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Best practice guidelines for service providers - NHS e-Referral Service

Generic guidelines for service providers and their responsibilities in the NHS e-Referral services (e-RS)

Generic guidelines

Users of e-RS must be appropriately qualified, trained, and compliant with required information governance standards. Find out more about information governance

Clinicians are responsible for any decision to delegate clinical actions within e-RS to non- clinicians.

Certain aspects of the system require clinical input, such as selecting clinically appropriate services, and reviewing referral information. Other tasks can be more appropriately carried out by administrative support staff, such as booking or re-scheduling appointments. Review the clinical responsibilities when delegating roles information for guidance about appropriate delegation.

Appropriate members of the clinical or administration teams must monitor worklists on a daily basis, to support effective management of referrals. Find out more about training on the management of worklists (N3/HSCN connection required to access this link).

Technical support teams must ensure that the correct equipment, infrastructure and user support is in place to enable optimum use of e-RS in all appropriate workplace environments.

Managers must ensure that operational policies (for example access or referral management policies) reflect the guidelines described in this page and that all relevant staff adhere to them.

Find out more about tools provided by the NHS Interim Management and Support (IMAS) intensive support team.


Service provider responsibilities

Service providers are responsible for:

Describing and publishing in e-RS directory of services all services which accept referrals from primary care clinicians (for example, GPs).

Providers must ensure that all clinics which accept referrals from primary care clinicians are correctly mapped to e-RS.

These services should be set up as directly bookable on e-RS, unless there are valid technical reasons preventing this (for example, current lack of compliance with Radiology Information Systems).

Providers must inform commissioners of the reasons for any services that are not directly bookable. Providers must ensure that a development plan is agreed with commissioners for transitioning to directly bookable services. This must not, however, prevent these services being set up on e-RS as indirectly bookable.

Find out more information about creating and maintaining directory of services.

Ensuring that all entries in the directory of services are current and accurate representation of the clinical services they deliver.

Clinicians must be involved in agreeing the clinical content of the directory of services. It is good practice to involve both referrer and provider clinicians in this review.

For each service, a lead clinician must take responsibility for agreeing and signing-off the clinical content of the service details.

A regular review of all directory of services entries must be undertaken (for example, at least yearly or sooner if there is a significant change to the service specification).

There should be a documented process to manage any changes to service details, including further clinical review and sign-off.

Making sufficient appointment slots available within e-RS to match referral volumes.

All new appointment slots should be released to e-RS.

Where appointment slot issues do occur, these should be managed according to the guidance published in the managing and minimising appointment slot issues information.

Managing within the e-RS application any alterations or cancellations to appointments booked through e-RS and discussing any changes with the patient.

Where a booked appointment is cancelled due to a referral being re-directed or a clinic alteration, the patient should be fully involved in choosing the location, date and time for their new appointment, which should be re-booked within e-RS.

Undertaking a clinical review of the referral information in e-RS in a timely manner.

All referrals received should be assessed for suitability and priority in line with local access policies.

Referrals should be reviewed and processed within e-RS within clinically acceptable timescales (to be agreed with local commissioners).

Any inappropriate referrals should be redirected to a more appropriate alternative service, if one can be identified, or rejected back to the referrer where the referral is clinically inappropriate, with clear information for the referrer as to why it was rejected.

Adding named clinicians to all consultant-led services in the directory of services.

Providers must comply with choice guidance and patients’ rights (including legal directions) under the NHS Constitution.

Information is available on NHS Choice Framework and guidance on making named clinician referrals.

Offering clinical advice and guidance services through e-RS, whether this leads to referrals being made or not.

There should be a documented process for managing responses to advice and guidance requests.

As with reviewing referrals in e-RS, provider clinicians should take responsibility for the clinical content of the response.

Clinically acceptable response times should be agreed with local commissioning organisations and adhered to by the service provider.

Find out more about advice and guidance.

Ensuring that clinical assessment services are only published in e-RS directory of services where they add clinical value to the patient pathway.

Clinical assessment services should only be used where an additional level of clinical expertise is needed to ensure that the patient is treated in the most appropriate service.

Clinical assessment services should be specialty-based and targeted to support local referrers and specific patient pathways.

Find out more about clinical assessment services.

Last edited: 15 November 2019 2:42 pm