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Advice and guidance for NHS e-Referral Service (e-RS) leads and service managers

Advice and guidance gives referrers the facility to ask questions, send attachments (including photographs) and convert the advice and guidance into a referral, all in a single system.  

How advice and guidance is used

Advice and guidance in e-RS helps commissioners use one national system to support NHS England's long term plan to use digital technology to reduce unnecessary hospital referrals. 

Further information about how advice and guidance can help commissioning organisations is available within the advice and guidance benefits section.   

Practical information on how to use advice and guidance

The e-RS information analyst role will give access to a rich source of system data to support advice and guidance using:

  • the B1130 role to give e-RS users the information analyst role, which your organisation’s Registration Authority (RA) agent can add to appropriate users’ smartcards
  • the Directory of Services (DOS) tab (through the service provider clinician or admin role) which allows you to see other local and national services, which can be used as a research tool
  • the EBX05 extract (combined with other extracts), also gives data on all national services
  • communication between service definers and clinicians, so all team members are engaged with e-RS and how their services are described in the DOS

If you are new to e-RS you can read our quick guide on how to log on to e-RS.

Read our training section and e-RS help files (N3/HSCN connection required).   

What e-RS leads and service managers can do 

We have created a high level step guide to using advice and guidance for e-RS leads and service managers.  


You can read guidance produced by NHS England and NHS Digital including:

Look up local and national advice and guidance services available on e-RS, through the directory of services tab within e-RS

To access and analyse existing advice and guidance data, both locally and nationally, you may want to: 

  • use or obtain the information analyst role (B1130), or you could ask your information analyst to get the data for you
  • analyse the AG01 (activity report), using the information analyst role, to look at local data including advice and guidance activity, users and outcomes
  • evaluate the EBSX05 (and other extracts) to look at national advice and guidance services
  • gather information on local requirements by speaking with professional users of advice and guidance 
Planning and commissioning

Understand the barriers to using advice and guidance and work with commissioners to overcome these.

Work with clinicians to ensure time is allocated in their schedule to support advice and guidance and ensure that:

  • commissioned services have achievable advice and guidance response targets
  • processes are in place to adapt to fluctuations in the volume of advice and guidance requests and the potential for a gradual increase in demand from primary care
  • there is sufficient clinical cover to respond to advice and guidance, for example: consider a rota system during periods of absence
  • there is sufficient consultant workforce to balance advice and guidance workload against other clinical activity

With commissioners and clinicians decide how advice and guidance services are going to be set up.  For example, will they be:

  • tariff based (see NHS England benchmark prices for advice and guidance services, found in the Non-mandatory prices 2019-20 spreadsheet (Benchmark-advice and guidance tab), in the National tariff payment system: supporting documents)?
  • appointment and advice and guidance services or advice and guidance only services?
  • available locally on the primary care menu or nationally on the secondary care menu (services set up on the primary care menu will need commissioning on e-RS by a local commissioner)?

Work with your service definer to:

  • review new and existing advice and guidance services along with service information in the directory of services (DOS)
  • ensure professional users are given access to advice and guidance services through the workgroups in the DOS

Work with your:

  • CCG and referring GPs to highlight new advice and guidance services
  • Registration Authority team to arrange for appropriate roles to be added for users
  • IT department to ensure that all computers can access e-RS
  • training team (or other training provider) to give appropriate training

Find out more on our training section

  • ensure IT infrastructure is in place and training is delivered, as detailed above
  • monitor advice and guidance responses to ensure they are reviewed and responded to in a timely manner, including during times of clinician absence
Analyse and audit

Service leads and clinicians should analyse data by establishing regular 6-12 monthly internal audit/service evaluations. Suitable standards include:

  • activity per clinician, including response times
  • the percentage advice and guidance requests where referral only is recommended
  • conversion rates to referrals – consider establishing systems to cross check referrals within a defined period, for example: 6 months using NHS numbers rather than UBRN
  • qualitative review of 20-30 advice and guidance responses as a team across all reporting consultants 
  • undertake and review quality assurance analysis, by using the AG01 (activity report) and the EBSX02
  • ongoing review of advice and guidance services to ensure they meet local requirements
  • completion of a post implementation lessons learnt exercise and share findings with clinicians and commissioners
Last edited: 21 April 2020 12:17 pm