NHS Advice-and-Guidance Safety Tracking & Escalation Layer

When responsibility moves between primary and secondary care, unanswered advice, converted referrals, rejected requests and follow-up actions can become safety-critical. Existing referral systems do not guarantee that local organisations can see pathway-level risk or reliably escalate exceptions.

Likely buyers are trust digital, patient-safety, planned-care and ICB transformation leaders. Users need a safety overlay that works with e-RS rather than another competing national referral system.

This is a safety-governance opportunity rather than a referral-routing opportunity: detect when advice is unanswered, repeatedly redirected, converted incorrectly or leaves a patient without a clear accountable next step.

Pilot in one trust/ICB across one high-risk specialty. Track unanswered requests, time-to-specialist response, converted referrals, patient follow-up, safety incidents and pathway leakage against an existing baseline.

Defensibility requires safety analytics and cross-pathway audit rather than intake/routing: configurable safety rules, patient-level continuity, incident linkage and an evidence pack for trust/ICB governance. Integration with e-RS is essential.

Allow A&G expansion without making safety risk invisible, and give clinical/governance teams a measurable way to evaluate pathway performance.

Directly evidenced — medium confidence.

- Paid test offer: Paid service or employer pilot: £10,000–£25,000 Proof-of-concept £10,000–£30,000; recurring £15,000–£60,000/year per trust/ICB depending on specialties and integrations. G-Cloud referral benchmarks include Patient Pass £5,000–£15,000/licence/year, Scribe £15,000–£25,000/licence/year and RIVIAM core referral management from £3,250/month.

Evidence basis: Patient Pass (£5,000–£15,000 per licence per year) is the closest verified direct anchor used here. Its buyer, duration and scope are not assumed to be identical; implementation is separated where the opportunity requires integration, assurance or managed delivery.

Ask one accountable NHS, council, employer, school-system or care-service budget owner to fund a paid test of NHS Advice-and-Guidance Safety Tracking & Escalation Layer lasting 8–12 weeks, using an opening price of £10,000–£25,000 and covering two operational teams and 50 representative referrals, cases or employees. Paid scope: A safety-monitoring and escalation layer that sits alongside e-RS/A&G workflows, detects pathway exceptions and gives trusts evidence about where patients are being delayed or lost. Charge by service, organisation, enrolled person or managed cohort and compare the fee with current referral, case-coordination, absence-management and specialist-support effort. Measure time to action, safe escalation, case completion, avoidable hand-offs, staff hours and sustained return/retention. Continue only if time to appropriate action improves by at least 20%, no safety escalation is missed and the budget owner elects to continue. Stop or reprice if clinical or safeguarding quality falls, coordination effort rises or the buyer will not fund the next cohort.

Raise the score if trusts cannot currently measure unresolved A&G pathway risk and a pilot identifies preventable exceptions. Lower it if e-RS enhancements deliver equivalent safety monitoring nationally.