1. E-Referral Service Paper switch off communication toolkit Version 1
5 February 2018

2. Context and introduction
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Context and introduction
This toolkit is intended to support local paper switch off (PSO) project teams and/or provider trusts, to help them plan and deliver effective communications to achieve NHS e-Referral Service PSO targets by the local deadline.
Many PSO project teams do not have professional communications staff to support them, so this toolkit should help you deliver the communications needed. It is recommended that your local communications teams are involved in the project and, where they can be involved, we hope this toolkit will save them time and help create effective, consistent communications.
It draws on national guidance developed by NHS Digital’s communications and implementation support professionals and successful PSO projects.
The toolkit is based on the Government Communications Service best practice guidelines and real examples that have worked well in practice.
If you have any examples or ideas that you can share with others please contact

3. The Standard Contract for 2017/19
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The Standard Contract for 2017/19
The Standard Contract for 2017/19 requires the full use of the NHS e-Referral Service for all consultant-led first outpatient appointments. From 1 October 2018, providers will no longer be paid for activity that results from referrals made other than through the NHS e-Referral Service. The PSO programme has been launched to provide support for health communities in readiness for the contract change. There are usually two stages to a PSO project: Stage 1 – increase your use of NHS e-RS to a level where it is feasible to implement a paper referral returns process. Stage 2 – stop using and accepting paper referrals in your health economy for all GP to first consultant outpatient appointments. Some PSO projects are designed to “switch off” paper through a staged approach – certain specialities at a time. Nationwide implementation has been broken down into a number of phases across the country, so that PSO will be delivered in all organisations by October 2018.

4. Communications to support PSO
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Communications to support PSO
“Good communication between the providers and the CCGs/GPs is the key to the smooth implementation of PSO.”
Jo-Anne Roberts, Outpatients Service Manager, The Princess Royal University Hospital, Kings College Hospital NHS Foundation Trust
Getting the communications right is critical and ensuring primary and secondary care understand what they need to do and when, will ensure that there is less confusion and a better experience for patients.

5. Communications to support PSO
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Communications to support PSO
The paper switch off implementation pack for trusts covers some information about communications. This toolkit goes into more detail and is a single reference point for communications.
This toolkit includes:
guidance on communicating internally within trusts
external communications - trusts and CCGs working together to communicate with local GP practices and Local Medical Committees
a communication plan template (for internal or external communications)
lessons learnt about communications from the pioneer PSO trusts - what has worked well for them and what hasn’t
examples of communication material from the pioneer trusts
communicating success – when you have achieved PSO.

6. Communications planning
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Communications planning
The trust and CCG must work together to develop a PSO communications plan based on your switch off dates.
You can use the communication plan template in this toolkit to guide you through the process, adding your own communications channels and approvals processes.
Use it to plan your internal and external communications.
The template covers:
where are we now? Defining the current position
what does success look like?
establishing communication objectives (and insight objectives)
defining your target audiences
identifying communication channels
developing key messages
determining what needs to be done, how, when and by who?
producing a detailed activity plan.

7. Delivering the communications
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Delivering the communications
What you need to consider:
Trust communications – plan and deliver an internal communications campaign within the trust.
External communications – plan and deliver an external communications campaign targeted at your external audiences.
Planning – develop a detailed communication activity plan. Identify key publication dates and meeting dates. Assign someone to be responsible for delivering the communication plan as a whole or nominate people who will lead on individual elements of the plan i.e. CCG rep re bulletins to GPs and a trust rep regarding internal communications.
Involve your Local Medical Committee (LMC) – contact your LMC early on to explain your plans and keep them informed. Ask them to help by sharing your key messages and news with their members. They can be a good sounding board, highlighting any issues before they become problems.

8. Delivering the communications
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Delivering the communications
Timing – start your communications as soon as possible and keep your audience regularly updated about progress. Ask for their feedback and views and provide a feedback mechanism. Yeovil District Hospital contacted GPs two months before their switch off target date and updated them regularly.
Issue a phased series of communications - repeating the message is good as someone may have missed the article in the first bulletin. This way your audience will stand a better chance of finding out what is happening and what they need to do.
Possible phasing:
Now – issue initial communications advising of the PSO deadline the trust is working to. Give details of current activity and any call to action. Issue follow-up communications to provide an update on progress. Be clear what the call to action is. What do GPs/practices/booking clerks need to do and by when?
Issue further communications as required – giving further updates on progress. Be clear what the call to action is. For example “From (insert date), you should only use e-RS and paper referrals will no longer be accepted by the trust”.

9. Delivering the communications
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Delivering the communications
Design - consider developing a strong and consistent design to use on all of your communications materials so that it stands out from the crowd and has a chance of being noticed. Be creative, but work within your organisation’s brand guidelines. Look at the example from Yeovil District Hospital.
Be clear – what is in it for me? – talk about local benefits, news and progress. Get peers to relay the messages.
Call to action – include a clear call to action. What does your audience need to do and by when?
Communications channels – the communication plan template includes some suggested communication channels for your internal and external communications.

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Lessons learnt
What worked well for Sherwood Forest Hospitals NHS Foundation Trust?
The CCG used a number of channels to reach practices such as weekly newsletters, direct telephone conversations, clinical executive committees.
Some FAQs were also developed and shared based on queries from GP practices.
Ensure that GP practices are communicated to early on in the project and regularly. Also consider direct communication to ensure they are aware of the revised process and the date(s) for the switch off.
Use as many different kinds of communication as possible to ensure coverage – bulletins might not be read by all (which was evident when the CCG followed up with a phone call.)

11. Examples of communication material
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Examples of communication material
Take a look at some examples of communication material developed by other trusts. These include:
articles for CCG bulletins to GP practices
s advising of key dates, processes, request for action
consistent branding - an signature graphic
flyer sent to GP practices
automatic response s following receipt of paper referral
Q&A for GP practices.
Celebrate your success – continue to communicate after you have achieved your PSO target. Use the press release template to let your local community know what has been achieved and to promote the benefits of patients booking their own appointments online. Celebrate success internally.
Don’t stop talking - continue to communicate with GP practices, so that you can identify and solve any outstanding issues and continue to build relationships.

12. Background information
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Background information
You may also find these background documents and webpages useful:
PSO implementation pack
a sample engagement presentation
e-RS overall benefits for referrers, providers and commissioners
benefits case studies by stakeholder groups
letters and directives (sample) issued to all CEOs of provider trusts and CCG accountable officers to ensure senior executive ownership and support for the PSO project

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More information
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