Advice and guidance for consultants and provider clinical teams

Review the benefits section to find out more information on how using advice and guidance, via the NHS e-Referral Service (e-RS), can help consultants and other provider clinicians.

A typical patient journey using advice and guidance starts with the patient visiting their GP noting if the patient has agreed for the request to be converted to a referral by that provider.

The patient visits their GP and the GP creates an advice and guidance request. Patient images or other attachments can be added as required.

The provider clinician reviews the advice and guidance content and responds, either by:

• giving advice on diagnosis and management based on the information received, and adding attachments as required (such as clinical guidelines, patient information)
• requesting further information from the referrer, in which case the advice and guidance request remains in the providers worklist until a response has been received from the referrer  
• converting the request to a referral (where authorisation has been given) and providing management information to the referrer

Watch our short film from Peterborough City Hospital about how they use advice and guidance. Note: this was filmed prior to the conversion functionality being available.

Below are details of how to respond to an advice and guidance request.

1. Log onto e-RS using your smartcard.
2. Select the worklist tab and the advice and guidance requests option from the worklist type dropdown menu to open the advice and guidance requests worklist.
3. Under the filters section, select show all on the consultant dropdown to show all advice and guidance requests into that service (show all will also be the usual recommended default setting in the service, speciality and location setting – please discuss with your e-RS manager).
4. Select the load results button to display the advice and guidance requests.
5. Open an appropriate advice and guidance, by selecting the UBRN (unique booking reference number).

6. Review advice and guidance information, including any attachments which may be embedded in the advice conversation or attached in the left-hand column under advice request details.
7. Click on the patient name at the top of the screen for details including address and contact details.
8. Action the advice and guidance request in one of the following ways, including adding attachments if required, by selecting add attachment. You can copy and paste from provider systems into an advice and guidance response (and/or vice-versa), by highlighting the text and using Ctrl C (copy) and Ctrl V (Paste).

'Return to referrer with advice'

When selecting this option, you will be required to select one of the four options, indicating your intent. This is for audit purposes only and the information can be found in the AG01 enquiry

‘I require further information’

Select this option when more detail is needed from the referrer, specify the information required and tick the ‘I require further information’ box. Note, that the advice and guidance will remain on your worklist if you choose this option.

Convert this to a referral

This option will only be displayed if the referrer has provided authorisation for the provider to convert the request to a referral. Selecting this option will present two further sub options of ‘I will refer the patient now’ and ‘Request admin team to refer the patient’.

Note: Each provider response will return the request back to the referrer and appear on their worklist; the referrer can then choose to either close or to continue with the conversation.

More guidance on how to process a converted referral and be found in the consultants and provider clinician teams quick reference guide.

There are two enquiries in e-RS that allow you to see all the historic advice and guidance requests and responses information, including attachments.

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. 

Your e-RS lead can provide summary reports on advice and guidance activity for individual consultants and clinical teams through the AG01 (advice and guidance activity report).

The Directory of Services (DOS) tab allows you to review your advice and guidance and appointment clinic specifications, including conditions treated and exclusion criteria. You can also view the DOS for other local and national services for comparison.  

The NHS e-RS DOS is the provider’s portfolio of services. To ensure that advice and guidance requests and referrals are appropriate for their service, managers will be working with their clinical colleagues to regularly review and update key areas, such as conditions treated, procedures performed, recommended investigations and any exclusions. Advice and guidance and referral advice should be provided in line with these DOS specifications.

Attachments for advice and guidance can be added in the same way as they can for referrals. Attachments:

• are a beneficial way of enhancing the information you are sending to the clinician (for example: treatment plans, local or national guidelines, patient information leaflets)
• added using e-RS web-based can be up to a maximum of 5MB per file and there is no limit to the amount of files 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.

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.

You can learn more about attachments by using the e-RS help files, or visit the training section for providers for more information about training and support.

We have created a high level guide to using advice and guidance for consultants and provider clinician teams.  

Advice and guidance should be:

• consultant-led
• delivered either by the consultant or by another senior clinician (including specialist registrars and specialist nurses) where the consultant retains responsibility for the service and the advice provided

If the implementation of e-RS advice and guidance does lead to increased workload burden, clinicians should be allowed to incorporate this into their job plans/work schedules as appropriate, based on the average time taken to provide an advice and guidance response compared to face to face clinical activity.

Advice and guidance will not be applicable to all elective pathways, and specialties need to be agreed at a regional/local level.

Service managers and e-RS leads should work with consultants and clinical teams to agree that:

• processes are in place to ensure that advice and guidance requests are reviewed and responded to/actioned in a timely manner, as it is essential that turnaround times for responses through the advice and guidance function are realistic and appropriate for the level of staffing
• processes are in place to adapt to fluctuations in the volume of advice and guidance requests, and the potential for increasing advice and guidance demand from primary care
• there is sufficient clinical cover to respond to advice and guidance, for example, consider a rota system during periods of absence
• there is sufficient consultant workforce to balance advice and guidance workload against face-to-face clinical activity

The BMA has published a guide for e-RS advice and guidance - e-RS guide for secondary care doctors. It is essential that any new services are carefully planned and properly resourced as failure to do so may make them burdensome and difficult to deliver. Where departments replace existing informal channels with the advice and guidance function, care must be taken to ensure a smooth transition. Where any additional workload burden is created, departments should look for quick resolutions by:

• reviewing work scheduling 
• categorising advice and guidance as DCC (direct clinical care) work for consultants and SAS (staff grade, associate specialist and speciality) doctors
• identifying where juniors may be losing out on education and training opportunities in face to face clinics
• identifying where juniors may benefit from education and training opportunities in advice and guidance

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