Dummy appointments in the NHS e-Referral Service (e-RS)

To allow patients to book their first hospital appointment via the NHS e-Referral Service (e-RS) patient portal or via the NHS App providers must first link their hospital’s Patient Administration System (PAS) clinics and synchronise appointment slots so they are visible within e-RS. When an appointment is booked via e-RS, information including  the patient’s NHS number allows the patient and their referral to be registered on the PAS.   

The term ‘dummy slot’ is used when an appointment slot is not a real appointment but is used for ‘administrative purposes’. The NHS e-RS cannot determine if an appointment slot is ‘real’ or if it is a ‘dummy slot’.  

Where ‘dummy slots’ are being used they cause confusion and frustration for patients.  More patients are choosing their healthcare provider using digital tools, including managing their referral and first appointment via the Manage Your Referral website and via the NHS App.

Where a patient has different choices from which to select, service names which includes terms “DO NOT ATTEND”, “NOT FOR PATIENT ATTENDANCE” or “ADMIN APPOINTMENT ONLY” are confusing for patients. Even where further information is added to the booking instructions, patients still find this very confusing when shown adjacent to an appointment date and time.

It is recommended that where providers are using ‘dummy slots’ they should move away from doing so as soon as possible.

Providers should be aware of the issues, risks, and impact to patients of continued use of e-RS dummy slots. Providers have 3 options:

1. Utilise Referral Assessment Services (RAS) for all complex pathways, or where pathways require an initial review of a referral prior to the patient requiring an outpatient appointment. Providers can utilise features within e-RS that allow providers to manage access to onward-referred outpatient services and appointments. For example, using Restricted Service functionality and the Patient Booking Window.
   
   Please contact the e-RS team if you require any assistance with using these features.
    
2. Providers should replace all ‘dummy slots’ with real appointment slots which align to the true outpatient waiting times for the speciality and service. This will allow patients to make an informed choice of how long they can expect to wait for their first appointment. There are features within e-RS which allow providers to determine the range of appointments that can be made available to be booked by GPs/referrers or patients.
   
   As an example, Hospital A is currently booking patients from their ENT waiting list into outpatient appointments 30 weeks in the future.  Using the e-RS patient booking window, they have made appointments available in e-RS for routine referrals in a range of 32 weeks to 40 weeks. This allows the hospital to continue book their backlog in priority order up to 30 weeks and any new appointments are then booked via  e-RS from 32 weeks onwards.
    
3. Integration with e-RS is available using modern Application Programming Interfaces (APIs). APIs allow e-RS referrals and advice requests, whether they have been received via a RAS, booked appointment or via an Appointment Slot Issue (ASI), to be managed within the providers’ internal systems. This means the patient and their referral can be automatically registered, the clinical referral information downloaded and managed within the PAS/EPR. Where providers’ PAS/EPRs have been developed to use e-RS APIs there is no need to use ‘dummy slots’ which can significantly reduce the admin burden.