HSSIB warns of patient safety risks in GP advice and guidance referrals
- Aug 18
- 2 min read
The Health Services Safety Investigations Body has warned of patient safety risks linked to NHS advice and guidance services between general practice and hospital specialists.
Advice and guidance allows GPs to seek specialist input before, or instead of, referring a patient to hospital for specialist assessment.
HSSIB said these services can improve communication between general practice and specialist teams, and can help patients receive specialist input more efficiently.
However, its interim report found evidence that advice and guidance had contributed to near misses and incidents of patient harm where services were poorly implemented, integrated or monitored.
The report said harm had arisen through delayed or missed diagnoses, and delays to care and treatment.
HSSIB also found evidence that advice and guidance was being used in some pathways where general practice had requested specialist assessment for suspected cancer. Incidents showed this had contributed to delays in diagnosis.
The investigation identified gaps between how advice and guidance processes were being used locally and national expectations. Examples included local pathways requiring GPs to use advice and guidance instead of making direct referrals, and referrals for specialist assessment being declined despite GPs having ongoing concerns.
HSSIB has recommended that NHS England and the Department of Health and Social Care carry out a rapid evaluation of advice and guidance processes, including single point of access models.
The recommendation focuses on patient safety risks linked to capacity, oversight, training, digital systems and incident reporting.
The broader relevance
Advice and guidance can be useful when it helps GPs and specialists share information and plan care more efficiently.
The concern is what happens when the process becomes a barrier to assessment, especially when a GP remains concerned that a specialist referral is clinically appropriate.
For patients, delayed referral can mean delayed answers, delayed treatment and more time living with uncertainty.
The report focuses on NHS services in England.