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

The following steps should be followed by a service provider in managing clinical assessment service (CAS) referrals in the NHS e-Referral Service.

Reviewing referrals

image of a reviewing referrals screen within the NHS ERS

  1. all referrals for review will appear on the Referrals for Review worklist once an appointment is booked and referral letter attached
  2. the UBRN of the referral to be reviewed should be selected. A summary of the referral details will be displayed

Available actions include:

  • selecting Accept, Review Next or Record Assessment to accept the referral. If the record assessment option is selected then the next screen displayed is the Record Assessment screen
  • selecting Accept, Review Next to display the next referral for review. This accepts the referral into the service and allows the referral to be assessed at a later time
  • selecting Cancel to return the user to the worklist
  • selecting Accept, Review Next moves the referral to the Referrals for Assessment worklist

Once a referral has been accepted, it cannot be rejected or further/supplementary information requested from the original referrer via the NHS e-Referral Service. A referral should therefore only be accepted once it has been triaged and is ready for the next stage.

Other available options for the reviewing clinician

  • reject– if clinically inappropriate, the referral can be returned to the referring clinician. A reason should be added indicating why the referral is being rejected
  • change Appointment Date/Time – this can be used to change the appointment date if required. A reason for the change will be requested. Selecting this option will automatically accept the referral, removing it from the Referrals for Review worklist
  • change Service – this can be used to change the service to a more clinically appropriate service. Again this will automatically accept the referral
  • add Clinical Information – this can be used to instruct clinical or administrative staff to arrange any tests that are required prior to the appointment
  • add Additional Requirements – this can be used if the patient requires transport, advocacy or interpreter services arranging for the appointment and if the receiving service has made these options available

Recording assessments

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 NHS e-Referral Service
    • refer on, Outside the NHS e-Referral Service – records that the patient has been referred to another service that is not available on the NHS e-Referral Service
  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

Referring on and shortlisting services

  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
    • either the Search Primary Care or Search All buttons 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. This may be printed for the patient if required
  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.

Booking an appointment

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

Managing the outbound referrals 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

It is important that referrals in a Rejected state on this worklist are managed by the CAS to allow other users to modify the referral.

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

If the referral remains in a rejected (and therefore un-booked) state, the patient will be sent an automatic reminder letter to book their appointment.

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

Overview of CAS worklists

Referrers 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

Referrers 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 assessement outcome column. For example not assesed, 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 oneward provider
  • DNA'd their appointment with the onward provider

diagram of ers flow chart and managing clinical assessment services

Last edited: 15 November 2019 12:28 pm