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Booking and Referral Standard

A standard for healthcare IT systems that enables booking and referral information to be sent between NHS service providers.

Content in progress

Content in progress

This is draft documentation for a developing standard and the content is subject to change. If you are interested in developing a solution using this standard, contact us.  


This Booking and Referral Standard (BaRS) is an interoperability standard that enables booking and referral information to be shared efficiently and securely between healthcare IT systems and across care settings. 

We're building the necessary national infrastructure and components that underpins delivery of BaRS. Initially, it will be implemented in two care journeys:

  • between 999 and NHS 111 Clinical Assessment Services (CAS)
  • between NHS 111 and emergency departments (also known as accident and emergency or A&E)

We'll use the experience gained from these two initial implementations to improve BaRS ahead of making it available to other care settings over the next few years. 

Using this guide

This page provides guidance on how to implement BaRS and gain accreditation where required. It is an implementation guide, covering everything from use cases for booking and referrals through to authentication. 

You can use it to guide your analysis and define the scope of your solution. 

As a developer, you need to use this documentation to understand:

  • workflow
  • error handling
  • non-functional requirements

It also includes resources for stakeholders such as project managers, business analysts, commissioners and NHS service providers who are involved at every stage of going live with a solution.

About the standard

The Booking and Referral Standard (BaRS) deals with 'bookings' and 'referrals' as they relate to a patient's journey. In the context of BaRS, we use these terms to mean the following: 


Booking is the administrative function of reserving time-based capacity at a service provider. It can take one of two forms:

  • the traditional appointment at a specified time 
  • a timeframe within which the patient can expect to be seen, based on their assessed clinical severity (acuity) and capacity at the service

Booking consists of the sender and receiver roles:

  • the sender is the service assessing the patient and wishing to send them to another service
  • the receiver is the the service the sender wishes to send the booking to

When a booking is made in conjunction with a referral, the receiving service must be capable of linking the booking and referral together. 


A referral is a request for a care service, other than a specific diagnostic investigation or diagnostic procedure, to be provided for a patient.

The information included in the referral is primarily clinical and must allow the receiver to understand the reason for referral and detail of assessment by the sending service. This is key for patient care and experience as the patient transitions between services. 

The referral must include key information from the assessment at the sending service. This includes:

  • acuity
  • details of assessor
  • any new or existing safeguarding concerns
  • what action the sender wants the receiver to perform if appropriate

The referral information data model is based on user research with NHS 111 service providers, 999 ambulance service trusts, clinical and administrative Emergency Department staff. The research was undertaken in parallel with the Professional Records Standards Body  (PRSB) who examined the wider brief of 'referrals from NHS 111 to any other care setting' 

Use cases

Initially, BaRS covers two use cases:

  • Booking and referrals from the NHS 111 service into Emergency Departments (ED)
  • Referral from 999 services to NHS 111, including referrals to NHS 111 clinical assessment services (CAS) to validate category 3 and 4 ambulance outcomes 


NHS 111 to ED


999 to CAS


Your application must support different functionality depending on:

  • its use case

  • whether it's a sender or receiver

This list of functionality will expand in later versions of BaRS.


A receiver must be capable of:

  • configuring their system to allocate service capacity in the form of 'slots'. A 'slot' is a unit of capacity within a service which can have various states for example, free or busy
  • advertising these to senders wishing to use the available capacity
  • managing booking requests made by senders - create, read and update requests

A sender must be capable of:


A receiver must be capable of:

  • providing a FHIR resource message definition statement to indicate what a sender must include in a service request 
  • managing service requests made by senders - create, read and update requests
  • notifying a sender if a patient with identified safeguarding concerns fails to attend (NHS 111 to ED)
  • notifying 999 sender of a validation outcome by a CAS (999 to CAS)

 A sender must be capable of:

  • searching for services. This is typically achieved using the Urgent and Emergency Care Directory of Services (UEC DoS)
  • querying a receiver's message definition
  • building a service request based on the message definition
  • managing service requests made by themselves - create, read and update
  • accepting feedback of a failed attendance for a patient with Safeguarding concerns (NHS 111 to ED)
  • accepting a validation outcome response from an original request (999 to CAS)

All applications

All applications must be capable of:

  • providing a capability statement for API functionality 
  • auditing sufficient information for support or clinical investigations 

Future releases

We are considering the following functionality for our future releases:

  • trace a patient journey through multiple referrals 
  • third parties are able to subscribe to bookings and service requests made for a patient 
  • patient engagement on their experience of service performance 
  • patient portal access to view their pending bookings and service requests
  • services report 'avoidable referrals' to other services 
  • negotiated referrals between services 
  • reporting on service activity and to guide service improvements

Last edited: 4 November 2021 10:49 am