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Once the referrer has selected the defer to provider option, the patient must choose which of the services with no slots they would like to be referred to – a referral request can only be deferred to one service. This is done by selecting one of the radio buttons on the deferral options details screen.
From the deferral options summary screen the referrer can confirm the patient’s choice of provider and print the appointment request letter. Both this screen and the letter will indicate a date by when the patient should have heard from their chosen provider, and will be based on the priority of the referral.
The date is calculated from the date of deferral plus:
- two working days for two week wait referrals
- five working days for urgent referrals
- ten working days for routine referrals
The referrer can monitor the status of their patient’s referral via the awaiting booking/acceptance worklist, which will show the referral as deferred to provider until it is booked.
Patients will not be sent reminder to book letters while their referral is in a deferred to provider state. This helps to alleviate the frustration experienced by patients who have tried to book an appointment, been told that the provider will contact them and who then receive a letter reminding them to book their appointment.
Appointment slot issues compound waits by creating a backlog of patients whose waiting time has already started, creates a significant amount of avoidable administrative work and can cause patient safety issues as outlined above.
Providers must remember that:
- they are contractually required to ensure that sufficient appointment slots for first outpatient appointments are available on e-RS as set out in the NHS Standard Contract 2018/19
- all NHS organisations must have systems in place to promote equality and support all patients in the booking of their outpatient appointments
- they are obliged to accept all clinically appropriate referrals and cannot turn patients away because they are not able to treat them within waiting time targets
- the waiting time clock starts as soon as the referral appears on the provider’s ASI worklist within e-RS
- if the referral is being sent initially through a clinical assessment service (CAS) then the waiting time starts from the date on which the original assessment appointment is booked
- if the referral is sent initially through a referral assessment service (RAS) then the waiting time starts from the date that the clinical referral information is attached to the RAS referral and it then appears on the provider’s referrals for review worklist
Managing the Appointment Slot Issue worklist
Senior managers in provider organisations should ensure that all staff managing the ASI worklists are appropriately trained, are in the correct workgroups and have the necessary skills and authority to manage these referrals effectively and within the required timescales.
If a two week wait referral is entered into the ASI process, it will appear immediately at the top of the provider’s ASI worklist. As outlined above, the patient will expect to be contacted within two working days to arrange their appointment. Providers should make every endeavour to always ensure that there are sufficient appointments available for their two week wait services in order to minimise unnecessary stress to patients. Patients whose two week wait referrals appear on an ASI worklist should be contacted by the provider immediately to have an appointment booked. Urgent and routine patients expect to be contacted within one week and two weeks respectively.
The UBRN received date will turn red when the date given to the patient has already passed. Providers must not wait until the UBRN received date turns red on their worklist before they take action as it is likely that the patient will be in the process of contacting either their referrer or service provider to say that they have not received an appointment and potential patient safety issues may be occurring. It is recommended that all non two week wait patients are contacted within four working days to have their appointment arranged.
If the provider is unlikely to be able to arrange a patient’s appointment within the necessary timescales, the provider should contact the patient to explain the delay and provide details of how they can be contacted with any further queries. The provider should not direct the patient to contact their GP unless they now wish to book with a service not on their original shortlist.
From the ASI worklist providers can perform the following actions:
- add additional requirements
- book appointment
- cancel request
- record ASI contact
- review referral
- view history
- view request
The key actions are further explained below:
This will open the ‘Appointment Search Screen’, from where it is possible to book the appointment into:
- an ordinary, available slot
- a reserved slot (which is identified with an *)
- a slot within the ‘slot protection’ time.
It is worth noting that where named clinician functionality has been used to search for services and an ASI has been experienced, this may be because there are no appointments available for the named clinician, but there may well be appointments still available within the service for generic referrals. Where a referrer has used a named clinician to search for services this will be displayed on the Deferral Options Summary screen and also on the Appointment Search screen.
Wherever possible the patient should have their appointment booked within e-RS. If this is not possible and the appointment has to be booked outside of e-RS, then the appointment request within e-RS must be cancelled and the reason ‘Patient booked outside the NHS e-Referral Service’ should be selected from the list. It is good practice to also enter the date and time of the new appointment in the accompanying free text box. This information will be available to all professional users who view the history of the referral.
Record ASI contact
This enables the provider to make a record of a contact (or attempted contact) with a patient whose referral is in the ASI process. The ‘Record ASI Contact’ option allows free text relating to the contact to be recorded and be available to others managing the process. ASI contacts are recorded in the history of the referral and are always available from any worklist that allows users to view the history. This functionality helps providers to manage their ASI worklists and maintain a record within e-RS of all attempts to contact a patient in order to book their appointment. Referrers and other users accessing the patient history will also be able to see both the number of attempted contacts and the recorded outcome of each.
Provider clinicians can review the referral information and decide what the most appropriate course of action is for the patient prior to an appointment being booked.
There are three options when using this action:
- Refer/Book Now - Accepts the referral into the service and continues on to the service search screen where you can shortlist services for the patient to be booked in to.
- Accept and refer/book later - Accepts the referral into the service and puts the referral onto the Appointments for Booking worklist for admin staff to book an appointment for the patient.
- Return to referrer with advice - If the referral is not appropriate for the service or if further information is required from the referrer prior to acceptance, the referral can be sent back to the referring clinician with comments from the provider clinician.
This enables the provider clinician to review the clinical referral information prior to the booking to ensure the patient’s referral does not remain on the worklist if it is clinically inappropriate for them to wait.
Note: referrals will be removed from the worklist after 180 days if no action is taken.