Digital communications system supports collaborative working between primary and secondary care

A digital communication tool is being rolled out across primary and secondary care in Lancashire and South Cumbria. The web-based system, known as Advice and Guidance (A&G) allows GPs (and other clinicians working within primary care) to seek help from specialists within secondary care, at the touch of a button.

Primary care clinicians can send a request via EMIS through the A&G system in cases where a specialist’s opinion needs to be sought e.g. cardiology, radiology, dermatology, dietetics, diabetes, neurology and podiatry (to name just a few). Most replies from secondary care are received by the primary care clinician within 48 hours and the specialist does not have to keep logging on to check the system for new requests; they will receive an email notification sent straight to them. A&G automatically creates a secure audit trail of the conversation so the reason for the request and the outcome itself can be recorded and learnt from. Almost 71% of over 11,000 conversations recorded in the NHS Morecambe Bay Clinical Commissioning Group (CCG) area during 2019/20 have resulted in a change to the patient pathway.

NHS Morecambe Bay CCG and University Hospitals of Morecambe Bay NHS Foundation Trust developed A&G and have been using it together for the past few years to great success. In 2019, the Integrated Care System (ICS) Care Professionals Board endorsed it for rollout across the other Integrated Care Partnership areas in Lancashire and South Cumbria.

George Dingle, Clinical Lead at the ICS and a GP in Garstang, helped to design the system and said:

“Designing a system which is very easy to use for busy clinicians across primary and secondary care was a key aspect. Facilitating communication and collaborative working between GPs and hospital specialists about patients and their specific health conditions has many benefits.”

Rolling the system out into one area would usually take around 4-5 months, but by working together during the COVID-19 pandemic, clinical and technical experts across the ICS have been able to expedite the process in the central Lancashire and Fylde Coast areas. Central Lancashire’s A&G was up and running in just nine weeks, going live on 15 June 2020 with 30 specialities and Fylde Coast followed on 6 July, initially using the system for seven specialities.

A&G not only promotes closer, collaborative working between primary and secondary care, but it often can save patients’ time by replacing the need for a GP to make a referral to a specialist that would require the patient to wait for another appointment and then travel to a hospital setting to attend it. This has been particularly pertinent during COVID-19 in alleviating the need for patients to travel to a hospital setting unnecessarily.

In 2019/20, in cases where GPs in Morecambe Bay used the system to access advice from specialist colleagues for their patients and their health conditions, it is estimated that the advice received reduced the need for subsequent outpatient referrals by up to 33%. The impact is still being measured in central Lancashire but in the first four weeks, 73 requests using A&G were made, 100% of GPs have reported that the system is easy to use, 93% have rated it ‘useful’ or ‘really useful’ and a change in how patients and their resulting treatment are managed following A&G has occurred in 64% of cases.

Dr Gerry Skailes, Medical Director at Lancashire Teaching Hospitals NHS Foundation Trust, said:

“Getting this system up and running in such a short space of time is a great achievement and I’d like to thank all those who made this possible. Despite all their other pressures, our clinicians have really embraced this new way of working and the early indications are that our patients are already experiencing tangible benefits. We are looking forward to building on these early successes and hope the system will allow more patients to have the advantages of specialist advice without the inconvenience of having to travel into hospital for their treatment – a win/win for us all.”