3.1 There are several possible causes for being unable to access the NHS e-Referral Service, but the end result is the same - interruption to the availability and use of the system. The response to a loss of access depends on the setting, cause and context of the problem.
3.2 Should there be a national outage of the NHS e-Referral Service, communications will be sent to those who have registered for the national alerts (see 2.4 above to register for alerts). All local service desks responsible for supporting e-RS must be aware of this communication channel and already be registered to receive these alerts/updates so that they can initiate local processes for disseminating this information.
3.3 Where GP practice staff are unable to access e-RS, a referral cannot be initiated or progressed for a patient. If one has already been initiated, then patients may still be able to use the online booking service (Manage Your Referral), use the NHS App or contact The Appointment Line (TAL) to book or change their appointments.
3.4 Where a provider organisation cannot access the NHS e-Referral Service, this may affect their ability to review referrals or to retrieve appointment slots and may prevent patients from booking appointments. New referrals into their services may, however, continue to be initiated by referrers.
3.5 In the event of an outage, a clinical risk management approach will need to be adopted and alternative arrangements considered for the sending and receiving of referrals.
These arrangements will need to consider:
- What (if any) other systems are ‘down’ within an organisation, in addition to e-RS
- The urgency of the referrals being sent / received
- The volume of referrals being sent to or from affected organisation(s)
3.6 Local business continuity arrangements may vary across local commissioning organisations, GPs and providers. They must be documented as part of an e-RS contingency policy and must be available to all users of e-RS.
Provider organisations
3.7 Within provider organisations, business continuity arrangements must include protocols that ensure timely messages are issued to relevant internal users and to commissioners for onward communication to referrers. It is important that such protocols include processes for communicating with the range of local commissioning organisations from which providers receive referrals and advice and guidance via e-RS.
3.8 Communication channels must be maintained throughout any periods of disruption so that on-going status reports can be issued, including information to confirm the resolution of an incident.
3.9 Protocols should include information on alternative referral channels that are available and the means for accessing these channels (e.g. NHS mail addresses)
Referring organisations
3.10 Within referring organisations, contingency plans should clearly describe all alternative methods via which referrals might be initiated/processed, recognising that circumstances at the time of the outage will determine which, if any, alternative plans are implemented. These might, for example, include information on whether referrals will be sent via NHS mail during any outage.
3.11 Contingency plans should include instructions on how to establish communication channels between referrers experiencing problems with e-RS and their support teams, e.g. in local commissioning organisations / CSUs. This may simply be a telephone number (e.g. to an IT help desk) to call in cases of difficulty in using e-RS.
Timings for Invoking alternative plans
3.12 Trigger points for initiating alternative arrangements should be agreed based on the likely length of the disruption and the type of referral required. For example, a suspected cancer referral may require action to be taken sooner than for a routine referral, although a switch to alternative referral routes too early may actually result in a delay to care for all but lengthy outage periods.
3.13 Best practice would advise that, where e-RS is unavailable for less than 24 hours, all referrals should be held and then added to the system as soon as it is available.
3.14 If referrers are advised that an outage is likely to last for longer than 24 hours, then ‘Rapid Access’ (e.g. next day) referrals will need to be managed by alternative means. These are usually local services and individual arrangements will need to be made for such services and communicated urgently, via established communication channels (see above).
3.15 Routine and urgent referrals can be held for several days (e.g. up to five working days) before resorting to alternative channels and are still likely to be processed faster by waiting for e-RS to become available again than by using alternative means. Alternative referral channels will need to be agreed and communicated at the time of any outage, depending on which systems are unavailable.
3.16 If an outage exceeds 24 hours, then plans should be considered for sending suspected cancer referrals by alternative means (to be agreed at the time), although even for these referrals, waiting for e-RS to become available again may be more efficient and result in sooner appointments.
3.17 Any decision to invoke alternative referral mechanisms should be taken jointly by local commissioning organisations and providers. In the event of business continuity arrangements being invoked the scope of arrangements will need to be clarified and communicated effectively. For example:
- Where a single provider is unable to access e-RS using alternative methods for ALL referrals may impact upon other providers who were unaffected and are still able to receive referrals through e-RS
- If a single GP practice or local commissioning organisation is unable to access e-RS, a provider may still want to receive referrals from other local commissioning organisations via e-RS