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Referring a patient - NHS e-Referral Service

A step-by-step guide to referring patients using the NHS e-Referral Service (e-RS). Initiate referrals, attach referral letters, and manage existing referrals.

Initiate a referral

If you are referring using the NHS e-Referral Service web-based system, firstly, find the patient in the "Patient Tab" using one of the three search methods: NHS number, Unique Booking Reference Number (UBRN) or Demographics.

Image of screen banner with no information entered.

Once you have done this you can refer the patient.

Select "Refer/Advice".

If you are referring using an integrated GP clinical system (such as SystmOne, EMIS), start the referral process according to the system’s guidance.

For both methods, you will then reach the "Service Search Criteria" screen and continue with the referral creation process in the following way:

  1. If you are logged in as a "Referring Clinician Admin" you will need to select the "Initial Referring Clinician".
  2. Click on the "Request Type" drop-down and select the "Referral" option.
  3. Click on the "Priority Type" drop-down and select an appropriate priority.

In the "Service Search Criteria" screen, complete at least one of the mandatory fields (marked with a *). Each field in this screen can be filtered to aid quick selection of the correct services.

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There are three ways to search for services:

1. Searching for services using clinical terms

Image of clinical terms with information entered (knee).

  1. Enter the SNOMED CT clinical term that you wish to search for in the "Clinical Term" field.
  2. Click on the ellipses (or press "Return") and the "Clinical Term Search" screen will appear.
  3. The term you are looking for is populated in the "Find" field.
  4. A list matching your initial clinical term will be displayed.
  5. Click on the appropriate term to select it.
  6. The "Preferred Term" field is now populated.
  7. Select your preferred term which will then appear in the "Selected Term" field.
  8. Once you are satisfied with your preferred term, select "Done".
  9. If you are not satisfied with any of the terms shown, click on "Clear" and start your search again.
  10. When you return to the "Service Search Criteria" screen, the clinical term field will have the SNOMED CT term that you have selected.
  11. Select either "Search Primary Care" (for locally commissioned services only) or "Search All" (for locally commissioned and national, consultant-led services).

2. Searching for services using speciality and clinic type

Image of specialty and clinic type, specialty information entered clinic blank.

  1. Open the drop-down list by clicking the "Specialty" box and selecting the appropriate specialty.
  2. Select the correct clinic type using the "Clinic Type" drop-down.
  3. Select either "Search Primary Care" (for locally commissioned services only) or "Search All" (for locally commissioned and national, consultant-led services).

3. Searching for services using named clinician

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  1. Enter the surname of the clinician in the "Named Clinician" field on the "Service Search" screen.
  2. Click on the ellipses (or press "Return") and the "Named Clinician Search" screen will appear.
  3. Select the appropriate clinician (or use the other search fields first, to refine your search) and then choose "Done".
  4. When you return to the "Service Search Criteria" screen the "Named Clinician" field will have the clinician you selected.
  5. Select either "Search Primary Care" (for locally commissioned services only) or "Search All" (for locally commissioned and national, consultant-led services).

Service selection

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Click in each checkbox beside the service(s) chosen.

e-RS appointment search and request buttons

Then you can select either:

  • "Appointment Search" to book an appointment for the patient
  • "Request", which lets you complete the referral, allowing  the patient or their representative to book an appointment at a later stage

Selecting either of these options will display a pop-up window with further details on the service(s) selected.

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From here, you can check that your patient meets the referral criteria and then choose to either:

  • deselect inappropriate services
  • return to the previous screen to change the service selection
  • continue with the selected services

If you choose to book an appointment using the "Appointment Search" function the next screen will display appointment dates.

Image of appointment search criteria with information entered.

Select an appropriate day and time.

Select "Book" to continue with the referral.

Note that when you either book an appointment or select the "Request" option, you will be prompted by the "Check Patient Details" pop-up box to confirm that the patient’s contact details are correct.

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To change the patient’s details, click on the "Update Person" button.

If the details are correct, click "OK".

Complete the referral

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After reviewing the patient’s details, you are presented with the "Appointment Request Details" screen.

Note that, at this stage, the referral is not complete. This is an opportunity for you to check that all of the referral information is correct.

If the information is correct press "Submit".

If any of the information is incorrect, you can make changes using the "Back" button.

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The last screen is the "Appointment Summary" screen. From this screen you can print the request/appointment details for the patient, if applicable you can add additional requirements such as an interpreter or patient transport and you can add a referral letter.

Note that adding an additional requirement merely flags to the provider that you feel these are necessary. It does not book them.

Attach a referral letter

If the referral is created directly via an integrated GP clinical system, the referral letter/clinical information can be attached via that system. You will need to check the help information/training materials for that system to learn how to do this.

Attaching a referral letter via the web-based e-RS application can be done in several ways.

Attaching a referral letter as part of the referral process

When you have completed the referral request or booking, select the "Add Referral Letter" button in the summary screen.

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This will take you to the "Clinical Referral Information" screen.

  1. Select "Add Attachment".
  2. A referral letter should have been previously created and saved to a secure location.
  3. Locate the file and select "Open" to attach the file.
  4. This step can be repeated to add multiple files to a limit of 5MB each (number of files permitted in total is 50MB).
  5. Select "Submit ".
  6. Select "Close" to complete the action.

