{
  "abstract": "Introduction NHS waiting lists are at an all-time high with increasing demands on overstretched primary and secondary care services. Advice & Guidance (A&G) system is designed to bridge the gap between primary and secondary care, allowing for specialist recommendations without the need to wait for a face-to-face hospital outpatient appointment. Epsom & St Helier University Hospitals NHS Trust serves South West London and North East Surrey and received approximately 55,000 A&G requests in the past 3 years. In this study, we aim to quantify the time-trends in utilisation of A&G in primary care in South West London and to examine the effects on secondary care resource allocation.Materials and Methods Pseudo-anonymised A&G activity data was obtained using the Information Analyst role designated in the eRS system between 1 April 2021 and 31 March 2024. Data was imported to Microsoft Excel for further analysis, focusing on major medical specialities: Cardiology, Respiratory, Nephrology, Haematology, Diabetes and Endocrinology and Dermatology.Results and Discussion We received 54,431 requests for A&G from primary care (catchment area of 497,000 patients) with most requests received in Cardiology (7,242). During the 3 years under study, there was an increase in requests year-on-year in all specialities (see figure 1). From 2022 to 2023, the largest growth was seen in Dermatology and Cardiology (by 43 and 41 percent) respectively compared to others (average by 31 percent). Estimating each A&G response to take about 10 minutes to complete, we estimated the number of consultant programmed activities per week to deliver the service (see table 1).Abstract 7-031 Figure 1Temporal trends in A&G in different medical specialities from April 2021-March 2023Abstract 7-031 Table 1Estimated number of Consultant Programmed Activities required per week to deliver A&G (Based on 52 week year with prospective cover) 2021 2022 2023 Cardiology 1.7 2.3 3.2 Dermatology 1.5 1.7 2.4 Diabetes & Endocrinology 0.8 1.1 1.4 Haematology 1.7 2.0 2.5 Nephrology 1.2 1.6 2.2 Respiratory 0.3 0.5 0.7 The increasing demand for A&G is also highlighted in the article by Charman et al,2 probably owing to the easy access and asynchronous platform, and the function to share images. This subsequently increases the requirement of dedicated time for speciality doctors and consultants to provide good clinical responses.Conclusion The A&G service remains an efficient portal for communication between primary and secondary care and sees an increasing demand over time, not only in Cardiology but also in other medical specialties, imposing an increased pressure on secondary care providers to deliver the service and consuming approximately one to two days per week of consultant time. Whilst A&G is believed to reduce the need for onward referrals and inappropriate clinic appointments, its role in increasing productivity and reducing waiting lists remains to be determined.References NHS Digital. Advice and guidance toolkit for the NHS e-Referral service (e-RS) [Internet]. Leeds: NHS Digital; [cited 2024 Sep 8]. Available from: https://digital.nhs.uk/services/e-referral-service/document-library/advice-and-guidance-toolkit.Charman C, Wainman H, Rabindranathnambi A, Whybrew C, Williams HC. How to do digital Advice and Guidance well. Clin Exp Dermatol. 2023 Aug;48(8):860–865. https://doi.org/10.1093/ced/llad139.",
  "authors": [
    {
      "affiliations": [
        "Epsom and St Helier University Hospitals NHS Trust, UK"
      ],
      "name": "TH Nyi"
    },
    {
      "affiliations": [
        "Epsom and St Helier University Hospitals NHS Trust, UK"
      ],
      "name": "L Lee"
    },
    {
      "affiliations": [
        "Epsom and St Helier University Hospitals NHS Trust, UK",
        "St George’s University Hospitals NHS Foundation Trust, UK"
      ],
      "name": "R Bogle"
    }
  ],
  "title": "7-031 Advice & guidance utilisation in cardiology and other medical specialities: increasing temporal trend and implications for secondary care resource allocation",
  "uid": "847a6fe1-6dab-5254-818a-a4a96da3d6d2"
}