Service providers: advice and guidance enhancements - January 2021

Changes have been introduced which allow referrers to authorise advice and guidance requests to be converted to referrals by the provider, where appropriate.

Information stating if consent has been given to convert the advice and guidance request into a referral is displayed on the Advice Request Details screen. This shows if the receiving request has been authorised to be converted.

The options displayed are either:

• a green tick is presented with the wording “Authorised To Convert To A Referral

• a red cross with the wording “Not Authorised To Convert To A Referral”

Users will notice to the right of each option is an information icon. Hovering over this will display further information related to status presented.

The option: ‘Convert this to a referral’ - will be only displayed if the referrer has given authorisation to convert the request.

The option: ‘Convert this to a referral’ displays two further options:

• ‘I will refer the patient now’
• ‘Request admin team to refer the patient’

Referrals should be accepted in line with local referral and commissioning guidelines.

When converting advice and guidance into a referral, comments must be added as these are displayed to the referrer.

Before converting the request, providers should ensure they have the appropriate clinical information, this could be:

• the advice and guidance dialogue
• any other clinical information

The comments field should be completed with detailed management information as this is displayed to the referrer. This could include instructions on medication or treatment prior to the patient's appointment.

Users should also be aware that selecting 'Return to referrer with advice' will follow the original workflow.

The e-RS pathway start will capture the date on which the provider converts the referral.

Selecting the ‘I will refer the patient now’ option will present either the appointment search screen or the service search criteria screen.

Appointment search screen

This screen appears when the appointment priority is unchanged, and the advice and guidance service is also one that supports appointments (for example, is not an advice-only service):The provider can select the ‘Change Service’ button to shortlist elsewhere.

From the appointment search screen, an appointment can be selected. If the patient is referred to the same service as the advice and guidance request, the referral will be automatically accepted into the service and will not appear on the referrals for review worklist.

Choosing to cancel the referral flow at this point returns the user to the Advice Request Details screen with nothing submitted.

Service search criteria screen

This screen appears when either the:

• advice and guidance service supports triage requests
• advice and guidance service is an advice only service
• the priority is changed

In these cases, the speciality and clinic type from the advice and guidance request will be populated but can be changed.

Choosing to cancel the referral flow at this point returns the user to the Advice Request Details screen with nothing submitted.

From the Service search criteria screen the provider can search for the appropriate service/s, then either:

• raise the referral request (for booking later), placing it on the Appointments for Booking worklist
• search for and book the appointment

Selecting the ‘Request admin team refer the patient’ option will present a Record Triage Outcome pop-up box.

From here the provider can change the priority of the referral and add clear instructions for the admin team in the mandatory comments field.Selecting the ‘Back’ link will remove the pop-up box and present the Advice Request Details screen.

If returning to the pop-up box within the same session (meaning if you have not exited out of the flow, for example, back to worklist or an enquiry), any information previously added will be presented.

Once submitted the referral will be displayed on the Appointments for Booking worklist and removed from the Advice and Guidance worklist.

Converted advice and guidance requests needing to be booked will appear on the Appointments for Booking worklist with a reason of ‘Triaged – A&G converted, see comments’.When the UBRN is selected the ‘Service’ displayed is where the referral has been referred from. The reveal also provides the Triage Outcome and Comments.Selecting the Actions dropdown and choosing to ‘Update/book’ will take the user to either the Appointment Search screen when the appointment priority is unchanged, and the advice and guidance service supports appointment requests, or the Service Search Criteria screen when either the:

• advice and guidance service supports triage requests
• advice and guidance service is an advice only service (for example, does not also support appointments)
• the priority is changed

Details on the subsequent processes can be found above in the: ‘I will refer the patient now’ section.

If the advice and guidance is converted into a referral into the same bookable service, it will be automatically accepted and will not appear on the Referrals for Review worklist.

If the converted referral is sent to any other service, it will always appear on the Referrals for Review worklist.

Note: if the advice service is also the triage service the referral will still appear on the Referrals for Review worklist.

Reviewing the referral

When reviewing the converted referral, information is available in the Attachments section of the Clinical Information summary. This is a PDF which contains the full advice conversation, including the authorised to convert instruction.

When reviewing the clinical information, users need to be aware that on the left of the screen they can select the:

• ‘Clinical Information’ link to view additional information added by the referrer
• ‘Service Provider Activity’ link to view the comments the clinician made for booking
• ‘Advice & Guidance Details’ link to view the advice conversation within e-RS

Selecting the ‘Advice and Guidance Details’ link will display the following screen. The advice status is on the grey bar.

Actioning the referral

Clinicians should review all clinical information associated with the referral before selecting any of the actions located at the bottom right of the Review Referral Summary screen.

Key actions

Accept, Review Next - once you have reviewed the referral and decided it is clinically appropriate for the clinic, select ‘Accept Review Next’ in the review referral summary screen. When you accept a referral, e-RS will automatically show the next UBRN on the worklist for review. Once accepted, the referral will be removed from the worklist. To find a referral after it’s been accepted you can use the Patient Enquiry with either the patient’s NHS number or an appropriate UBRN.

Request Admin to Rebook - this option allows you to review referrals and pass on instructions to admin teams to rebook referrals. Find out more about the Admin to Rebook function.

Reject - once you have reviewed the referral and decided that it is clinically inappropriate for the clinic, select ‘Reject’ in the Review Referral Summary screen. Select a reason from the Reason dropdown list and enter further information in the comments field. This information will be visible to the referrer and help them understand why the referral has been rejected. Selecting ‘Submit, Review Next’ will automatically cancel the appointment in your Patient Administration System (PAS) and the next referral will be displayed for your review.

Note: Once rejected, the referral will be removed from the worklist. You will be able to find it via the Patient Enquiry, but only for six months after the rejection.

Change service - once you have reviewed the referral and decided that it is clinically appropriate but for a different clinic (service), selecting this option will allow the referral to be re-directed to the appropriate clinic(service).

Cancel – Clicking on the cancel button will cancel the referral summary screen which is open and take you back to the searched results.

Providers and commissioners should work together to agree processes.

Where possible providers should provide advice even if converting to a referral,  to support patient care while on appointment waiting lists.

Before converting a request ensure the appropriate clinical information has been attached.

If the request is converted and referred to a service with a different provider, the patient should be contacted.

Functionality allows an advice-only service to be an authorised service for a restricted service.

Where separate advice and guidance and referral services exist, within the same speciality or sub-specialty, combining the services will allow streamlined transition between the advice and guidance request and the referral (this would avoid the need for a separate clinician to review and accept the converted advice and guidance)

Review the advice and guidance changes implemented in January 2021 to see background information and other key points relating to these new changes.