Trainer Notes about this document

Trainer Notes about this document
This document is intended for provider audiences and to be used in conjunction with the NHS e-Referral Service Provider Clinician and Service Provider Clinician Admin CAS Lesson Plan You are free to change its contents to suit local needs, but in doing so NHS Digital may not be responsible for its contents It is timed to take approximately 30 minutes to go through, in it’s current format The content is intended to give an overview of many aspects of NHS e-Referral Service and some outside, but that e-RS is linked with. It is extremely important that learners are given the opportunity to understand all aspects of e-RS and how it integrates with other systems. This slide is “hidden” when viewed via the Slide Show.

NHS e-Referral Service
Introduction to e-RS – Provider, CAS Presenter: xxxxxxxxxxxxxxx

Housekeeping

Objectives – during today’s session you will:
Understand the background of the NHS e-Referral Service Look at the different types of referral models that are used within the NHS Know the different functionalities within NHS e-Referral Service Learn how to manage referrals and worklists Appreciate local processes and expectations of the organisation for the way you will use e-RS

First thing’s first For every UBRN, there is a referral For every referral there is a patient!

First thing’s first For every referring organisation there are:
Doctors Nurses Medical Secretaries Receptionists Practice Managers, and Patients!

First thing’s first For every provider organisation there are:
Consultants Nurses Medical Secretaries Booking/Outpatient staff Directorate managers a Patient Access team; and of course patients!

Who is going to be involved and what for?
Patient IT Department Registration Authority Team Local CCG Training Department Directorate Management Patient Access Team IT Department Link e-RS to a booking system (PAS) Testing Setting up desktops for users To report issues to and either resolve or report to HSCIC Continued support Registration Authority Agent/Manager Issue Smartcards Add/remove/manage roles Local CCG Promote new services Support with queries Deal with complaints Training Department Train new staff Keep up to date with new functionality Produce materials Directorate Management Setting up services Planning clinics Capacity & Demand Patient Access Teams Rearranging clinics Prepping clinics Booking/rebooking appointments

Overview of the NHS e-Referral Service (e-RS)
e-RS (previously Choose and Book) is an electronic referral and management system, using Spine information, that can integrate with other systems e-RS is able to be dynamic and responsive to patient, clinician and NHS England requirements Background getting the patient to the right place, first time and without undue delay provides a secure environment to send patient information between referrers and providers enables on-line booking/management of appointments integrates with other systems, eg GP clinical systems and provider appointment booking systems What is e-RS about? Trainer Note: Background – Further explanation e-RS (previously Choose and Book) is an electronic referral and management system, using Spine information, that can integrate with other systems The Spine is a name used for where Patient Demographic Information (PDS) is held and can be accessed from. Integration with other systems includes referrers GP clinical systems, eg Emis, and provider Patient Administration Systems (PAS)/Appointment Booking Systems eg Lorenzo. e-RS is able to be dynamic and responsive to patient, clinician and NHS England requirements New releases of e-RS are now (usually) every 4 weeks. New functionality is developed, tested and installed in shorter timescales. Issues can be identified, fixed and uploaded more often. Problem solving has been brought in-house and is being managed by personnel with more knowledge of how the system is used than before.

Overview of the NHS e-Referral Service (e-RS)
Everyone! GPs, nurses, hospitals, admin staff, diagnostic and community services As it supports different pathway models, it can be used by a variety of providers Who uses e-RS? As long as the referral is kept in e-RS: Better patient care Paperless Secure Instant Choice Simple to use What are the benefits? Better patient care: You can use the system to refer patients to the right service more easily and in real time - You can monitor their referral at any time, using the system worklists or Patient Activity List - Patient knows they are in the system and have the ability to either be supported in their appointment booking, or have an appointment booked whilst they are with the GP, or book it themselves in their own time - Patient can see exactly what is happening to their referral through their on-line portal (Patient Web Application) Instant A patient’s referral can be made, an appointment can be booked and referral information sent over to the provider during a consultation with their doctor A provider can immediately see the referral to triage it (as long as all the above is completed) Appointment booking/cancellations/rejections etc are all completed in real time Paperless (or Paperlite) Referral sent by GP and triaged (by provider) electronically Rejections, DNA and CAS messages can be sent on-line Referrals can be moved internaly, on-line Choice Patients and clinicians can choose where the patient is referred to, based on the information given at the time of the referral, eg waiting times, location etc Service information is available to see on-line Secure - Smartcard access only allows those given permission to access the referral

