The Royal College of Physicians (RCP) has responded to the results of an investigation that explores risks to patient safety where electronic patient record (EPR) systems, introduced to support referrals for patient care, have contributed to harm from missed or delayed care.
The Royal College of Physicians (RCP)has responded to the results of an investigation that explores risks to patient safety where electronic patient record (EPR) systems, introduced to support referrals for patient care, have contributed to harm from missed or delayed care.
The Health Services Safety Investigations Body (HSSIB) has published an interim report examining patient safety concerns linked to Advice and Guidance (A&G) services in the NHS in England. NHS A&G services allow clinicians in general practice to seek specialist advice from secondary care, either before or instead of making a hospital referral.
The HSSIB has recommended that NHS England/Department of Health and Social Care (DHSC) undertakes a rapid evaluation of A&G processes.
The Royal College of Physicians (RCP) has previously expressed concerns over the implementation of the A&G pathway. RCP survey in June 2026 found that almost half (47%) of physicians delivering A&G have no dedicated time for it written into their job plan, with many reporting that they complete this work in the evenings and on weekends.
The RCP’s survey also found that 89% of physicians have received no formal training on delivering A&G. The HSSIB recommends that patient safety be improved by addressing gaps in knowledge and skill across the medical workforce for A&G tasks. The RCP supports this call, which is critical to supporting consistent and effective delivery of A&G across the country.
With plans for A&G to be incorporated into the electronical referral system (e-RS), it is imperative to improve some of the technical barriers that inhibit communication between general practitioners and specialists.
The RCP’s survey also identified concerns about the appropriateness of some requests. 70% said they sometimes (42%) or often (28%) receive requests they believe are inappropriate for the A&G route, including some that require urgent clinical intervention.
Dr Hilary Williams, RCP clinical vice president said:
‘Today’s report echoes concerns that we have been hearing from our members as Advice & Guidance (A&G) referrals continue to increase. This month we have seen the highest number of referrals on record. More people are living with multiple health conditions, and it is increasingly difficult for physicians to provide accurate, detailed advice, often with an incomplete picture from the referral, and without appropriate time allocated for the volume of complex requests they receive. It is vital, for both patients and staff that people in need of care don’t experience a cycle of referrals and A&G requests without receiving the timely, coordinated care and clear outcomes they need.
'We welcome the safety recommendations put forward to review how A&G is used, as we hear the impact of inappropriate and inconsistent use on patient care. For the single point of access to be successful, we urge NHS England and DHSC to also address the need for A&G to be appropriately factored into job planning.’