Attaching the referral letter as a separate task

From the "Patient Activity List" (Patient tab) or "Outstanding Referral Letter worklist":

  1. Select the appropriate UBRN.  
  2. From the "Referral summary screen", select the "Add Referral Letter" option from the "Actions" button (see image below).
    Image showing available actions for a referral, including 'Add referral letter'.
  3. A referral letter should have been previously created and saved to a secure location.
  4. Select the "Choose a file" button.
  5. Locate the file and select "Open" to attach the file.
  6. This step can be repeated to add multiple files to a limit of 5MB each (number of files permitted in total is 50MB).
  7. Select "Submit" to complete the action and return to the "Referral summary screen".

Suitable file types

Suitable file types for referral attachments are:

  • Plain Text (text/plain) - .txt
  • HTML Text (text/html) - .html, .htm
  • PDF (application/pdf) - .pdf
  • XML Text (text/xml) - .xml
  • RTF Text (text/rtf) - .rtf, .rtx
  • Basic Audio (audio/basic) - .au
  • MPEG audio layer 3 (audio/mpeg) - .mp3
  • PNG Image (image/png) - .png
  • GIF Image (image/gif) - .gif
  • JPEG Image (image/jpeg) - .jpg, .jpe, .jpeg
  • TIFF Image (image/tiff) - .tif, .tiff
  • MPEG Video (video/mpeg) - .mpg, .mpeg, .mpe
  • MSWORD (application/msword) - .doc
  • MSWORD (application/vnd.openxmlformats-officedocument.wordprocessingml.document) - .docx

If there are any queries about attachment file type, check the above and ask the Service Provider’s IT department to allow it within their organisation.

Managing worklists

Each worklist must be reviewed and acted upon appropriately. The actions available for each referral will depend on the referral’s history.

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When you open the Worklists tab you will see two filters ("Filter by Referrer" and "Filter by Worklist") allowing you to sort the referrals you want to see.

Columns can be sorted by clicking on the heading. When you have done this, a white arrow will appear next to the heading.

e-Rs UBRN created filter

Referrer action required worklist

Referrals on this worklist must be acted upon. They will have one of the following categories in the "Referral Status" column:

e-RS referral status


After the receiving clinician has assessed the referral information provided by the GP; it is felt that the patient could be managed more effectively either by an alternative, more clinically appropriate service or in primary care. The referrer must act upon these referrals. This may include cancelling the referral or identifying new, more suitable services.

View any comments made by the service provider and take clinically appropriate action from the options available.

Cancelled UBRN

Referral requests, along with the patient’s appointment have been cancelled.

Check the reason why the referral request has been cancelled and remove it from the worklist.

Assessment Result

Referrals with this status have been sent to a service with Clinical Assessment Service (CAS) functionality.

Review and remove.

Triage Response

Referral sent to a Referral Assessment Service (RAS) has been assessed by a service provider and sent back.

Review and action accordingly.

DNA (did not attend)

If a patient was referred to a directly bookable service and they did not attend their appointment, the provider sends this back to notify the referrer.

View the referral and take the appropriate action, which may include re-submitting the referral request to the same (or a different) service.

Awaiting booking/acceptance worklist

Referrals on this worklist should be monitored but not necessarily acted upon. In the "Referral Status" column each referral will be categorised as either:

  • Booked
  • Cancelled by Patient/Provider
  • Deferred to Provider
  • Not Yet Booked
  • Awaiting Triage

Referrals will move on and off this worklist depending on the actions carried out on them. These actions may be made by the provider, patient or referrer.

Monitor this worklist and decide what/whether/when to act upon each referral.

Outstanding referral letters worklist

Referrals on this worklist require actioning. A referral has been created but no referral letter/clinical information has been attached. Once a referral letter is attached (either via the web-based e-RS system or an integrated GP clinical system), the UBRN will be removed from this worklist.

Service providers will not be able to view and action the referral until a referral letter has been added.

The “Letter Due” date is automatically calculated. For Routine referrals it is 3 days after the referral request is created, 1 day for Urgent and 1 day for 2 Week Wait. After that time, the date in the Letter Due column will turn red as a reminder. This date will turn Red when the referral letter is overdue.

Advice and guidance worklist

Referrals on this worklist are for advice requests and responses. You can act by either replying to the response, ending the conversation, converting the response into a referral or remove the referral from the worklist (provider converted referrals only).

  1. Select the UBRN.
  2. Review the contents, which may include attachments.
  3. If you need to continue the conversation you can type your reply and click "Submit".
  4. Where no further action is required, print the conversation for the patient’s medical records if required and click "End Conversation" or, for a referral that has been converted by a provider, "Remove from worklist".
  5. Where a referral is required you can click "Refer Now" to convert the UBRN into an appointment request.

The patient tab

The "Patient" tab can be used to find a patient’s referral if you have the right smartcard access and the referral has been active in the last 18 months.

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You can search for a patient using either their NHS number, a specific UBRN or their demographic information.

Image of patient search screen with information entered.

A "Patient Activity List" will be displayed with each referral created for the patient, with actions for each one.

In the "Patient" tab you can also use the "Update Person" button to change patient information.

Select the "Show all Non-Archived Referrals" tick box to see referrals for the patient that were last acted upon 18 months ago or more.

Last edited: 5 October 2021 10:44 am