What facilities does e-RS give me?
The on-line Directory of Services (DOS) shows users what services are available and all their service details Information The ability to refer and book appointments on line, especially useful for vulnerable patients Capability to manage referrals via worklists and enquiries On-Line Referral Management Knowledge that you can still refer patients to a service with no appointments Referral Deferral An on-line capability to ask a provider clinician a question, instead of (or before) sending the patient for an outpatient appointment. Advice & Guidance Reports and extracts that give you information about your referral patterns Reporting

How does NHS e-Referral Service support different referral models?
Within the NHS referral pathways depend on a number of elements, for example: If the patient is being referred to a community, secondary care or tertiary service Where diagnostics are required before an appointment If a referral management service is in place When it is for a patient with mental health issues 2WW referrals e-rs can support these pathway models by being using direct to service or assessment service functionality. How does NHS e-Referral Service support different referral models?

Introduction There are a multitude of referral pathways that patients will travel to get to a clinic. Although Service Providers have to make their clinics fit into e-RS functionality, there are several to pick from We will look at three different referral pathways: Direct to Service Clinical Assessment Service Referral Management Centre Tailor this section according to your local needs if required

Direct to Service - Introduction
Who uses it? Hospitals, community clinics, independent sector providers What for? Mainly first outpatient clinics Why? Simplicity

Direct to Service GP and patient decide on further treatment
Patient visits GP GP and patient decide on further treatment GP creates a referral from their GP clinical system into e-RS Appointment booked and referral letter attached Review A Provider clinician reviews the referral and accepts or rejects it Patient treated The patient is seen in an outpatient appointment. e-RS journey is complete

Direct to Service A referral is sent directly to the service.
This can be accessed immediately by service personnel and clinicians. Service A GP Referrer Service B Service C Note: An appointment needs to be booked and a referral letter must be attached for the referral to be accessible.

Direct to Service If the referral is appropriate for the service no other actions are required, apart from it being accepted on-line. The patient will be seen in the clinic booked into. Service A GP Referrer Service B Service C

Direct to Service If the referral is not appropriate for the service the referral can simply be redirected to the correct service. This can be done to internal services on-line. Service A Service B GP Referrer Service C

Benefits Significant cost savings possible.
Referral letter immediately available at service. No internal transfer of paper referrals. Referral can be redirected to other services electronically if needed. to provide referrers with relevant information at time of referral. Can provide advice and guidance to help reduce inappropriate referrals. Providers Immediate access to correct service Can be supported in the booking process by referrer at time of referral if needed. Reassurance that they are ‘in the system’ before leaving the practice. Patients Immediate visibility of available services at a local and national level. Supporting information shows at the time of referral. Able to book appointments immediately to support vulnerable patients. Access to advice and guidance. Referrers

Clinical Assessment Services - Introduction
Who uses them? Community clinics, hospitals but much less so What for? Triaging referrals and treating patients Why? Ability to refer on/onward refer

Assessment Services Scenario 1 – A locally commissioned CAS
A Clinical Commissioning Group (CCG) sets up a physiotherapy service to see and treat patients in primary care. Patients are referred into the service and a clinician triages the referral. Patients could be: treated in clinic and discharged back to their GP referred onward to secondary care straight away treated by a physio but still need secondary care so referred onward

Benefits Ability to triage all referrals to a service.
Can ‘Refer On’ to any service either inside or outside the organisation if required. Provider Complex cases can be assessed to ascertain the appropriate pathway. Patient Single point of access for referrals Referrer

Referral Management Centres - Introduction
Who uses them? Clinical Commissioning Groups (CCGs) What for? Triaging – preventing unnecessary referrals Why? Cost cutting (managing referrals to cheaper, local services) or offering advice on local management Trainer Note: Depending on your local perspective, you may want to mention some disadvantages to a Referral Management Centre, eg: Adds time to the patient’s referral to treatment time (RTT) as it adds an extra layer into the patient’s journey Can cause confusion for patients, particularly vulnerable patients because people think that the “dummy/ghost” appointment they are given is a real one. There are many examples over the years of patients turning up to appointments that do not exist, or waiting to hear from providers at a certain time – usually midnight! Add extra cost to the referral pathway. An administration arm needs be set up to triage incoming referrals (must be an appropriate clinician eg GP), administration staff to manage referrals and appointment bookings, management, offices, etc.

