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Service providers: advice and guidance enhancements - January 2021

The NHS e-Referral Service (e-RS) introduced functionality which affects providers when reviewing and actioning advice and guidance requests.

Introduction

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


Reviewing an advice and guidance request - what's changed?

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.

Image of advice request details screen showing the advice and guidance request has been authorised to convert to a referral

The options displayed are either:

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

Image of the authorised to convert message

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

Image of the not authorised to convert message

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

Image of the information displayed when hovering over the information icon on the advice request details screen. This reads “If the referring clinician has authorised you to convert this advice and guidance dialogue into a referral, you should only do so if you feel this is clinically appropriate and adequate clinical information is available for you to proceed with this as a referral.”


How to convert an advice and guidance request

The option: ‘Convert this to a referral’ - will be only displayed if the referrer has given authorisation to convert the request. Image of the advice request details screen with the ‘new convert this to a referral’ tick box.

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

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

Image of the advice request details screen with the ‘new convert this to a referral’ tick box selected, and the subsequent options displayed.

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.

‘I will refer the patient now’ option

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): Image of the appointment search screen 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. Image of the service search criteria screen with the priority, speciality and clinic type populated 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

‘Request admin team to refer the patient’ option

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. Image of the record triage outcome pop up box 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.


Booking a converted referral

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’. Image of the appointment for booking worklist with the new reason code displayed and enlarged 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. Image of the appointment for booking worklist with a UBRN selected. The information panel displays the triage outcome and triage comments. This section is also enlarged. 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.


Reviewing a converted advice and guidance referral

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. Image of the referrals for review worklist for a triage service.

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. Image of the review referral summary screen with the advice conversation PDF highlighted.

 

Image of the advice conversation PDF

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

Image of the review referral summary screen with the linked options highlighted Selecting the ‘Advice and Guidance Details’ link will display the following screen. The advice status is on the grey bar.

Image of the advice request details screen with ‘Authorised To Convert A Referral’ and ‘Advice Status: Advice Converted’ Status enlarged


Additional information

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 allowz 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)


Supporting information

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

Last edited: 16 June 2021 12:36 pm