LMC leaders have urged practices to “avoid using” advice and guidance (A&G) while calling on the BMA to negotiate better advice pathways for GPs.

At the English LMC annual conference in London today, GP leaders voted in favor of a motion saying the use of A&G across the country has led to an “unsustainable shift in the burden of work towards general medicine”.

The motion insisted that cabinets “take into account” the advice of the BMA’s GP Committee England, as part of a collective actionto stop engaging with A&G unless it is “clinically useful”.

He also called on the GPCE to “require a duty” for hospital trusts to “provide separate advice and separate direct referral options” for each specialty to allow GPs to choose the most suitable route.

Where advice and referral pathways are in place, the LMCs have called for a national “standard time frame” for responses from trusts, as well as a “standard structure and quality of response” which ensures that any specialist advice can be followed contractually within the general framework. practical.

The LMC also recommended that any financial savings generated by A&G should be “shared with GPs” rather than simply “absorbed by hospital trusts”.

Proposing the motion, Dr Jackie Applebee of Tower Hamlets LMC said the reality is the whole project has been “a massive and stellar offloading of workload onto general practice”.

She said: “Refusing to engage in advice and guidance is one of BMA’s 10 suggestions for collective action, all carefully chosen with safety in mind to work without breaking your contracts.

“Demand a referral and if they push back, push back harder. There is no contractual obligation on this subject.

“Lead by example, write in the advice box that you expect the patient to be seen, unless you really just want advice. »

Dr Matthew Prendergast, from Hampshire and Isle of Wight LMC, who spoke in favor of the motion, said: “It is imperative that we do not agree to do more with less. It is imperative that we enforce the contractual position in which we have the right to refer.

Dr Stephanie Betts-Masters from Cambridgeshire LMC, who also spoke in favor of the motion, said: “Every GP is a GP expert and manages remarkable medical complexity for our communities.

“We deserve to be able to ask our secondary care colleagues for help and our patients deserve that advice when we feel it is the appropriate next step.”

“We know our patients better than anyone and our concerns should not be blindly ignored without appropriate secondary care review. »

Recent Pulse survey suggested that a quarter of practices have stopped engaging in advice and guidance either before or after the start of collective action this year, while almost 40% do not plan to take this action.

In November last year, NHS England said there would be no national mandate that GPs use advice and guidance in a number of cases, and that local systems should design their own targets and processes.

But in June, Pulse revealed NHS England document which confirmed that it wanted to “optimize” referrals from GPs to secondary care via an improved A&G model.

The document encourages local commissioners to “strengthen” specialist advice services with an “advice and referral” model, meaning all referrals or requests for advice from GPs “come through one channel”.