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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.

Referrers are responsible for:

Identifying clinically appropriate services for their patients

Referrers should use the most suitable search mechanism to locate services. Choose from:

• SNOMED Clinical Term
• Speciality and Clinic Type
• Named Clinician

For each potential service identified, referrers should review the service details to ensure that the referral conforms to the service requirements (including exclusions).

Making a referral is always the responsibility of the referring clinician, who with the patient, should decide on the most clinically appropriate options for the referral and onward pathway. Find out more about training for referrers.

Ensuring that patients are supported in selecting their chosen provider and booking their appointment

This will include:

1. Discussing the available options from the list of returned services where the resulting shortlist may contain one or more clinically appropriate options
2. Booking the appointment directly, where either the patient may require support in doing this, or where the referral is for an urgent or Two Week Wait appointment

For all other referrals and scenarios except those in 2 (above), referrers must initiate the referral within e-RS and either:

• book the appointment directly with the patient, providing them with the appointment details letter
• provide the patient with an appointment request letter and password to allow them to make the booking at their convenience (either via the internet (Manage your Referral App, NHS App), on the telephone, or facilitated by a member of the referring practice staff)

Adhering to relevant professional standards when attaching clinical information to referrals within e-RS

The clinical content of the referral letter should be appropriate, but not excessive and where professional guidelines exist, these should be followed.

Referrers should review the service details for the relevant service(s) to ensure that all necessary information is included and that, where indicated, referral pro-formas are completed and attached.

Ensuring that clinical referral information is added within the recommended timescales

The recommended timescales are:

• two week wait and urgent referrals - within one working day
• routine referrals - within three working days