Assessment Services Scenario 2 – A Referral Management Centre (RMC)
A Clinical Commissioning Group (CCG) sets up a Referral Management Centre to manage referrals on behalf of GPs in that area. Patients are referred into the RMS /RMC and referrals are triaged. The RMC refers on to another service. Also known as a Referral Management Service or RMS Functionally the process is the same

Assessment Services Scenario 3 – A Provider CAS
A provider sets up a CAS to manage complex pathways Patients are referred into the CAS referrals are triaged. The CAS refers on. Functionally the process is the same

An example of how this works…..
Service A A patient visits their GP and is referred to a local physiotherapy service. Service B GP Referrer CAS (Physio service) Service B

Clinical Assessment Service
Patient Referred Appointment Booked Service A GP Referrer CAS Physio Service Service B Service B The patient books an appointment and the GP attaches a referral letter.

Referral triaged Service A GP Referrer CAS Physio Service Service B Service C The referral letter is reviewed/triaged by a clinician at the physio service.

Referral letter attached Patient triaged Service A GP Referrer CAS Service B Service C Once the referral is triaged, the patient will either be: seen/treated by the physio and discharged seen/treated by the physio and referred onward for further treatment Referred onward straight away All of this can be managed via e-Referral Service

Patient Discharged Service A GP Referrer CAS Physio Service Service B Service C If the patient is treated and discharged, then the referrer will be advised accordingly.

Patient referred onwards Service A GP Referrer CAS Physio Service Service B Service C If the patient is referred onwards (at whatever stage), services will be shortlisted and an appointment booked. Note: The original referral letter can be used as the clinical information or a new one can be attached.

Patient referred onwards Service A GP Referrer CAS Service B Service C A second UBRN will be created, which is forwarded to the service when the patient is booked an appointment. Note: The UBRNs are linked and both are visible, along with any attachments.

Referral triaged at next service GP Referrer CAS Service B At this point the referral will be triaged by the service they have been referred on to and, if the referral is appropriate, will be accepted into the service and seen. Note: Any information sent back to from the new service will go to the CAS not the original referrer, eg rejected referrals, cancelled requests, etc.

What do Service Definers do?
Setting up Services on the Directory of Services (DOS)

What’s involved in setting up services
Service Definer Sets services up on the DOS Clinicians - to ensure the right information is included Working with the PAS Manager to make the services DBS Request services be commissioned (if on the primary care menu) Keep the DOS up to date Work with colleagues to understand service referral pathways

Smartcards

Smartcards Smartcards give you access to any system that uses the NHS Spine, eg e-RS, GP clinical systems, PAS’s, PACS, etc, as long as you have the right access. Access is given by an RA Manager or Agent within your organisation (or associated organisation), eg CCG or CSU. RA Code Smartcard Role Name Log in Role Name and Description User Examples B1110 Manage Inbound Referrals Service Provider Clinician Users can view and review clinical information, manage referrals, change appointments, etc. on-line. Clinicians who will review referrals. B1115 Proxy Manage Inbound Referrals Service Provider Clinician Admin Users can view clinical information, manage referrals, change appointments, etc. on behalf of a clinician. Admin staff, Medical Secretaries acting on behalf of clinicians. B1120 Manage Inbound Appointments Service Provider Admin Users can manage referrals, change appointments, etc. on behalf of a clinician, but cannot access clinical information. Admin staff, Patient Access teams, booking staff. B1140 Manage Indirect Appointments Booking Manager Users can book and manage appointments for indirectly bookable services they are linked to. Users cannot view patients clinical information. Admin staff, booking staff. Other roles you may hear when working with e-RS: Referring Clinician and/or Referring Clinician Admin – GPs and Admin staff working at a GP practice Service Definer, providers who set up services on the e-RS Directory of Services (DOS) BMS Admin, eg CCG staff, The Appointments Line staff Information Analyst

The practicalities of a patient being referred via e-RS

Referring a patient Referral is created Appointment booked
Patient seen in practice Agreement that a referral is needed GP system and e-RS used to create a referral Referral letter attached The referral is reviewed on-line by a clinician Referral accepted or rejected by clinic provider Referral is created Appointment booked Referral triaged Patient receives paperwork with all relevant information to book their appointment

