Advice and guidance for referrers quick reference guide

Log onto and open e-RS via your usual method, either through your integrated GP clinical system (for example, SystmOne, Emis), or e-RS web-based.

If you are creating advice and guidance using the e-RS web-based system; firstly, find the patient in the patient tab, using one of the three search methods: NHS number, unique booking reference number (UBRN) or demographics.

If you are using your integrated GP clinical system to create advice and guidance please refer to the associated user guide.

From web-based e-RS search for the patient.

Once you have found your patient you can create an advice and guidance for them. By selecting the ‘Refer/Advice’ button.

You will then reach the service search criteria screen and continue with the advice and guidance creation process. You will:

1. select the initial referring clinician if you are logged in as a referring clinician admin
2. select the 'Advice' option from the request type drop-down
3. select an appropriate priority from the priority type drop-down

In the service search criteria screen, complete at least one of the mandatory fields (marked with a *). Each field in this screen can be filtered to aid quick selection of the correct services.

1. enter the SNOMED clinical term that you wish to search for in the clinical term field
2. select the ellipses button (the button to the right of the field with three dots shown) to search for the term
3. the clinical terms search screen will appear displaying the term you are looking for populated in the 'Find' field
4. a list matching your initial clinical term will be displayed
5. click on the appropriate term to select it
6. the 'Preferred Term' field is now populated
7. select your preferred term which will then appear in the 'Selected Term' field
8. once you are satisfied with your preferred term, select done
9. if you are not satisfied with any of the terms shown, click on 'Clear' and start your search again

When you return to the service search criteria screen, the 'Clinical Term' field will have the SNOMED clinical term that you have selected.

Select 'Search' (for locally commissioned and national, consultant-led services).

1. open the drop-down list by selecting the 'Specialty' box and selecting the appropriate specialty
2. select the correct clinic type using the 'Clinic Type' drop-down
3. select 'Search' (for locally commissioned and national, consultant-led services)

Watch the specialty and clinic type overview video which explains the terms as used within e-RS and demonstrates how specialty and clinic type are used to locate a suitable service for patient referral.

A list of available services will appear in the service selection screen. You should:

1. select the radio button beside the service you choose to send the advice and guidance request to
2. select 'Request', at the bottom of screen

A pop-up window will appear displaying further details on the service selected.

In the 'Review referral criteria' pop up, you can check that your patient meets the referral criteria and then choose to:

• return to the previous screen to change the service selection by selecting ‘Back with selected services’ or ‘Cancel’ or,
• select 'Continue with the selected services'

Once you select the 'Continue with the selected services' option the advice request screen will appear. Input your advice request details into the mandatory free text box, commonly in the form of a question to the provider.

Referrers will need to select the appropriate radio button to indicate if authorisation has been given for the provider to convert the request into a referral. If  ‘Yes - .....' is selected, referrers must ensure appropriate and adequate clinical information is attached.

This decision can be changed by the referrer after the request has been sent to the provider by opening the advice request via the advice and guidance worklist.

You can copy and paste the content of the advice and guidance request, into and out from e-RS by:

1. highlighting the text for copying, then use Ctrl C (to copy the text)
2. placing the cursor on the position you want to position the text, then using Ctrl V (to paste the text)

If you have finished the advice request, select the 'Send Request' button.

See the attachment section to add files to the advice request.

The advice request is accessible via both the:

• advice and guidance worklist
• patient tab, once you have input the patient’s details (see the patient tab section for more information)

The advice and guidance request will be visible immediately to the chosen provider.

When sending an advice request, the attachment should include appropriate clinical information. If you are authorising the provider to convert the request to a referral, adequate information should be included in the request to allow this decision to be made

Adding an attachment

Attachments can be added either:

• at the time the advice request is sent, by clicking on the add attachment text, which will open a pop-up that allows you to find a document to attach
• at a later stage, by either opening the advice request via the advice and guidance worklist or the patient tab or by selecting the process advice request, then click on add attachment, find the document and upload it

Advice and guidance responses will be returned to the patient’s referrer, for example a GP practice, via the advice and guidance worklist. This can be found by:

1. selecting the worklist tab

2. A referring clinician user will have additional options present at the top of their worklist tiles for viewing either their own worklist only or that of the organisation they have logged in under

3. selecting the ‘Advice and guidance’ tile to see all active advice and guidance requests and responses in one place

You can view and sort advice responses by:

• sorting columns; select the arrows next to the column heading (for example, last activity date)

• using filters; select from filters on the left (filter by referrer). When filters are selected, a ‘Filter applied’ label appears details results of how many referrals are being shown from the number of referrals available on the worklist

There are four advice and guidance statuses:

• ‘Provider Response Required’ - the advice and guidance request needs attention by the provider clinician/clinical team
• ‘Referrer to review response' - the provider clinician/clinical team have sent a response which required the referrer to review and action as required
• ’Referrer To Submit Further Information’ - the provider clinician/clinical team have sent a response, asking the referrer to give more information, or clarification on some aspect of the original advice and guidance request
• ‘Update Available – Referral Accepted’ – the provider clinician/clinical team have converted the request into a referral, meaning the provider is now responsible for the referral

In the response status column, if the text shows as 'Referrer to Review Response' or ’Referrer To Submit Further Information’ then the patient’s referrer (GP practice) should review the advice response, which has been sent by the chosen provider. To do this select the UBRN to open the advice request details screen.

Review the contents which may include attachments.

If you need to continue the conversation, complete the advice request details free text box, adding any attachments if necessary, and click the send request button, at the bottom of the screen.

This will be seen immediately by the chosen provider.

Note: you will not be able to continue the conversation if the provider has converted the request into a referral.

Select the UBRN to open the advice request details screen. Where a referral/appointment booking is required click the 'Refer Now' button, at the bottom of the screen, to convert the UBRN into an appointment request in the usual way.

Ensure an attachment is added, so the chosen provider can review the referral.

Advice and guidance responses can be held on the worklist (for up to six months). Within this time, they can be ended or actioned (for example, converted into a referral).

• To end an advice response - select the UBRN to open the advice request details screen, then either:

a) click on the ‘End Conversation’ button or,

b) click on the ‘Remove from Worklist’ button. This will be displayed when a provider has converted the request to a referral. The final comment from the provider should be reviewed as this may include management information for the patient whilst they await their appointment.

• To action a response - where a referral is required you can click "Refer Now" to convert the UBRN into an appointment request, as detailed above

The ‘Print’ button, on the advice request details screen, will allow referrers to extract the full conversations and upload into the patients record.

The advice and guidance request and response can be found via the patient tab, once you have input the patient’s details (see the patient tab section for more information).

The patient tab can be used to find a patient’s referral, where the referral has been active in the last 18 months.

You can search for patient using either their NHS number, a specific UBRN or their demographic information.

A patient activity list will be displayed with each referral created for the patient, with actions for each one.

You are also able to select the show all non-archived referrals tick box to see referrals for the patient that were last actioned over 18 months or more ago.

Further information and training materials can be found in the NHS e-RS document library.

Further resources including videos can be found at the support information page