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Booking and Referral Standard

The Booking and Referral Standard (BaRS) is an interoperability standard for healthcare IT systems that enables booking and referral information to be sent between NHS service providers quickly, safely and in a format that is useful to clinicians. It will eventually be available in all care settings.

Latest news

BaRS V1.0.0 now live 

The first stable release of BaRS, V1.0.0 is now live. See the implementation guide for all the necessary detail required to scope, design and develop to BaRS.

BaRS Information Standard approved

The Data Alliance Partnership Board (DAPB) has approved BaRS as an Information Standard and published a corresponding Information Standards Notice on 13th April 2023.  

About BaRS

A patient journey - from the patient presenting with symptoms, to appropriate treatment then discharge - often involves two or more NHS services. Booking, clinical and administrative information need to follow the patient at all stages of this journey. This frequently requires paper processes and multiple healthcare IT systems which can be inefficient.

The BaRS ensures healthcare professionals receive the information they need, in a format they can use, integrated into their existing healthcare IT systems.

The Government's Plan for Digital Health and Social Care states:

The new Booking and Referrals Standard (June 2022) will be deployed between 111 and emergency departments, between 999 and Clinical Assessment Services, and at other key interfaces in the UEC system (March 2025)

It's now available for the following care journeys:

  • between NHS 111/ clinical assessment services (CAS) and emergency departments (also known as A&E)
  • between NHS 111/CAS and urgent treatment centres (UTC)

With the care journeys below to follow:

  • between 999 and CAS for referral
  • between 999 and CAS for ambulance validation

You can monitor supplier progress in implementing BaRS on our supplier status page.

The experience gained from these initial implementations will help to improve the standard ahead of making it available to all appropriate NHS services in England, such as pharmacy, via their healthcare IT systems.

View the prioritised future care journeys for BaRS


999 Ambulance Service Trust (AST) - 999 AST
GP - Community pharmacy (CPCS)

Contact us if you would like to discuss how BaRS can support another care journey. 

What is an interoperability standard?

An ‘interoperability standard’ describes a standardised set of rules, that govern the format, language and delivery methods for transferring data or information from any healthcare IT system to another. In the case of BaRS, it helps a service to send or receive booking and referral information to or from another care provider for the purpose of a patient's ongoing care.

If all care settings adopt the same interoperability standard for sending and receiving referrals, it makes it easier, faster and safer to move patients through their care journey.

BaRS supports NHS England's standards roadmap and priorities.

We are going to:

  • build the necessary national infrastructure and components that will underpin delivery of BaRS
  • provide a messaging standard that allows multiple systems to communicate with each other in a simple and logical way
  • publish a standard that supports the administrative task of booking a patient into their next care setting, as well as providing the correct and relevant clinical referral information to care givers so that they can make or accept a patient referral
  • produce a standard that is accepted, agreed and adopted by health care system providers and rolled out across the health system to improve patient experience and care outcomes

Benefits of the Booking and Referral Standard

National interoperability standards, such as BaRS and the digitisation of booking and referrals are important priorities for the NHS as described in the Long Term Plan, Future of Healthcare Vision and NHS Transformation Directorate Delivery Plan.

An interoperability standard for patient booking and referrals will have several benefits.

Patients will:

  • be able to efficiently book appointments and time slots with the service that's right for them
  • get the right advice and treatment when they most need it, safely and easily

Healthcare workers will:

  • receive the information they require, and in sufficient detail, to enable them to undertake the patient care activity requested
  • be able to triage the patient without asking them to unnecessarily repeat information already collected earlier in their journey
  • send and receive booking and referral data that is integrated into existing healthcare IT systems - this avoids working across 2 or more applications or systems and saves time

IT suppliers and care providers should find it easier and more efficient to implement a single, agreed national interoperability standard, rather than supporting the multiple and varied standards currently in operation.

Commissioners and Integrated Care Systems will find it easier to integrate care journeys across care settings using existing systems.

recent government report has acknowledged the work already done in this area and the benefits of sharing booking and referral data between healthcare IT systems and across care settings:

The join up of 111 and accident and emergency (A&E) departments through digital information has helped keep A&E departments safe by enabling 111 to directly book GP, pharmacy, and outpatient appointments.

Putting data, digital and tech at the heart of transforming the NHS, 23 November 2021, Department of Health and Social Care

Implementation guide

Supplier status

These resources are still being refined and added to as we develop the standard. Any of the content may be subject to change.

Clinical safety

Throughout each development cycle of the standard, the BaRS programme will consider and maintain patient clinical safety through ongoing clinical risk management activities.

