Referral Assessment Services - NHS e-Referral Service

Referral Assessment Services (RAS) allow providers to:

• assess the clinical referral information from the GP/referrer without the need for an appointment being booked
• decide on the most appropriate onward clinical pathway
• contact the patient to discuss choice (if an elective referral)
• arrange an appointment, where needed
• return the triage request to the original referrer with advice, if an onward referral isn't need

This facility 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.

Note: where a RAS is part of a consultant-led pathway, a referral into a RAS service will generate a referral-to-treatment clock start.

Service definers can set up RASs using the service definition screen in e-RS.

To do this:

1. Select the 'Add New Service' button.
2. Under the Request Types Supported section select 'Triage Request'.

Note: that a RAS can be set up to offer advice and guidance as well but cannot be set up to offer appointments.

3. There are no booking requirements for setting up a RAS service as there are no appointments available.
   
   An error message will appear when converting a pre-existing service if it allowed appointment booking
4. Continue to set up the service as you would for any other e-RS service definition.

Find out more about setting up services in e-RS.

Referrers can send their patient referrals directly into a RAS without having to book an appointment for the patient.

Watch our short videos on how to refer a patient into a specific RAS and how to create a shortlist to include bookable and RAS services. 

Once the request has been created, the clinical referral information will need to be attached to the referral before the service provider is able to complete a triage.

Referrers can provide patients with a letter or email if the patient is fully verified with the NHS App, detailing the service that they have been referred to and what to expect next. An example letter is shown below:

RAS referrals can be returned, in the event that the service provider feels that this is necessary. This may be because the referral needs to be redirected to another service, the provider clinician may need more information, or the patient may be suitable for treatment in primary care.

Returned referrals will appear on the Rejected/Triage Response worklist with a referral status of "Triage Response".

Selecting the UBRN from the worklist will open the referral summary screen. From here, referrers have several actions that they can complete for the referral. These will be relative to the referral state. Below is an example of the type of actions that could be available from the Action button.

"Cancel referral" will complete the referral and remove it from all worklists, effectively closing the referral.

Information must be entered into the Reason and Comment fields.

If for example, a triage response has been received informing that the provider will be booking or managing the patient’s referral outside of e-RS, then the "Cancel referral" action should be selected and a reason of "Other" chosen and the appropriate comments entered. Cancelling the referral in this scenario will have no impact on the provider’s management of the referral.

After selecting "Continue" a checking screen screen will be displayed. Selecting "Confirm" will present a screen confirming the action has been completed.

In the example above where a provider is to book or manage the patient's referral outside of e-RS, then any contact with the patient is now the responsibility of the provider and the practice does not need to contact the patient.

"Change service" option from the Action menu above allows the referrer to change the referral to a new service.

If referral letter/clinical information needs amending, this can be undertaken from the "Attachment" section on the Referral summary screen in e-RS, or through the GP integrated system if the files were attach from here initially.

Service provider clinicians can review referrals sent to their service using the "Referrals for Review" worklist. The "Referrals for Review" worklist can show different types of referrals depending on the filters used. This can be filtered to see only RAS referrals when the referral type is filtered by clicking on the "Triage" button.

Below are loaded results showing all referral types.  This is where the filter button (Show All) under the Referral Type has been applied. This can be identified using the Appointment column.

Below are loaded results showing only RAS referrals, where the filter button (Triage) under the Referral Type has been applied. This can be identified using the Appointment column.

Selecting a UBRN will open the referral summary page. From here, the referral should be reviewed and a triage outcome recorded by clicking on the "Record Triage Outcome" button.

Service provider clinicians can then record the triage assessment by selecting the appropriate outcome and adding comments plus attachments if needed.

Service provider clinicians have three different triage outcomes to select:

Refer/Book Now - allows the service provider clinician to shortlist the appropriate service and make a request. The clinician, before making the request, can also book an appointment for the patient if he/she wishes to perform that task. When this option of Triage Outcome is used the referral will be removed from the "Referral for Review" list and will appear on the "Appointment for Booking" worklist if the appointment is yet to be booked. If the appointment has been booked, then you will be able to find this referral on the "Outbound Referral" worklist.

Accept and Refer/Book Later - allows the service provider clinician to change priority of the request and add an attachment if needed. There is also a mandatory comment box which allows the clinician to add onward instructions to allow later processing of the request. When this option of Triage Outcome is used the referral will be removed from the "Referral for Review" list and will appear on the "Appointment for Booking" worklist.

Return to Referrer with Advice - allows the service provider clinician to return the triage request with advice if an onward referral is not needed. When this triage outcome is selected the request will be removed from the provider worklists.

Triaged referrals that require an appointment to be booked will appear on the "Appointment for Booking" worklist.

The Reason column will display the following statuses:

• "Triaged – see comments" – when a clinician has reviewed the referral and added comments/instructions for the administrative staff regarding the booking.
• "Triaged – To be booked" - when a clinician has reviewed the referral and has shortlisted appropriate service/s for the patient with comments/instructions for the administrative staff.

Note: service provider administrators are unable to change the selected service.

To perform an action on a referral, select the required UBRN. Information is displayed which includes the Triage Outcome and Triage Comments. From here the Actions drop down can be selected the appropriate option chosen.

End Triage Request will complete the referral and move it from all the provider's worklists.

Selecting "End Triage Request" will display pop up window allowing a reason and comments to be added (see the image below).

Recent feedback from service providers shows that there is some uncertainty around where the comments entered in the "End Triage Request" field can be viewed and who by.

At this point in the referral process the provider is responsible for the referral; comments entered in this text box are purely for the providers admin and audit purposes. They are not visible to the referring clinician.

Note: any clinician information related to the referral will only be available to you within e-RS for 180 days. Therefore, it is important that information is saved as part of the end triage request if they are likely to need it in the future.

Update/Book allows the provider to change/maintain the service and send request or book an appointment for the patient.

View History allows the provider to view the referral history including the triage outcome and comments.

View Request displays the request details and provides options to add clinical information or additional requirements.

The historical RAS advice, comments and clinical referral information are retained in e-RS. However, providers can only access historical referrals received into a RAS via the "Enquiries" tab (Patient Enquiry) for a period of time*. This period ends when the RAS is archived (after 18 months) or if the provider cancels (via End Triage Request) the RAS. For example, when transferring the referral to the patient administration system (PAS) or a waiting list. The provider can only access the RAS for up to 180 days after it has been cancelled. Only the patient’s GP or referring practice can access the RAS advice, comments and clinical referral information after it has been archived or after 180 days following cancellation.

*Note - historical advice and guidance conversations can only be accessed via the "Enquires" tab until they are archived (after 18 months) or up to 180 days after the advice and guidance conversation has been ended. However, providers can utilise the e-RS "Advice & Guidance Responses" enquiry to search for all historical advice requests they have received. 

Additional support information on RAS's can be found in the e-RS help.