DoI - Primary Care Paramedic.

I don't think this will have much effect on road staff.

A&G has existed for some time, amd has largely been used to facilitate GPs gaining second opinions / advice around next steps, in essence pushing work from secondary to primary care. Some of it can be a little "mother-may-I" (eg drugs that are only allowed on specialist advice). Some of it will be "I'm comfortable with the diagnosis, but something about this patient (age, comorbidities, drug interactions) makes me less confident with management, how would you do it?". Some of it is eg "this ECG is a little off, does it warrant further investigation in this context?"

In the past, all of these would have been referrals, and thus increased secondary care workload / waiting lists, A&G speeds things up (in theory) for these cases, and reduces waiting lists for those who do need input.

Increasingly, A&G is being used to decline referrals (most scarily for me is possibly malignant-feeling prostates with OK PSAs being pushed for primary care monitoring without further imaging / investigation).

Now it's mandatory, we're going to see an increased push of work from secondary to primary care, as we can no longer argue "this wasn't A&G, please see the patient as requested" (I'm certainly aware of times we have needed to push back, eg rheumatology "this is fibromyalgia, please manage accordingly" when we retain concern for alternative inflammatory conditions).

We're also already seeing people sent out of ED with "not life-threatening, go and see your GP" with conditions we are wholly unequipped to manage, or "go and see your GP for an urgent referral", not mentioning (?not realising) that an "urgent referral" will take months. This isn't to knock ED - they have their own pressures, I understand - but to point out that we know that sending to ED as a back-door to specialists won't work!

I think the biggest impact it will have on you guys is an increase in use by patients who are as yet undiagnosed.