The Clinical Safety Standards listed below are mandatory under the Health and Social Care Act 2012. BaRS programme and supplier responsibilities for each of the standards are described underneath.

DCB0129: Clinical Risk Management: its application in the manufacture of health IT systems

  • The BaRS programme is responsible for implementing DCB0129 to achieve endorsement from the NHS Digital Clinical Safety Group (NHSD CSG)
  • Suppliers are responsible for implementing DCB0129 for each release of their BaRS conformant product
    • Suppliers supporting public beta deployments will submit their clinical safety case report and hazard log to NHSD CSG to attain Clinical Authority to Release

DCB0160: Clinical Risk Management: its application in the deployment and use of health IT systems

  • Providers are responsible for compliance with DCB0160 to manage clinical safety for their local deployment

The BaRS programme has delivered, as part of the standard, a clinical safety case report and supporting hazard log in accordance with DCB0129. The purpose of the clinical safety case report and associated hazard log is to identify, assess and manage clinical safety hazards arising from the creation and implementation of the BaRS. It demonstrates that associated hazards have been identified and managed, where possible, to ensure they do not give rise to unacceptable risks to patients and delivery of care. Whilst this has informed the development of the BaRS, any APIs developed to work with BaRS are not within the boundaries of the BaRS Programme. Where risks have been identified that are outside of the BaRS Programme boundary, they are transferred to the relevant party in the hazard log.

For communication and management of risk, suppliers and providers must:

  • review and integrate the risks identified into their own hazard log where risk(s) have been transferred
  • implement the appropriate mitigation stipulated

The NHSE Clinical Safety Group (CSG) has fully endorsed the clinical safety management approach followed by the BaRS programme in support of the development and publication of BaRS version 1.0.0. The endorsement does not result in a transfer of risk to the NHSE CSG in respect of any part of the BaRS version 1.0.0. The element of clinical risk management remains the responsibility of the manufacturer of the BaRS conformant solution and the deploying organisation.

Contact us for a copy of the BaRS Clinical Safety Case Report and BaRS Hazard Log.

Information governance

An NHS England Direction to enable NHS Digital to develop an interoperability standard for patient record systems and a related API (Booking and Referral Standard Service) has been published for the BaRS programme. A record has also be added to the NHS Digital GDPR Register.

BaRS Privacy Notice - A note for healthcare providers 

Healthcare providers using BaRS are responsible for transparency to patients.  If patients do not understand that their data is traversing NHS Digital systems as part of the referral service, there could be a breach of the fairness principle of UK GDPR.    

BaRS, developed by NHS Digital, does not directly collect any information except in the case of 111 online.  NHS Digital does not store any personal data except for 'online identifiers' of sending and receiving providers, e.g. IP Address/Event Logs and the NHS Number (if provided) which is stored for audit purposes.

We encourage all healthcare providers who will be using BaRS to review the Privacy Notice and update their transparency information accordingly.

View the BaRS Privacy Notice

What type of information we have:  

The Booking and Referral Standard is an interoperability standard for patient record systems that enables booking and referral information to be sent between NHS service providers quickly, safely and in a format that is useful to clinicians. The data that traverses the NHS Digital infrastructure in the form of messages is a combination of personal data and special category. NHS Digital will only collect audit and monitoring data for the Booking and Referral Standard. Alongside the Standard, an information model has been developed and approved by the Professional Records Standards Body (PRSB) that defines the booking and service request and confirms the data items that will travel with the request. 

The Health and Social Care Act sets out the powers of the Secretary of State and NHS England to direct NHS Digital to carry out additional functions concerning information functions, the information functions of any health or social care body and systems delivery functions. Section 254 of the Health and Social Care Act enables NHS England to direct the HSCIC (now known as NHS Digital) on matters concerning the provision of NHS services in England.  

NHS England has directed NHS Digital under sections 254(1) and (6), and section 304(9), (10) and (12) of the Health and Social Care Act 20121 (the 2012 Act) and Regulation 32 of the National Institute for Health and Care Excellence (Constitution and Functions) and the Health and Social Care Information Centre (Functions) Regulations 20132 (the Regulations) to develop an interoperability standard for patient record systems that enables booking and referral information to be sent between NHS service providers quickly, safely and in a format that is useful to clinicians.    

Service providers on the sending system will collect the following mandatory data items, which will be carried in the payload and used by the receiving system to verify the patients’ details.  NHS Digital will not store these data items. 

