Endocrine Abstracts

There have always been conversations between clinicians about management and potential referral of patients, predominately from primary care to specialists. This has been called variously ‘advice and guidance (A&G)’, ‘specialist advice’ or ‘advice and refer’ by NHS England (NHSE). In the last few years, A&G has become increasingly relevant with escalating clinic pressures and is now part of the NHSE/GIRFT ‘elective care recovery and transformation programme’, but uptake by hospitals has been variable. All Trusts in England are now required to develop an effective advice and guidance system. Similar pressures and responses exist in the other UK nations. There are potential advantages listed across NHSE websites for patients, referrers, specialists, and provider organisations, some more compelling than others. It’s clear that providers and commissioners are finding different ways of approaching A&G, depending on local arrangements and individual clinician enthusiasm. However, there are concerns in secondary care about how it will be integrated into endocrine clinical workload and specifically into job plans. There are worries from primary care about work being shifted back into their very busy practices without additional resources, and from both sides, about how clinical responsibility is allocated. By November’s BES, I will have been trialling the NHSE electronic advice and guidance platform in a secondary care endocrine clinic for four months. I’m using this time to review my workload, experiment with different ways of using A&G, note its impact on local referrals and discuss with operational managers and local GPs. I am polling endocrine colleagues across the UK and in my integrated care role, examining how it is supported by managers in different hospitals. From this I can present some observations and suggestions relevant to endocrine services in general and possibly yours in particular.