Periodic review

Approval isn’t a one-off. Local services, staffing and guidance change, and approved cards need checking again when they do.

When to review again

Review your cards at least once a year, and sooner when:

• a local pathway changes, for example a new MSK referral route or a change to your duty doctor model
• your workforce or skill mix changes: new clinicians, new appointment types or retired services
• NICE or NHS England guidance is updated in a way that affects signposting
• staff tell you a card doesn’t match reality, or they keep asking about the same one. Staff suggestions reach your practice admin; see Suggestions
• you notice a card being used differently from what it says
• the release notes announce changes to shared cards your practice uses

Some changes send cards back to Pending automatically, so they appear in your queue without anyone asking:

• any change your practice saves to a card
• AI customisation, improved-wording suggestions and saved smart visuals (see AI drafts and smart visuals)
• new symptoms your practice creates

Finding what has changed

What’s changed

The What’s changed link on the signposting home page lists cards approved at your practice in the last 14 days (or since a date the Signposting Toolkit team has set for your practice), labelled New or Updated, with the date each was approved. Filter by All, New or Updated. Cards waiting for review aren’t shown.

Use it to:

• brief staff on what you have just approved
• spot-check recent approvals with a colleague

Sorting the queue

In Clinical Review, the Most recently changed sort puts the latest review decisions first. Use it with the Approved view to see what was approved most recently, or with Changes requested to follow up the newest requests. Cards sent back to Pending by an edit show Not reviewed and sort to the end, so use the Pending view to find those.

Other sorts help target a review:

• High-risk symptoms first after a change to urgent or emergency routes
• Clinician-type symptoms first after a change to an ANP’s, pharmacist’s or physiotherapist’s scope
• an age group filter after a change to children’s services

An annual review without resetting everything

You don’t need Request re-review for a planned review. It sets every approved card, and every card with changes requested, back to Pending at once, replaces each reviewer’s name with yours and clears reviewer notes, and staff then see pending warnings across the library.

Instead:

1. Open the Approved view and divide the cards into ranges, for example by letter or age group.
2. Select each card name to open the full page and check it against What to check on every card.
3. If it is still right, select Approve. This updates the approval date and records you as the reviewer.
4. If it needs changing, edit it or choose Request changes.

Start with high-risk cards and the cards staff use most. Your practice admin can see which cards are viewed most in Analytics.

Keeping the pending count low

Staff see switched-on Pending cards with a warning, and a notice on the home page while any are waiting. Aim to keep the number waiting low: fewer than 10 is a healthy target.

• Check Clinical Review regularly, and after any AI run or batch of edits.
• Resolve Changes requested cards quickly, or disable them if they aren’t safe to use.
• Your practice admin can see pending reviews, changes requested and the last review activity on the Clinical Governance card in ☰ Menu›Practice settings›Surgery Health. See Setup checklist and Surgery Health.

Editing a card after go-live sends that card back to review, but it doesn’t take your practice back into setup.

Related

Clinical governance sets out who is responsible for review in your practice. After go-live covers the wider routine of running the toolkit.