Health boards given three months to boost A&G strategy and cut… read more
Welsh health boards have been instructed to create detailed plans within a three-month timeframe to expand the use of Advice and Guidance (A&G) services by GPs. This move is part of a broader effort to improve NHS productivity across Wales and reduce unnecessary referrals to hospitals.
The directive follows the acceptance of 29 recommendations proposed by the Ministerial Advisory Group (MAG) on NHS performance and productivity. The group, established in October 2024, was tasked with evaluating the current structures and efficiency of NHS Wales. The review was led by Sir David Sloman, the former chief operating officer of NHS England, and it concentrated on several key areas including planned care, diagnostics, cancer services, and emergency care. The overarching goal was to uncover methods to boost both performance and efficiency within the healthcare system.
The MAG’s findings revealed significant disparities in how A&G is utilized across different health boards. In some regions, as much as 40% of GP-to-consultant communications occur through electronic advice, whereas in other areas, outdated practices like paper referrals and a lack of electronic triage persist. A&G data showed that 53% of practices request advice through phone calls and 35% through messaging platforms. This inconsistent adoption has led to variations in patient care and system inefficiencies.
According to the MAG, there is no justification for the existing discrepancies, and all health boards should aim to match the performance of the highest adopters of A&G systems. The advisory group emphasized the need for rapid change, urging each board to develop a comprehensive plan aimed at reducing traditional outpatient referrals in specialties with high volumes of patients. Alternatives to face-to-face referrals should be identified, expanded, and integrated into routine practice.
The group also called on the Welsh Government to maintain national funding for both A&G systems and the broader National Community Health Pathway Programme. It highlighted the potential of these programmes to reduce pressure on secondary care services when fully implemented.
In response, the Welsh Government stressed that health boards must work to address and eliminate “unwarranted variation” in referral patterns between GP practices. While some high referral rates may be justifiable based on population health needs, differences not based on medical necessity need to be corrected. Progress on these goals will be closely monitored and evaluated during monthly performance reviews.
Health secretary Jeremy Miles acknowledged the system’s current underperformance but also expressed optimism. He recognized the professionalism and commitment of NHS staff and cited this as a foundation for driving necessary changes. He reiterated that the goal is to enhance service quality and health outcomes while ensuring the NHS provides value for money as demand continues to rise.
Starting in June 2025, health boards and NHS trusts will be required to publicly report their progress on these plans each month. These updates will also be reviewed during regular performance and productivity meetings.
