Norfolk and Suffolk Integrated Care Board (ICB) officials faced tough questioning from councillors at a meeting on 17 September 2026 over a scheme that routes patients through GP-specialist consultations before they reach hospital outpatient lists.

The Advice and Guidance (A&G) model is designed to get patients the right care more quickly by allowing GPs to seek specialist advice digitally, potentially avoiding a formal outpatient referral altogether. However, committee members heard that uptake has been lower than expected and that comprehensive outcome data is not yet available.

Deputy Medical Director David Brandon told the committee that over 50% of A&G requests received a specialist response within two working days, with a further 25% answered within three to five days. But councillors questioned whether reductions in outpatient appointments were genuinely improving care or simply delaying it.

Concerns were also raised that the model shifts responsibility onto GPs without adequate resources, and that it could be used as a substitute for increasing hospital capacity. Brandon acknowledged that problems could arise where the model was implemented poorly or used as a barrier to care.

A backlog of unanswered A&G requests had previously been investigated through the patient safety process. Officials confirmed no instances of patient harm were identified, and that safety monitoring sits with the ICB's Quality Committee.

The committee voted unanimously to require the ICB to begin collecting data on delays affecting patients who go through the A&G process and still end up needing an outpatient appointment. The ICB must also monitor usage data at individual GP practice level — something not currently tracked.

Officials agreed to provide briefing notes on outpatient attendance trends and patient safety reporting, as well as details of complaints received from healthcare professionals about the model.

The ICB was also asked to explore whether the model could be extended to pain clinics, which councillors suggested were particularly well suited to it, and to report back to the committee in 12 months.