a guide for local negotiation for all specialities. Where advice and guidance services involve the review of several attachments e.g. clinical photographs, ECGs, higher tariffs may be negotiated depending on the average time taken for reporting compared to face-to-face consultation.