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Independent sector provider guidance for the NHS e-Referral Service

This guidance will support Independent Sector Providers (ISPs) in understanding how to make their services available for referral and booking through the NHS e-Referral Servic, including gaining authorisation to access NHS Systems and using the NHS e-Referral Service.


Before patients can be referred to an ISP through the NHS e-Referral Service, there are a number of building blocks that need to be in place:

1. Contract

ISPs must have a contract agreed by one or more NHS Commissioner for each service they want to set up on the NHS e-Referral Service.

2. Compliance

To have access to the NHS e-Referral Service, each ISP must have:

  • an N3/HSCN connection
  • an Organisational Data Services (ODS) code
  • necessary Information governance assurance

3. Connect

ISPs will connect to the NHS e-Referral Service using smartcards which will be issued and managed by a sponsoring commissioner.

4. Commission

ISPs setting up services on the NHS e-Referral Service directory of services need to have each one commissioned within the system to appear on the primary care menu.

Gaining authorisation to access NHS systems

Dedicated support for independent and third sector providers of NHS services that require integration with NHS systems and applications is available through the NHS Business Partners Programme.

Of particular relevance for connecting to the NHS e-Referral Service is the NHS Business Partners mini guide, available within the ‘Further Guidance’ section of the business partners website. Amongst other things, this document provides guidance on:

  • contracting
  • information governance assurance
  • obtaining an ODS Code
  • installation of an N3/HSCN connection

Using the NHS e-Referral Service

The starting point for all providers looking to use the NHS e-Referral Service is to consider:

  • which services they will deliver and where
  • which NHS e-Referral Service models are most appropriate
  • how patients will book their appointments
  • who will manage the administration of referrals and bookings

Where will services be delivered

All services on the NHS e-Referral Service must be set up against the address at which the clinic is held, and each address must have its own unique location code. These codes are called Organisation Data Services (ODS) codes and, within the NHS e-Referral Service, are listed in brackets after each organisation name.

Independent Healthcare Service Provider (IHSP) organisations are setup differently to NHS organisations, as each IHSP has a “HQ” organisation ODS code, with specific location codes below it.

It is important that the NHS e-Referral Service roles (service definer, provider clinician etc. are created under the “HQ” codes and not individual location codes.

Which service is most appropriate

Most services on the NHS e-Referral Service allow the referring clinician to refer patients directly, based on their clinical judgement and the supporting information in the directory of services. In other cases, it may be appropriate to use a referral assessment service (RAS) or clinical assessment service (CAS) model.

A RAS offer a facility which supports complex care pathways, such as gastroenterology and cardiology, where it's not always clear whether a patient needs a consultant appointment or a diagnostic test. A RAS set up by the provider will ensure patients' referrals are triaged correctly.

Find out more about referral assessment services.

A CAS is an intermediate service that allows for a greater level of clinical expertise in assessing a patient than would normally be expected of a referring clinician, for example, a GP. This expertise should be used to ensure that patients are directed efficiently and effectively into the most appropriate onward care pathway.

Learn more about clinical assessment services.

How will patients book their appointments

How patients book their appointment is dependent on whether the service is set up as directly or indirectly bookable (DBS or IBS). The ability to offer a DBS system is determined by whether the provider’s Patient Administration System is able to support the messaging exchanges required with the NHS e-Referral Service.

Directly bookable services (DBS)

Patients can book and manage their appointments online, either:

  • at their referring practice, for example their GP surgery
  • via the Manage Your Referral (MYR) online service
  • by ringing the appointment line (TAL)

Appointments will be booked straight into the provider’s patient administration system (PAS), which will also register new patients. Any appointment changes made in the NHS e-Referral Service will be updated automatically in PAS.

Indirectly bookable services

Patients can only book their appointment by contacting the service/clinic they are referred to. Within the directory of service, clear instructions must be given to the patient on how to book their appointment including the times that they can call to make their booking.

The provider has to book the appointment into the NHS e-Referral Service and their PAS separately. Any changes to appointments must be updated in both the NHS e-Referral Service and PAS to ensure that information is kept up to date.


To understand who needs to be given a smartcard and the appropriate roles, providers need to consider the following:

Appointment booking

  • if offering DBS, this is done on-line and into PAS automatically
  • if offering IBS, booking staff will be needed

Clinical triage

  • referrals must be reviewed by an appropriate clinician
  • a process must be in place to do this
  • the NHS e-Referral Service supports online triage processes
  • if a referral is not considered clinically suitable for the service it will need to be managed
  • the patient will have an appointment that needs cancelling or rearranging

Appointment/referral management

  • appointments can be changed either by the patient or provider
  • how they can be changed is dependent on the service set up (DBS or IBS)
  • providers will need to chase referrers where patients have an appointment but the referrer letter has not been attached yet

How will users access the system

Once an ISP has its ODS code(s) and N3/HSCN connection, a smartcard - with relevant roles on it - will be needed for each user. A registration authority (RA) sponsor can provide smartcards and will add/remove roles as appropriate. ISPs will need to work with their (main) commissioner to identify an RA sponsor.

Learn more about the NHS e-Referral service business roles

Next steps

Providers should review the supporting information and technical guidance available within NHS e-RS business roles.

Last edited: 15 September 2020 3:43 pm