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

At the annual conference of English LMCs 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 transfer of workload to general practice”.

The motion insisted that practices should “heed” the BMA’s GP Committee England’s advice, as part of collective actionto stop working with A&G if it is not “clinically useful”.

It also called on the GPCE to “require an obligation” on hospital trusts to “provide separate advice and separate direct referral options” for each specialty to enable GPs to choose the most appropriate route.

Where advice and guidance pathways are in place, LMCs have called for a national ‘standard timeframe’ for responses from trusts, as well as a ‘standard structure and quality of response’ which ensures that all specialist advice can be acted upon as agreed in general practice.

The LMC also recommended that any financial savings generated by A&G be “shared with general practice” rather than only being “absorbed by hospital trusts”.

Dr Jackie Applebee, of Tower Hamlets LMC, suggested to the motion that the reality is that the whole scheme has been “a massive, fantastic workload dump on general practice”.

She said: ‘Refusing to engage in advice and guidance is one of 10 BMA collective action proposals, all carefully chosen with safe working in mind without breaching your contracts.

“Ask for a referral and if they push back, push back harder. There is no contractual obligation to do this.

‘Lead by example, write in the advice box that you expect the patient to be seen if you don’t just want advice.’

Dr Matthew Prendergast, from Hampshire and Isle of Wight LMC, who spoke in support of the motion, said: ‘It is imperative that we do not accept doing more with less. It is imperative that we maintain the contractual position so that we have the right to refer.’

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

“We deserve to be able to ask for help from our colleagues in secondary care and our patients deserve that opinion when we think it is the right next step.

“We know our patients best, and our concerns should not be blindly ignored without a proper review of secondary care.”

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

Last November, NHS England said there will be no national mandate for GPs to use advice and guidance in a certain number of cases, and for local systems to design their own targets and processes.

But in June, Pulse uncovered a document from NHS England which confirmed it wants to “optimize” GP referrals to secondary care via an improved model of A&G.

The document encouraged local commissioners to “strengthen” specialist advice with an “advise and refer” model which means all referrals or requests for advice from GPs “come in via a pathway”.