1. NHS e-Referral Service
Introduction to e-RS – Referrer Roles
Presenter:
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2. Housekeeping

3. 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
Learn about your organisation’s expectations and processes when using e-RS

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

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

6. 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!

7. 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

8. 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.

9. 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

10. 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

11. 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.

12. 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

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

14. 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

15. 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.
Ability to book appointments immediately to support vulnerable patients.
Access to advice and guidance.
Referrers

16. 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

17. 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
Six people
Person one – GP referring
Person two – patient (Wasan)
Person three – CAS
Persons four to six – Services A, B & C

18. 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

19. 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:
Please ensure that you localise this as there are many different types of Referral Management Centres/Services, so this may not reflect how it works in your area.
If you do not know how it works in your area, please seek guidance or remove this and/or the following slide/s referring to RMCs.

20. 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
Six people
Person One - GP Referring
Person Two – Patient (wasan)
Person Three – RMC
Persons four to six – Services A, B or C
Functionally the process is the same

21. 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.
Six people
Person One - GP Referring
Person Two – Patient (wasan)
Person Three – RMC
Persons four to six – Services A, B or C
Functionally the process is the same

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

23. What’s involved in setting up services
Service Definer
Sets services up on the DOS, completing all relevant information.
Liaises with clinicians to ensure the right information is included, especially Snomed terms
Works with the electronic booking system manager (PAS) to make the service directly bookable (a DBS)
Requests services be commissioned (if on the primary care menu)
Updates DOS information to ensure referrers and patients have the latest information

24. Let’s see some roles relevant to you
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.
Let’s see some roles relevant to you

25. Smartcards RA Code Smartcard Role Name
Log in Role Name and Description
User Examples
B1101
Manage Outbound Referrals
Referring Clinician
Users can refer a patient in their own right and take on responsibility for each referral they create.
Users have access to clinical information.
GPs
B1102
Proxy Manage Outbound Referrals
Referring Clinician Admin
Users can refer a patient on behalf of a referring clinician within their referring organisation.
Medical Secretaries, Practice Managers and Administrators
B1103
Referring Admin
Users can manage appointments and some referrals on behalf of the referring organisation they work for.
Users have NO access to clinical information.
Admin staff, receptionists
Other roles you may hear when working with e-RS:
Service Provider Clinician, eg Consultants
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

26. The practicalities of referring a patient

27. 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

28. 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.

29. 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).

30. 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.

31. 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

32. 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:
This is the brief version and should be described fully when using the system.

33. How referrals are created
Let’s have a look at how referrals are created.
Trainers Note:
Refer to the Lesson Plan for this section.
Remember that the Lesson Plan does not cover how to use GP integrated systems. You will need to either create your own lesson plan for this or refer to the GP system suppliers own training plan/sessions.

34. Managing Referrals And now how they can be managed Trainers Note:
See next slide and refer to the Lesson Plan for this section.

35. Introduction to Managing Referrals
Referral management is a vital part of using NHS e-Referral Service. Key points are:
Referrals in NHS e-Referral Service should always be:
reviewed by an appropriate clinician
actioned within an appropriate timeframe
kept within NHS e-Referral Service
reviewed, monitored and managed

36. 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

37. Trainer Note
This should be adjusted to suit you locally
Final points

38. 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

39. Discussion:
Have I achieved the objectives?

40. NHS e-Referral Service Help Files

41. 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.

42. 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.

43. Trainer Note:
Customise to suit your local needs.