Referrals and bookings - guidance for specific use cases

Overview

For some use cases, we provide national services, APIs or standards to make referrals and bookings quicker and easier. This includes:

end user applications for healthcare workers and patients
APIs and API standards that allow senders' IT systems to talk directly to receivers' IT systems

An API is where we provide a physical, callable API for the participating systems to use. An API standard is where we provide an API specification for participating systems to use when integrating directly with one another.

Our services and standards have evolved over time. This means there are different services and standards for different use cases. We are currently working on a single Booking and Referral Standard that will eventually be used for all use cases.

This page explains which national services, APIs or standards to use for specific use cases. For an index of use cases, see the left navigation menu. If your use case is not included on this page, contact us.

GP practice to hospital or clinic

For referring patients from a GP practice to a hospital or clinic, use the e-Referral Service (e-RS).

Patients can also view their referrals and bookings, and amend or cancel their bookings, using the NHS App and the Patient Care Aggregator.

For a summary of the various business processes for e-RS, see Supporting clinical referral pathways - NHS e-referral Service (e-RS).

The following table explains which service to use for specific use cases:

Party	Use cases	Channel	Service
Referrer (sender)	Service discovery, referral, booking	User interface	e-RS includes a point-of-care application for referrers - for details, see Referrers.
Referrer (sender)	Service discovery, referral, booking	API	Use e-RS, see guidance for specific use cases.
Provider (receiver)	Service discovery, referral, booking	User interface	e-RS includes a point-of-care application for providers - for details, see Providers.
Provider (receiver)	Referral	API	Use e-RS, see guidance for specific use cases.
Provider (receiver)	Booking	API	Use e-RS, see guidance for specific use cases.
Patient	Booking	User interface	e-RS includes a patient-facing application for appointment booking - for details, see Book an appointment using the NHS e-Referral Service.
Patient	View referrals and bookings; amend or cancel bookings	User interface and APIs	Patients can access referrals and bookings across multiple secondary care booking systems using the NHS App and the Patient Care Aggregator.

NHS 111 to GP hub

For referring patients from an NHS 111 service provider to a GP hub, use the following:

Use case	Service or standard	Notes
Service discovery - look up the patient's registered GP	Personal Demographics Service - FHIR API	Use this to look up the patient's registered GP - as an ODS code. This is needed to feed into the Directory of Services (see below).
Service discovery - find a suitable service	Directory of Services - Urgent and Emergency Care - SOAP API	There is also a REST API, but this is not suitable for referrals from 111. The Directory of Services (DoS) includes complex business logic to determine the best option for the patient. For example: it knows which services are bookable and which are not given the patient's registered GP practice, it will determine which GP hub is appropriate for the patient it has rules on which referrers a given provider is willing to accept
Booking	NHS Booking API (deprecated) GP Connect Appointment Management - FHIR API	Booking is optional, depending on the service being referred to. If a booking is made, it is done before the referral information is sent, not after. The NHS Booking API was preferred because it handled slot searches better. A slot search via the GP Connect API returns all slots for all GP hubs on the same "instance" of the GP system, not just for a single GP hub. Currently, TPP SystmOne uses the NHS Booking API and EMIS Web and Cegedim Vision both use GP Connect. 111 systems must support both APIs and use the appropriate one depending on the receiving system.
Referral	NHS 111 API standard	This is an API standard that is implemented point-to-point between sender and receiver. We do not have a central callable API to broker the requests. We do, however, have an adaptor that the receiver can use to transform inbound SOAP requests to FHIR.

NHS 111 to emergency department (ED)

For referring patients from an NHS 111 service provider to an emergency department (ED):

for new integrations, use the Booking and Referral - FHIR API
existing integrations use the same approach as for referrals from 111 to GP hubs, but will eventually be migrated to the Booking and Referral FHIR API

NHS 111 to urgent treatment centre (UTC)

For referring patients from an NHS 111 service provider to an urgent treatment centre (UTC), use the same approach as for referrals from 111 to GP hubs.

999 to NHS 111

For referring patients from a 999 service provider to an NHS 111 service provider, use the Booking and Referral - FHIR API.

Anywhere to a GP practice

For referring patients from anywhere to the patient's registered GP, use the following:

Use case	Service or standard	Notes
Service discovery	Personal Demographics Service - FHIR API	Use this to look up the patient's registered GP - as an ODS code.
Service discovery - from 111	Directory of Services - Urgent and Emergency Care - SOAP API	For details, see 'referrals from 111 to a GP hub'.
Booking - look up endpoint for registered GP system	Spine Directory Service - FHIR API	You need the physical endpoint for the registered GP system before you can use the GP Connect Appointment Management API.
Booking - business functions	GP Connect Appointment Management - FHIR API	You can book in at a specific GP practice but not with a specific GP. GP practices offer timed slots as well as untimed slots - essentially a call back that could happen at any time in a given period.
Referral - from 111	NHS 111 API standard	This is an API standard that is implemented point-to-point between sender and receiver. We do not have a central callable API to broker the requests. We do, however, have an adaptor that the receiver can use to transform inbound SOAP requests to FHIR.
Referral - from other GP or GP hub	N/A	When referring from GP to GP (or to a GP hub), there is no separate referral flow. Rather, referral information can be included with the GP Connect booking using the description or comment fields. The GP Connect API specification says that these fields should not be used for clinical information, but that rule was relaxed during the COVID-19 pandemic to allow referral information to be included with the booking.
Referral - from elsewhere, for example, an online consultation system	GP Connect Send Document - FHIR API

Patient to GP practice

A patient arranging to see their GP is essentially a self-referral. They consider themselves to be booking an appointment, but they usually also provide some details on what the problem is - that is, referral information.

There are a number of ways that patients can book an appointment (self-refer) with their GP:

in person, at the practice
by telephone
via a GP-provided patient portal where the patient can register for an account and book appointments
via the NHS App
via other third party software

The NHS App and third party software options use IM1 Pairing for integration with the GP system.

Patient to NHS 111

A patient can self-refer to NHS 111 by:

calling 111
using 111 online

For more details, see When to use 111.

Secondary care to GP practice

For a transfer of care from secondary care to a GP practice, use one of the following message integrations:

Note that in some cases, these interactions can be considered as the 'feedback' step of a referral from general practice to a hospital or clinic.

Optometrist to eyecare clinic

For referring patients from an optometrist to an eyecare clinic, use the Eyecare Electronic Referral Service API standard.

Other use cases

If your use case is not included on this page, contact us.