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Capacity alerts guidance – NHS e-Referral Service


Summary

We have introduced functionality into the NHS e-Referral Service (e-RS) to highlight to referrers where there are capacity issues in the system and to also point out providers with available capacity.

This functionality, known as ‘Capacity Alerts’ was trialled in the three CCGs around Barking, Havering and Redbridge University Hospitals Trust (BHRUT); NHS Barking CCG, NHS Havering CCG and NHS Redbridge CCG in a pilot project led by the Behavioural Insights Team (BIT, commissioned by NHS England).

Following the successful outcome of the pilot phase, which saw a reduction of 38% in referrals to the pilot specialties at BHRUT, NHS England is now expanding the use of the new functionality to support demand management across the rest of England.

This guidance document aims to help those responsible in the NHS England Regional and DCO teams understand what will be needed both within a local health economy and within the e-RS system itself to enable the functionality to be used effectively.

Considerations

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

As Capacity Alerts are able to be set at ‘Service’ level within e-RS, this represents a more meaningful representation of the RTT information as this may differ from the RTT for the overall Specialty.

An example of this may be where a trust is meeting 18 weeks for Orthopaedics overall but may have severe capacity issues within its spinal services and so a capacity alert could be used to indicate to referrers that patients may not be treated within 18 weeks for these particular services.

Capacity Alerts can be used to advise referrers away from services with poor capacity and will show a red warning of ‘Limited Capacity’, or to promote services with available capacity, which are highlighted at the top of the Service Search screen in e-RS. Examples of these screens are shown later in this document.

Principles

Setting Capacity Alerts should be used with caution 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 18 weeks.

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 to appear more prominently on the Service Search screen to help guide referrers towards them.

It is vital that this agreement with all the local organisations involved is reached before any alerts are set in the system as setting limited capacity alerts without the corresponding ‘good capacity’ alternatives will be confusing for referrers and may not have the desired outcome of moving referrals away from struggling organisations.

The setting and maintenance of the alerts needs to be closely managed and monitored so that they can be removed as soon as a situation improves. This will need a local process and governance model to be established and followed.

Points to note

  • 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 do not have any appointments showing in e-RS, they will not appear in the green box
  • the providers of these alternate services need to be aware of this and make sure that e-RS polling ranges are such that appointments are always available
  • adding too many ‘limited capacity’ alerts will limit their effectiveness
  • patient choice must always apply and if a patient specifically wants to go to a service with limited capacity they need to be made aware of the potential delay and as long as this will not be detrimental to their care they should still be allowed to choose that provider
  • the e-RS has been configured to only show ‘good capacity’ alerts against services up to a distance of 50 miles away (from the patient’s postcode). 

Referrer view

When searching for an appropriate service where no capacity alerts have been set, a referrer will see the services displayed as displayed below:

screen shot of eRS referrer view using the capacity alerts screen

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 one below:

screen shot of eRS showing an example of a capacity alert screen

The alternative service(s) with available capacity will be 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.

Pre-requistes

To be able to set and maintain capacity alerts access will be needed to the NHS e-Referral Service and to allow this, the following are required:

  • N3 connection
  • A smartcard that is registered to NHS England ODS code X24, with the business function of B1106 – Maintain Commissioned Services.
  • 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.
  • The RA software and a card reader have been installed on the user’s pc. This is the CIS Identity Agent software. Learn more further information is available from national service desk downloads (N3 access required). 

Setting capacity alerts

These can currently only be set in e-RS by NHS England users with a 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:

  • log into NHS e-RS as a commissioner
  • select the maintain capactity alerts tab

screen shot of EPS system displaying the maintain capacity alerts tabTo set a capacity against a service the service must be searched for. There are a number of ways to search for the service.

  • speciality and clinic type
  • clinical team
  • named clinician 
  • organisation name

When using the speciality and clinic type search which e-RS speciality the service is set up under, as they do not map accross to all the national specialities (or RTT Treatment functions).

To further refine the search once the speciality has been selected then finding the organisatoin that provides that service will reduce the time locating the service. 

screen shot of eRS showing an example of  a capacity alert screen

 

  • 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 have been entered click search. 

Screenshot where user adds speciality, clinic type and alert review status

  • the services that meet the criteria are then shown
  • select the services that the capacity alert needs to be set against by checking the tick box against the service name and then selecting the Capacity Alert button
  • the option is then given to set a start and end date for the alert
  • this can be set for a maximum of 92 days
  • The user will then need to select whether they are setting a Limited Capacity Alert or an Available Capacity Alert. 

eRS screen shot showing how to set a limited capacity with effective date ranges

 

 

 

Setting a limited capacity alert

Selecting the limited capacity option will then offer 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. 

eRS screen showing how to set a capacity alert screen

 

Setting available capacity 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.

 

eRS screen showing how to set a capacity alert screen

Once alerts have been set they are visible to referring organisations when they are searching for services.

 

 

Removing capacity alerts

  • log into the NHS e-Referral Service and select the Maintain Capacity Alerts tab
  • the service that has the capacity alert set against it will need to be located
  • searching for the service the user can use the same criteria used to locate the service when the alert was set
  • as an alert is already set then the quickest method of searching is by searching on the Alert Review Status.

eRS screen showing how to remove a capacity alert screen

 

  • select the services that you wish to remove and select the ‘Remove Capacity Alert’
  • 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.

 

Editing capacity alerts

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

Monitoring slot availability

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 and easiest 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 DoS 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).

 

Last edited: 21 June 2019 9:39 am