Analysis of advice and guidance primary care queries to rheumatology over a calendar year—a diagnostic service evaluation

O’Shaughnessy, Ethan and Mulhearn, Ben and Bukhari, Marwan (2026) Analysis of advice and guidance primary care queries to rheumatology over a calendar year—a diagnostic service evaluation. Rheumatology Advances in Practice. ISSN 2514-1775

Abstract

Objectives In the United Kingdom, Advice and Guidance services allow general practitioners (GPs) to seek consultant assistance without formal referral, supporting decision-making and reducing unnecessary secondary care referrals. However, a significant proportion of Advice and Guidance queries represent frequently asked questions (FAQs), placing avoidable burden on consultants and delaying patient care whilst replies are awaited. This diagnostic service evaluation aimed to identify common FAQs within rheumatology Advice and Guidance queries at Morecambe Bay Hospitals Trust (MBHT), with the goal of developing targeted educational material for GPs. This material seeks to improve the quality of Advice and Guidance referrals to reduce unnecessary secondary care attendances and enhance the delivery of urgent referral pathways in line with targets that are proven to improve patient outcomes. The methodology presented in this paper is a reproducible method to bring about iterative improvements to referrals to an individual department through education and behaviour change. Methods We conducted a retrospective, qualitative content analysis of 2,499 GP‑initiated rheumatology Advice and Guidance messages submitted between April 2024 and April 2025. Our analysis occurred in three stages. Firstly, we used NVivo 15™️ to perform a word‑frequency analysis to identify common, clinically significant phrases within Advice and Guidance queries. Next, for each often‑occurring term in our frequency map, we drew a purposive sample of the full Advice and Guidance conversation in which it appeared. From these, we conducted an in‑depth, iterative coding of their content—identifying and refining sub‑themes—until no new themes were identified. Finally, we filtered the dataset for messages containing ‘urgent,’ ‘acute,’ or ‘emergency’ to isolate time‑sensitive queries. Results Three major themes of FAQ were identified: interpretation of blood tests (especially incongruous blood results and the significance of inflammatory markers), management of osteoporosis (particularly medication queries), and initial treatment or diagnostic uncertainty in suspected giant cell arteritis (GCA). Queries marked as urgent were most commonly associated with GCA. The GPs’ questions were frequently similar within their themes and amenable to concise, standardised advice. Conclusions Recurring patterns in Advice and Guidance queries suggest an opportunity to support local GPs through focused educational material; a guidance document targeting the most common FAQs is in development. Although implementation and evaluation are pending, this low-cost, scalable approach may feasibly offer value across specialties and sites. Further study will assess its impact on Advice and Guidance usage and GP confidence.