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Advice and guidance changes implemented in early 2021

The NHS e-Referral Service (e-RS) has introduced new functionality which affects both referrers and providers. This allows providers to convert an advice and guidance request to a referral, where authorised.

Introduction

With the use of advice and guidance steadily increasing there has been a renewed focus on its use.

NHS England/Improvement Elective Care Recovery & Transformation Programme see advice and guidance as a critical enabling tool to:​

  • support the management of patients in primary care ​
  • avoid unnecessary referrals to secondary care ​
  • improve the interface between primary and secondary care

NHS England/Improvement advice and guidance steering group has worked with clinicians across England to understand requirements for enhancements to the current process.


What's changed

Provider clinicians have the ability to convert an advice and guidance conversation to a referral​.

New Application Programming Interfaces (APIs) are also now available, which allow provider systems to: ​

  • take an advice and guidance conversation into a patient’s hospital record​
  • manage an advice and guidance conversation from within the provider’s own system ​
  • convert an advice and guidance from within the provider’s own system 

Find further information on integration.


How this works

Process flows

Without referrer authorisation

  1. Referrer raises advice and guidance request.
  2. No authorisation given to convert to referral​.
  3. Provider responds to referrer​.
  4. Referrer makes referral if required.

Image of the process flow for an advice request which is not authorised

 

With referrer authorisation:

  1. Referrer raises advice and guidance request.
  2. Authorisation given to convert referral selected​.
  3. Provider converts the advice and guidance request and provides management advice back to the referrer.

Image of the process flow for an advice request which is authorised


Advice and guidance changes

Advice and guidance changes were implemented in January 2021. 

In August 2021 NHS England & Improvement and NHSX published a letter on the changes to e-RS Advice & Guidance View a copy of the letter.


Changes for referrers

Find out more about how these changes impact referrers when:

  • creating an advice and guidance request
  • reviewing the converted request information

Changes for providers

Find out more about how these changes impact providers when:

  • reviewing an advice and guidance request
  • converting an advice and guidance request
  • booking a converted advice and guidance referral
  • reviewing a converted advice and guidance referral

Additional information

Below are some points that users have raised during the review of the new functionality:

Changes to extracts

EBSX02 - change one:

When a referrer requests A&G, an 'ADVICE_AND_GUIDANCE_REQUESTED' action is logged against it.

This has changed to:

The ACTION_REASON_CD logged against this action will now populate a value to indicate whether or not the professional user authorised the service provider to convert the advice and guidance request into a referral. Users will need to use the EBSX03 extract to decodify the ACTION_REASON_CD into meaningful data (i.e the reason will be either ‘Authorised to convert into referral’ or ‘Not authorised to convert into referral’).

Note: Legacy A&G requests made before the functionality is introduced will have a blank ACTION_REASON_CD logged, but these can be interpreted as ‘Not authorised to convert into referral’ for reporting purposes.

EBSX02 - change two:

It was possible (via the ACTION_REASON_CD for the ADVICE_AND_GUIDANCE_CLOSED action) to determine whether:

  • the referrer ended the A&G conversation without converting it into a Referral (for example, ‘Advice Ended’)
  • the referrer converted it into a Referral (for example, ‘Advice Converted by referrer’)

This has changed to:

It is now possible to determine whether the provider converted the A&G into a Referral (for example, ‘Advice converted by provider’). Users will need to use the EBSX03 extract to decodify the ACTION_REASON_CD into meaningful data.

AG01 - change one:

When a referrer requests A&G, an 'ADVICE_AND_GUIDANCE_REQUESTED' action is logged against it.

This has changed to:

The Outcome column logged against this action now populates a value to indicate whether or not the Professional user authorised the service provider to convert the advice and guidance request into a referral. For example. either AUTHORISED_TO_CONVERT or NOT_AUTHORISED_TO_CONVERT

Note: Legacy A&G requests made before the functionality is introduced will have a blank Outcome logged, but these can be interpreted as NOT_AUTHORISED_TO_CONVERT for reporting purposes.

AG01 - change two:

It was possible (via the Outcome for the ADVICE_AND_GUIDANCE_CLOSED action) to determine whether:

  • the referrer ended the A&G conversation without converting it into a Referral (for example, ADVICE_ENDED)
  • the referrer converted it into a Referral (for example, ADVICE_CONVERTED_BY_PROVIDER)

This has changed to:

It is now possible to determine whether the provider converted the A&G into a Referral. For example, ‘Advice converted by provider’.

User awareness of the changes 

Help information appears on each screen where changes have taken place, the first time a users access these impacted screens. Users can select the ‘Done’ button to remove these messages permanently.

Image of the help information which is displayed for both a referrer and provider when the new changes are located on the screens

Patients using the manage your referral (MYR) website

Patients using MYR will be able to see their referral once the referral has been shortlisted or an appointment booked.

Patient choice

Providers can be confident that a patient has chosen them for their referral as, by authorising a provider to convert a referral, the referrer is confirming that their patient is happy to be seen by that provider​.

Referral rejections 

If an advice and guidance is converted and then sent to a service that subsequently rejects it, the rejection comments will go back to the originating GP/referrer and will be displayed on the Referrer Action Required worklist.

Referral to Treatment (RTT) clock start 

The e-RS pathway start is captured the date on which the provider converts the referral - this will be the date displayed where the ‘e-RS Pathway Start’ date is shown on worklists.

Source of referral

Where a referral is converted by the consultant, it will still show as a GP referral and the same UBRN will be maintained.

Integration with provider systems 

APIs (Application Programming Interfaces) to cover full advice and guidance functionality are now available. Find further information on integration.

Advice and guidance tariff 

Where an advice and guidance request is converted to a referral by a provider, any locally agreed tariff will continue to apply.

Find out more about tariffs on the national tariff payment system website.

Review the practical guide (on the Elective Care Community of Practice – login required) which outlines principles to consider around resourcing and paying for an advice and guidance service.

GP clinical systems

If your current process is to initially code an advice request as an ‘e-Referral A&G’ in your GP clinical system, then update to a ‘referral’ if you convert it to a referral, then you can continue to use the same process when you receive an ‘Update Available – Referral Accepted’ notification on your Advice and Guidance worklist.

It is important that practice staff are aware of this process alongside monitoring the Advice and Guidance worklist.


Supporting information

Find out how these changes impact referrers and providers.

Review the advice and guidance toolkit to find out more information on the complete advice and guidance process for all users.

Review the NHSE advice and guidance information detailing the future collaboration platform (log in required).

Integration/API queries can be emailed to nhserspartners@nhs.net.

For any advice on local implementation queries, not answered on our support pages, please contact - enquiries.ers@nhs.net

Last edited: 28 September 2021 2:58 pm