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About advice and guidance and when it can be used

NHS e-Referral Service (e-RS) advice and guidance allows a clinician to seek advice from another, providing digital communication between two clinicians: the requesting clinician and the provider of a service, the responding clinician. Advice and guidance responses are delivered either by the consultant or by another senior clinician, where the consultant retains responsibility for the service and the advice provided.

There may be a number of reasons why a clinician may wish to seek advice and guidance including:  

  • asking another clinician or specialist for their advice on a treatment plan and/or the ongoing management of a patient
  • clarification (or advice) regarding a patient’s test results
  • seeking advice on the appropriateness of a referral for their patient (e.g. whether to refer, or what the most appropriate alternative care pathway might be)
  • identifying the most clinically appropriate service to refer a patient in to

The referrer can attach documents to the advice request, which may include diagnostic results, clinical photos, scanned images or previous correspondence relating to the patient. The provider is then able to review the request (along with any attachments) and respond to the query, adding their own attachments, if required. These attachments could include a proposed treatment plan or links to external documents and websites.

The referrer is able to convert the advice request into a referral or appointment request, linking the advice information (and any attachments) to the referral.  This ensures that the receiving provider has all the relevant referral information and negates the need for a new referral being created.

What does advice and guidance look like?

Advice and guidance has an easy to follow screen, which shows the discussion between clinicians, and any attachments as a link. It has an easy to read flow, with a 'text message' like format.  

We have included an example of what a conversation looks like, starting with a question from the referring clinician and with a response from a provider consultant. 

image of an e-RS advice and guidance message between two clinicians

Where does advice and guidance fit within e-RS?

e-RS provides the following pathways for GPs to communicate with providers:

Advice and guidance – an advice service which allows a GP to request advice from a provider (e.g. consultant) before or instead of making a referral. If, as part of the advice, the specialist provider recommends referral then the decision and responsibility to refer remains with the GP. Advice and guidance should run in parallel with referral services, and is recommended to supplement, but not replace, referral services.

Bookable services – a referral service where the patient selects an appointment and books before the specialist provider reviews the clinical referral information. Directly bookable services are the most economical way of referring a patient into an outpatient appointment using e-RS.

Referral assessment services (RAS) - a referral triage, or assessment service, where the referral information is assessed by the provider before an appointment is booked. RAS pathways are suitable when specialist providers determine that referral pathways are clinically more complex, needing a level of triage to determine the most suitable pathway.

This process will require more administrative time and resource to manage. It may also reduce patient choice, if the process is not managed correctly at every stage.

Training and support resources

There are a variety of training resources on the e-RS training pages to support organisations to implement and use advice and guidance:  

Last edited: 15 November 2019 4:20 pm