Capacity alerts guidance on the NHS e-Referral Service

Functionality is available within the NHS e-Referral Service (e-RS) to highlight to GPs/referrers where there are capacity issues in the system and to also highlight providers with available capacity.

Previous pilots of this functionality resulted in a reduction of 38% in referrals to specialties highlighted as having capacity issues.

Referral to Treatment (RTT) information displayed in e-RS (in common with elsewhere) is shown at specialty level, for example, Orthopaedics. This does not always provide clear information regarding waiting times for referrers and patients when referrals are made at sub-specialty level, for example to a knee specialist/clinic, which may have a different waiting time compared to the overall main specialty/treatment function.

As Capacity Alerts are set at individual ‘Service’ level within e-RS, this represents a more meaningful representation of the waiting time information.

Please note, that Capacity Alerts can be set against both bookable services and referral assessment (RAS) services.  

Capacity Alerts are used to advise GPs/referrers away from services with limited capacity, and lengthy waiting times, and will show a red warning of ‘LIMITED CAPACITY’. Capacity alerts also promote services with available capacity, or shorter waiting times, which are highlighted at the top of the Service Search screen in e-RS. Examples of these screens are shown further down this page.

Setting Capacity Alerts should be used when considering all factors or local elective pathways and waiting times, and only after agreement has been reached with local commissioners and providers. Setting a 'limited' Capacity Alert will not necessarily stop all referrals into a service, but will allow referrers to be made aware that, should they refer their patient to such a service, it is unlikely that they will receive treatment within an acceptable timeframe.

To off-set the use of 'limited' Capacity Alerts, additional capacity should be made available in agreement with other providers which can have ‘good' Capacity Alerts set against them. These will appear more prominently on the Service Search screen to help guide referrers towards them.

It is vital that an agreement with all the local organisations involved is reached before alerts are set within e-RS as setting ‘limited' Capacity Alerts without the corresponding ‘good' capacity as alternatives will be confusing for GPs/referrers and may not have the desired outcome of directing referrals away from struggling organisations.

The setting and maintenance of e-RS Capacity Alerts needs to be closely managed and monitored so that they can be updated or removed as soon as a situation improves. This will need a local process and governance model to be established and followed.

• when GPs/referrers are searching for services in e-RS, a maximum of three ‘good' Capacity Alerts will be shown in the top section of the screen in a green box at any one time
• if any of these services are bookable services without any appointments available , they will not appear in the green box (not applicable to referral assessment (RAS) services)
• the providers of these alternate bookable services listed as 'good' capacity, need to ensure  that e-RS appointments are always available (not applicable to referral assessment (RAS) services)
• adding too many ‘limited' Capacity Alerts will limit their effectiveness
• patient choice must always apply and if a patient chooses to go to a service which is shown as having 'limited' capacity, they need to be made aware of the extended waiting time and as long as their GP believes this will not be detrimental to their care, they should still be allowed to choose that provider
• e-RS will only display services which have been set with ‘good' Capacity Alerts up to a distance of 50 miles away (from the patient’s postcode)

When searching for an appropriate service where no capacity alerts have been set, a referrer will see the services returned on the Service Selection screen in e-RS as shown in the image below.

When 'good' and 'limited' Capacity Alerts are set against services returned on the Service Selection screen in e-RS, referrers will see a screen similar to the image below.

The alternative service(s) with available capacity will be clearly presented in the green section at the top of the screen and those with poor capacity alerts set against them will have a red message of ‘LIMITED CAPACITY’ shown against them in the lower part of the screen.

To be able to set and maintain e-RS/Capacity Alerts, access will be needed to e-RS and to allow this, the following are required:

• HSCN connection
• appropriate internet browser configured with the NHS Credential Management and CIS Identity Agent software installed
• a smartcard that is registered to NHS England (ODS code X24), with the business function of 'B1106 – Maintain Commissioned Services' applied
• an NHS England Sponsor who will approve the addition and removal of access rights (roles) and who will help confirm the business justification for users to have these
• an NHS England Registration Authority Manager or Agent (RAM/RAA) to provide the smartcards for users
• RA is usually located within a Human Resources or IT departments

These are set in e-RS by NHS England users only with an e-RS/commissioner role on their smartcard.

