Locums work in a self-employed capacity. As such, they should define the terms of the service they offer, including a clear description of the caseload (both direct and indirect clinical care where relevant) they will offer within a given time. 

This is to ensure they are working safely within their capacity and competencies. It should recognise that a lack of familiarity with patients, processes, referral pathways and teams contribute a level of risk for the clinician which they need to manage through their terms and conditions. 

This may be reflected in the clinician choosing to offer different terms of service in different services. Any additional work asked of the locum outside of the terms of service they have offered is subject to their agreement, and additional mutually agreed remuneration. 

Advice and guidance referral system update 

NHS England is increasingly encouraging the use of A&G to relieve pressure on secondary care and reduce referrals into secondary care services.

Recently Acute Trusts and ICBs (Integrated Care Boards) have started to mandate that in some specialities all referrals must go via A&G, sometimes badged as ‘intelligent triage’. This can create further workload for GPs in arranging additional investigations or follow up appointments. 

Advice and Guidance cannot be mandated instead of a referral. 

This is covered in the NHS Standard contract (c6) and eRS referral routes must be kept open.

Also, to deny the ability of a GP to make a referral creates a system that prevents doctors from discharging their responsibility under good medical practice with the GMC, which states you must: ‘refer a patient to another suitably qualified practitioner when this serves their needs’. This is further underpinned by the NHS constitution around patient choice.

LMCs should be involved with any implementation plans around A&G, including business rules and payments for processing A&G. Therefore, unless A&G with appropriate funding via an LCS (Locally Commissioned Service) has been agreed by LMCs, we would recommend that: GPs cease taking part in Advice and Guidance from 1 June 2024 .

Individual GPs are of course free to utilise A&G where after discussion with a patient this would be better for the patient and their GP. For example, where a simple clarification is sought from a specialist.

The use of A&G is neither a contractual nor professional obligation. In some cases eRS only enables referrals to some trusts via the advice route, if, for these trusts, the GP requires specialist review and not advice, they should provide the full information required for a referral and state that the request is for the specialist to provide the patient with a consultation and is not a request for advice.

If despite requesting an appointment, the GP is then offered advice from the specialist instead, they should respond stating ‘The original request was for a referral to a specialist team, it was not a request for advice. As such, please provide this patient with an out-patient appointment as is their right under section SC6 of the NHS standard contract 2024’.