Advice and Guidance

Advice and Guidance (A&G) services are a key part of the National Elective Care Recovery and Transformation Programme’s work. A&G provides primary care with continued access to specialist clinical advice, enabling a patient’s care to be managed in the most appropriate setting, strengthening shared decision making and avoiding unnecessary outpatient activity.

What is Advice and Guidance?

A&G is defined as non-face-to-face activity delivered by consultant-led services which can be:

  • Synchronous (for example, a telephone call)
  • Asynchronous (enabled electronically through the NHS e-Referral Service, or through other agreed IT platforms or email addresses)

By providing a digital communication channel, A&G allows a clinician (often in primary care) to seek advice from another (usually a specialist) prior to or instead of referral. Reasons why a clinician may wish to seek advice and guidance include:

  • Asking another clinician or specialist for their advice on a treatment plan;
  • Asking for clarification regarding a patient’s test results;
  • Seeking advice on the appropriateness of a referral;
  • Identifying the most clinically appropriate service to refer a patient into.

Why use Advice and Guidance?

Growth in demand has meant that hospital outpatient visits have increased significantly over the past decade. The NHS Long Term Plan includes a commitment to redesign outpatient services so that patients will be able to avoid up to a third of face-to-face outpatient appointments over the next five years. This will remove the need for up to 30 million outpatient visits a year; saving patients time and improving their experience.

Mobilising A&G services will help transform the way referrals are managed by improving the interface and facilitating shared decision making between primary and secondary care. Through better enabled communication, A&G provides GPs with access to consultant advice on investigations, interventions and potential referrals. This helps manage non-urgent (elective) patients in the most appropriate setting, helping reduce unnecessary referrals into secondary care.

Further information and useful resources

To help teams get the most from A&G services, we’ve developed a series of short guides which set out practical advice and information.

Simply download the guide most relevant to your role to find out the key actions you can take to mobilise your A&G service.

Further information is available on the National Elective Care Transformation Programme’s Community of Practice site. This platform hosts a range of tools and resources to support local health systems implement A&G services. If you do not have an account for this platform you will need to request access by emailing

Support for all aspects of e-RS A&G can be found on the Advice and Guidance toolkit for the NHS e-Referral Service (e-RS).

Guidance on A&G and other clinical advice and referral channels available in e-RS can be found on NHS Digital’s website.

Improvements are being made to the e-Referral Service (e-RS) Advice & Guidance functionality. Enhancements include:

  • Changes which enable a service provider to convert an A&G conversation into a referral, when authorised (available by the end of January 2021)
  • Improved integration of e-RS with provider IT systems, meaning it will be quicker and easier for clinicians to use (available before the end of March 2021)

More information, including training materials and details of awareness sessions, are available on the NHS Digital website.

The Elective Care Community of Practice is for everyone working to transform elective care. Find out more.