Advice & Guidance at Scale: Cinapsis in Practice in Gloucestershire 

Advice & Guidance has become a central part of the NHS conversation around elective recovery and demand management.

But in many systems, its impact remains limited, constrained by inconsistent adoption, variable processes, and a lack of integration into wider pathways.

However the work in Gloucestershire, highlighted during a visit by Tara Donnelly, demonstrates how Cinapsis-enabled A& G can completely transform pathways when implemented at scale.

From tool to infrastructure

With 45,891 patients supported in a single year and more than 20 services actively using the system, Cinapsis-enabled A&G is no longer an adjunct, it is embedded into the infrastructure through which care is delivered. This distinction matters.

Rather than simply reducing outpatient demand, structured A&G is:

• Supporting earlier clinical decision-making
• Enabling more patients to be managed in primary care
• Improving the quality and appropriateness of referrals

22.5% of patients are avoided travelling to the Acute Hospital  and instead were managed in a community setting reflecting not just diversion, but more accurate allocation of care.

Reducing variation in clinical workflows

One of the longstanding challenges with A&G has been variability.

Unstructured requests, inconsistent formats, and incomplete information create inefficiencies for both referrers and specialists.

The Gloucestershire model addresses this through Cinapsis-enabled standardisation. Structured templates ensure that:

• Relevant clinical information is consistently captured
• Requests align with specialty requirements
• Responses can be delivered efficiently

This reduces the need for back-and-forth communication and allows clinicians to focus on decision-making rather than administration.

In practical terms, this has led to measurable improvements. As noted by Dr Alex Owen, Dermatology referrals now take approximately half the time compared to eRS, demonstrating how Cinapsis reduces friction and frees up clinician time.

Strengthening governance through design

A key advantage of structured Advice & Guidance is the data it generates.

Every interaction through Cinapsis contributes to a detailed record of clinical reasoning, enabling: 

• Audit and compliance
• Identification of unwarranted variation
• Data-driven pathway redesign

This is governance by design, rather than governance as an additional burden.

Clinicians highlighted the value of Cinapsis providing clear documentation and a full decision trail, not only for accountability, but also for shared understanding across teams.

In Stroke services, the ability to log and replay calls, as described by Dr Kate Hellier, further enhances this capability by embedding learning directly into operational processes.

Impact across urgent and elective care

While often associated with elective pathways, the Gloucestershire experience demonstrates that Cinapsis-enabled Advice & Guidance can have significant impact across urgent care as well.

By supporting earlier and more informed decision-making, structured systems help to:

• Reduce unnecessary escalation into emergency departments
• Improve patient flow across acute services
• Ensure patients are seen by the most appropriate clinical team

These effects are interconnected. Improvements in triage and referral quality upstream translate into better performance downstream.

Enabling scale through alignment

Achieving this level of impact requires more than deploying a digital platform.

The Gloucestershire model has been built on strong alignment between clinical, operational, and Cinapsis-enabled digital teams.

This includes:

• Collaborative pathway design involving frontline clinicians
• Continuous refinement of templates and processes
• Ongoing support to ensure adoption and usability

This alignment is what allows Advice & Guidance to function consistently across multiple services.

Without it, implementation risks becoming fragmented and impact diluted.

Beyond adoption: embedding new ways of working

One of the most significant indicators of success is the extent to which new processes have become embedded in everyday practice.

During the visit, clinicians spoke not just about efficiency gains, but how Cinapsis-enabled workflows changed the way they work.

• Greater clarity in decision-making
• Improved communication between primary and secondary care
• Increased confidence in patient pathways

As one clinician noted, the Cinapsis system has become something they would not want to work without.

This reflects a transition from adoption to normalisation, where new ways of working are no longer seen as new.

Beyond adoption: embedding new ways of working

One of the most significant indicators of success is the extent to which new processes have become embedded in everyday practice.

During the visit, clinicians spoke not just about efficiency gains, but about a broader shift in how they work. As Dr Chris Custard put it:

“It’s about control. We’ve moved from managing emergency care to planning urgent care.”

That shift in mindset is critical.

It reflects a move away from reactive, demand-led care towards a more structured, anticipatory model, where decisions are made earlier, pathways are clearer, and clinicians feel better supported.

As a result, Advice & Guidance is no longer seen as an additional step, but as an integral part of delivering care.

A model for wider system change

For integrated care systems looking to expand their use of Advice & Guidance, the Gloucestershire experience highlights several key considerations:

• Implementation should be system-wide, not limited to individual specialties
• Standardisation is essential to reduce variation and enable efficiency
  Data generated through structured processes should be actively used to inform improvement

Most importantly, Advice & Guidance should be viewed as part of a broader approach to pathway redesign.

When integrated effectively, it can play a central role in improving patient flow, reducing pressure on acute services, and supporting more sustainable models of care.

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