A Patient’s Referral Paperwork
Note: The details seen here are for a text patient and a test service. A Patient’s Referral Paperwork Patients should be given two pieces of paper with all the information they need to book an appointment, including: A password, which is also required to facilitate an appointment booking. A Unique Booking Reference Number (UBRN). This allows patients to book/change their appointment. The UBRN is used by the service to access the referral. In this example, an appointment is not yet booked. The information here lets a patient contact the provider and book an appointment themselves. If an appointment had been booked, the information would show confirmation of the appointment and ways to change this appointment, etc. Service/s details and how to book an appointment can be found in Section 2.

How do patients get their appointment?
This is dependant on whether the service is set up as directly or indirectly bookable (DBS or IBS). Directly Bookable Services (DBS) Patients can book and manage their appointments on-line either at their referrers practice (eg GP surgery), via the Patient Web Application (PWA) or by ringing The Appointments Line (TAL). Appointments will be booked straight into the clinic’s Patient Administration System (PAS), which will also registers new patients. Any changes made in e-RS will be automatically updated in PAS and reflected in the patients referral paperwork. Trainer Notes: You should explain how your organisation’s services are set up and discuss how your patients will book their appointments. BUT it is still important for staff to understand how indirectly bookable services work (next slide).

Indirectly Bookable Services (IBS)
Patients book their appointment by contacting the service/clinic they are referred to. An appointment must be given to a patient when they ring to book one. The service has to book the appointment into NHS e-Referral Service (e-RS) and the clinic’s Patient Administration System (PAS) separately. Clear instructions must be given to the patient on how to book their appointment and the times they can contact you to make their booking. This information should be clearly displayed in the Directory of Services (DOS). Any changes to appointments must be updated in e-RS and PAS to ensure that information is kept up to date.

The Referral to Treatment (RTT) “clock”
Patients have a right to be seen and treated within 18 weeks of their referral. The RTT clock starts either when: an appointment is booked a patient tries to book an appointment, ie rings into an IBS or is deferred (because there are no appointments on-line) The clock can be stopped under certain circumstances, eg a diagnostic treatment This is all recorded in the e-RS history/audit trail

Referral Deferral If a DBS has no appointments, referrers have an option to Defer to Provider, when creating the referral. This option will create a UBRN in the usual way and forward it to the provider you have chosen to defer to. This option is not available if the service is IBS or has any appointments (even one!). Trainers Note: It is very important for staff to understand the implications of this area and for more information to be given during training.

Training Session Setting up services on e-RS
Trainer Note: Refer to the Lesson Plan to take learners through how to set up services on e-RS Training Session Setting up services on e-RS

Your Services Let’s take a look at the services set up during today’s session as a referrer and provider. Trainers Note: It would really benefit staff if the trainer shows them how a referral is created. For Service Definers, it’s really useful if you can create a referral to the service/s learners have created during the session. Get them to note (at the very least) their speciality and clinic type of one of these, so that you can use this information to look them up. IF you can’t find their services, ask further questions about how they set up the service eg is there an age or gender restriction. After creating a referral (attaching a referral letter) have a look at the referral on the Referrals for Review worklist, as a Service Provider Clinician. This gives learners an rounded view of how they have set up a service and how it looks to referrers and works for their provider colleagues.

Recap session: Trainer Note:
Add a slide of recap questions to suit your audience, or use the Referrer Recap Exercises document, which can be found on our website Recap session:

Trainer Note Final points

Where can I go for support?
Local issues: [insert details of GP facilitator/trainer] Technical issues [insert details of your local IT Helpdesk] National help: [insert details of e-RS training pages] Trainer Note This should be adjusted to suit you locally

NHS e-Referral Service Help Files

Help Files NHS e-Referral Service has an “in-system” Help directory.
Everyone can access it, regardless of their role, once they have logged into e-RS. The Help files contain functional information, screenshots and useful information. The Help files are updated regularly by the national NHS e-Referral Service team.

Help Files Once a user clicks on the Help text, the Help files open to reveal search options, ie role based subject headings, A-Z, free-text searching. Role based searches are listed by subjects eg worklists, patient search, enquiries listed by name.

Discussion: Have I achieved the objectives?

Trainer Note: Customise to suit local needs

Trainer Notes about this document

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