Users within the NHS England Regional Teams will need to be identified to manage and monitor this process.

Steps to take:

1. Log into NHS e-RS as a commissioner.
2. Select the maintain capacity alerts tab.

3. Locate the e-RS service to set a capacity alert against. There are several ways to search for the service. Use the options as shown in the above image to search using:

• speciality
• clinical type
• named clinician 
• organisation name

To further refine the search once the speciality has been chosen, it is recommended to also search using the organisation which provides that service, as it will reduce the time locating the service.

To search by organisation name, choose Select next to Organisation or Site Name. Once the Service Provider Organisation Search window appears.

Add the name or partial name of the organisation in the Find box.

Select the appropriate organisation and click Done.

Once all the appropriate criteria has been entered, click Search. The services that meet the criteria are then shown.

4. Select the service(s) that the capacity alert needs to be set against by checking the tick box against the service name and then select Set Capacity Alert button.

5. A Set Capacity Alert window will appear.

6. Use the date fields to set a start-date and end date for the alert. The calendar icon can also be used to help select appropriate start and end dates. This can be set for a maximum of 92 days.
7. In the Set Capacity Alert window the user will then need to select whether they are setting a 'LIMITED Capacity Alert' or an 'AVAILABLE Capacity Alert'.

Selecting the 'LIMITED Capacity Alert' option will then display three questions that will need to be confirmed before the alert can be set:

1. Have you considered the local and national implications of setting this alert?
2. Have you identified that alternative capacity in the local area is available?
3. Have you identified a review process for this alert?

If all responses are yes, then you can apply the alert.

Selecting the 'AVAILABLE Capacity Alert' option will then offer two questions that will need to be confirmed before the alert can be set:

1. have you considered the local and national implications of setting this alert?
2. have you identified a review process for this alert?

If both responses are yes, then you can apply the alert.

Once alerts have been set, they are immediately visible to GPs/referrers when they are searching for services.

To remove Capacity Alerts:

1. Log into the NHS e-Referral Service via the NHS England e-RS/commissioner role and select the Maintain Capacity Alerts tab.
2. The service that has the capacity alert set against it will need to be located as detailed in 'Setting Capacity Alerts' above.
3. In addition to the above search recommendations, all active alerts can be easily found by searching using the Alert Review Status dropdown and choosing either Pending, Active, or Expired.

4. Select the service/s that you wish to remove and select ‘Remove Capacity Alert’.
5. A warning is displayed for the user to confirm that this is the alert they wish to remove and then Yes is selected to continue.

To edit or extend an existing Capacity Alert the user must first search for the service they wish to amend the Capacity Alert against. As an alert is already set then the quickest method of searching is by using the Alert Review Status:

1. Select the alert that needs editing and click on the Active Hyper link.
2. The edit screen is then displayed and from here the Alert date range can be extended or the Alert removed.

Providers of services with available capacity and Commissioners will need to carefully monitor the availability of appointment slots, to ensure that these ‘available capacity’ services remain visible to referrers.

The quickest way to monitor this is for Commissioners to use the Directory of Services tab and search for the service(s) in question. The Service Details will show the Indicative Appointment wait (in days), but if ‘Limited Availability’ is showing against the service, that means that the service(s) will not show in the available capacity green box at the top of the screen for the referrers. Please note, a priority must be selected (‘Routine’ recommended) for the Indicative Wait Time column to display.

The benefit of using this method is that a user can search on a specialty and the Directory of Services search will return all those providers of that specialty, so it is easy to see where slots are available or where action may need to be taken by the provider(s).

Please contact the NHS e-Referral Service team via [email protected] if you require any further information or support relating to e-RS Capacity Alerts.