Clinical assessment services (management) and the NHS e-Referral Service

Clinical Assessment Service (CAS) functionality allows providers to review referrals and/or see and treat patients and then to refer them on to another service if required.

How a CAS is set up, and what it is used for, will determine how you will utilise the functionality.

The guidance below sets out ways to manage referrals within a CAS.

Find out more information on the considerations which should be thought about when setting up a CAS.

Referrals to a CAS will be displayed in the Referrals for Review worklist. Find out more about how to action referrals on the Referrals for Review worklist.

Once a referral has been accepted, an assessment result can be recorded against it via the Referrals for Assessment worklist. The following steps should be followed:

1. From the Worklist Type drop down, the Referrals for Assessment worklist should be selected.
2. The UBRN of the referral against which the assessment is to be recorded should be selected
3. Selecting the Actions button will display the Record Assessment option from the drop-down list. The Record Assessment option should be selected.
4. The appropriate option from the Clinical Assessment Outcome list should be selected and any comments added. Outcomes for each option are:
   • advise Referrer – Closes the referral and returns the referral to the referrer with any comments added
   • resolved, Treated During Assessment – Closes the referral
   • resolved, Patient Request – Closes the referral
   • refer on – allows the CAS to refer the patient onto another appropriate service using the e-RS
   • refer on, Outside the NHS e-Referral Service – records that the patient has been referred to another service that is not available on e-RS
5. Once the required outcome option has been selected and relevant comments added, the additional options available to the user are:
   • don’t Record - Cancels that action and the referral will remain on the Referrals for Assessment worklist
   • record - Saves the assessment outcome but holds it on the Referrals for Assessment worklist to allow for modification at a later time
   • record and Complete - Saves the assessment outcome and will remove it from the Referrals for Assessment worklist (This option is not available if ‘Refer on’ has been selected, as the referral still requires further action)
6. After clicking on Record or Record & Complete a summary will be displayed which can be printed if required.

1. Once Refer on and then Record has been selected, the user has the option to add a clinically appropriate shortlist of options for the onward referral. This should be carried out in conjunction with the patient, where choice of provider should be offered if relevant/clinically appropriate.
2. Selecting Add Shortlist will take the user to the Service Search Criteria screen, allowing clinically appropriate services to be searched for.
3. The following Service Search options are available:
   • the Priority, Clinical Term, Speciality, Clinic Type and other search parameters used by the initial referrer will be displayed; which can be amended if required
   • the Search button can be selected to view the services available to the patient
   • according to the patient’s choice one or more services can be selected for the shortlist
   • if the Request option is selected, this will remove the referral from the Referrals for Assessment worklist and place it on the Appointments for Booking worklist
   • once the patient has booked an appointment the referral will then move to the Outbound Referrals worklist
   • if the appointment is to be booked immediately selecting the Appointment Search button will display available appointments. The patient should be involved in any process when booking an appointment for them
4. The Appointment Details Summary will be displayed with a new UBRN, which is linked to the original UBRN.
5. Selecting Submit will close this screen and the Appointment Summary screen will now be displayed. If required, this may be printed or emailed to the patient. More information on the print and email options can be found on the referring a patient page.
6. A new referral letter can be added at this time by selecting Add Referral Letter or this can be added later from the Outstanding Referral Letters worklist. This will add the onward referral to the Outstanding Referral Letters worklist.

If the referral does NOT require a new referral letter, the original clinical referral information can be accessed by the receiving service using the link back to the original referral (bottom left of the screen).

If the appointment was not booked at the time of creating the shortlist, then this can be done later through the Appointments for Booking worklist. From this worklist the user will need to select the referral for which they would like to book an appointment:

1. Selecting the Actions button will display the Book Appointment option.
2. An appropriate date and time can then be selected in conjunction with the patient.
3. Selecting Book, then Submit and finally Close on the subsequent screens will return the user to the Appointments for Booking worklist.

When a referral has been created and booked as part of the CAS process it will be reviewed by the receiving provider. If accepted, it will disappear from the Outbound Referrals worklist. Alternatively, referrals may be displayed with a status of either Rejected or Cancelled.

Any referrals with a status of Rejected or Cancelled must be managed by the CAS as the original referrer cannot see rejected or cancelled referrals.

Rejected referrals

1. To view the rejection reason the referral should be selected.
2. Selecting the Actions button will display the View History option.
3. In the history audit trail, Reject Appointment should be selected which will show the reason for the rejection and any supporting comments.
4. Selecting the Actions option again will allow the request to either be cancelled or an alternative service selected to refer the patient into.

Options available include:

• cancel Request - will remove the referral from the Outbound Referrals worklist and will close the referral request
• update/Book – allows the user to follow any instructions provided with the rejection (for example, if the patient needs to be referred to a more suitable service)

Cancelled referrals

1. To view the cancellation reason the referral should be selected.
2. Selecting the Actions button will display the View History option.
3. In the history audit trail, Cancel should be selected which will show the reason for the cancellation and any supporting comments.
4. Depending on the reason for the cancellation the next course of action should be considered. The Remove button can then be selected to remove the referral from the Outbound Referrals worklist.

Referrals for review

All patients that have:

• a booked appointment in the service
• a referral letter attached by a GP practice
• have not yet been triaged

Referrals for assessment 

All patients that have:

• been accepted into the service but not yet been assessed
• all patients that have not been triaged/assessed but not yet recorded or completed or submitted and closed
• the status of each patient will be listed in the assessment outcome column (for example not assessed, advise referrer, refer on)

Appointments for booking

All patients that have:

• been referred onto another provider/service for example, patients that have not been referred back to the GP or referred outside e-RS, but where an appointment has not yet been booked with that provider

Outbound referrals

All patients that have:

• been referred to another provider and have a booked appointment that has not yet been accepted by that provider
• been rejected by the onward provider
• had an advice request sent to the onward provider
• did not attend (DNA'd) their appointment with the onward provider