Advice and Guidance is promoted to access specialist support about clinical queries relating to patient care while working within primary care. This may be appropriate when you might have previously considered a referral.

The main point of access to advice and guidance is eRS advice and guidance

Echocardiography triage resource (British Society of Echocardiography)

Transthoracic echocardiography is an essential test in the evaluation of patients with suspected structural and functional cardiac conditions. When used appropriately it facilitates rapid diagnosis and timely intervention for patients. The British Society of Echocardiography has previously issued detailed guidance, aimed at hospital and specialist referrers, regarding the indications for, and optimal timing of, outpatient, inpatient, and critical care transthoracic echocardiography. 

However, the society also recognises that very often the most useful information in primary care is to know the clinical conditions in which transthoracic echocardiography is not routinely indicated at the time of initial clinical contact. These conditions are grouped by symptom or clinical finding in a primary care triaging poster for rapid reference by GPs for use in primary care settings. This guidance is not intended to override clinical judgment in individual cases and has chiefly been created to support situations where clinical judgement favours avoiding further investigation. 

• Primary care triaging poster: Conditions in which an echocardiogram has low clinical yield from primary care (BSE, April 2021)