  • Name 

  • Address 

  • Postcode

  • DOB

There are a number of recommended data items for system suppliers that they can choose to use dependent upon their system configuration.  The BaRS system will not store this data: 

  • Sex 

  • Gender 

  • Home phone number 

  • Mobile phone number 

The following data items will be stored in Splunk by NHS Digital for audit purposes when it is included in a BaRS API request: 

  • General identifier - NHS Number can be collected by the sending and receiving organisation

  • Online identifier 

Special Category Data  

  • Physical / Mental Health or Condition - The clinical referral information will be transported via the BaRS API across the NHS Digital network, but it is not stored as an asset by the BaRS system. 

How we get the information and why we have it: 

Data items are collected by sending and receiving systems when a sending organisation makes the booking and referral request; they use the API to send the payload to the receiving organisation.  System suppliers will have the option to include a number of optional data items based on the PRSB information model. 

To the extent that any personal data is processed by NHS Digital in the provision of the BaRS Service, NHS Digital’s lawful basis will be: 

  • UK GDPR Article 6(1)(c) - legal obligation (the Direction issued under section 254 of the 2012 Act is a legal obligation on NHS Digital to process personal data from providers to the extent necessary to provide the Booking and Referral Standard Service. 

To the extent that any special categories of personal data are processed by NHS Digital in the provision of the BaRS Service, the Article 9 condition for doing so will be one or both of: 

  • UK GDPR Article 9(2)(g) - processing is necessary for reasons of substantial public interest, supplemented by: 

  • DPA 2018 – Schedule 1, Part 2, (6) (1) – statutory etc and government purposes  

  • UK GDPR Article 9 (2) (h) – processing is necessary for the management of health or social care systems and services, supplemented by:  

  • DPA 2018 – Schedule 1, Part 1, (2) (2) (f) – Health or social care purposes. 

What we do with the information we have:

NHS Digital does not collect the personal data directly from patients except in the case of 111 online which NHS Digital is controller for. The personal data is collected by the sending and receiving systems to enable a booking and referral to be made using the BaRS API. The data that traverses the NHS Digital infrastructure in the form of messages (payload) is a combination of personal data and special category. NHS Digital will only collect BARS API transactional data for the Booking and Referral Standard. 

How we store your information:  

NHS Digital is the trusted national provider of high-quality information, data and IT systems for health and social care. Information is the core business of NHS Digital and it is NHS Digital's duty to keep information safe. 

An information asset has been created for the Booking and Referral Standard and an Information Asset Owner (IAO) assigned. An IAO is a senior member of NHS Digital staff who is responsible for the management of the information asset created and utilised by their team. The IAO role is mandatory across all government departments. 

NHS Digital does not collect patients personal data. The only data that will be stored by NHS Digital is BaRS API transactional data on splunk, this will be stored for 90 days only 

Your data protection rights: 

Under data protection law, you have rights including: 

Your right to be informed – You have the right to be informed about when your personal data is being used  

Your right of access - You have the right to ask us for copies of your personal information.  

Your right to rectification - You have the right to ask us to rectify information you think is inaccurate. You also have the right to ask us to complete information you think is incomplete.  

Your right to restriction of processing - You have the right to ask us to restrict the processing of your information in certain circumstances.  

You are not required to pay any charge for exercising your rights. If you make a request, we have one month to respond to you. 

If you would like to make a request, please contact us at [email protected] 

Further Information:  

Further information on how NHS Digital is keeping patient data safe is available here

We may make changes to this Privacy Notice. If we do, the 'last edited' date on this page will also change. Any changes to this notice will apply immediately from the date of any change. 

Last edited: 22 August 2022 12:20

Information standards notice

The Data Alliance Partnership Board (DAPB) has approved a BaRS as an Information Standard.  This means that all healthcare IT systems suppliers delivering systems to  healthcare providers in applicable care settings should work with their customers to determine any necessary changes. A corresponding Information Standards Notice, reference DAPB4060 has been issued to support adoption and use of the Standard.

Contact us

Use our online enquiry form to ask a question, request more information about the project or Standard, or to simply leave your feedback.

Further information

internal NHS e-Referral Service

The NHS e-Referral Service (e-RS) combines electronic booking with a choice of place, date and time for first hospital or clinic appointments. Patients can choose their initial hospital or clinic appointment, which they can then book online (a telephone service is also available) or in the GP surgery at the point of referral.

internal GP Connect

GP Connect is a service that will allow GP practices and authorised clinical staff to share and view GP practice clinical information and data between IT systems, quickly and efficiently.

Last edited: 21 April 2023 12:59 pm