Background Waiting times for outpatient consultations are consistently under pressure, and delivery of the mandatory 18 week target from referral to completed review remains challenging. An Advice and Guidance scheme offers an opportunity to access neurological advice while reducing face-to-face consultation needs. We designed this project to develop the requirements, methods, audit and costing of sustainable neurological advice.

Methods A DGH Neurology service worked with a local CCG comprising 18 GP practices. All 176 referrals and advice requests received during a 6 month pilot were considered for A and G instead of a clinic appointment.

Results Advice was offered in 37% of cases overall (48 patients), but a net increase of 12% in face-to-face consultations was observed, as 28 (16%) of advice requests required clinic review. Headache and alteration of consciousness were common, and cases with an established diagnosis the most tractable for the ‘Advice Only’ option. GP referral quality was judged good, neurology satisfaction was reasonable, and a cost of at least £68 per episode was indicated.

Discussion This pilot showed an increase in the number of face-to-face clinic reviews required. We suggest that other reported schemes may have not included advice requests that resulted in referrals in their metrics.