Referring a patient - NHS e-Referral Service

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.

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.

There are three ways to search for services:

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 "Search" (for locally commissioned and national, consultant-led services).

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 "Search" (for locally commissioned and national, consultant-led services).

Watch the video on Specialty and clinic types to understand how they are used to locate a suitable service for patient referral within e-RS.

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 "Search" (for locally commissioned and national, consultant-led services).

Watch our video to see a demonstration on how to initiation a referral (duration 3 minutes). 

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

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.

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.

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.

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

If the details are correct, click "OK".

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.

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.

Watch our video on how to select appropriate services for a patient and create a referral request (duration 7 minutes).

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.

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 up to a limit of 5MB each (unlimited number of files permitted) through the web-based e-RS portal and using APIs. If attaching files through GP integrated systems the total size is limited to 5Mb.
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).
   
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 up to a limit of 5MB each (unlimited number of files permitted) through the web-based e-RS portal and using APIs. If attaching files through GP integrated systems the total size is limited to 5Mb.
7. Select "Submit" to complete the action and return to the "Referral summary screen".

Suitable file types for referral attachments are:

• Plain Text (text/plain) - .txt
• PDF (application/pdf) - .pdf
• XML Text (text/xml) - .xml
• XML (application/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
• DICOM (text/dcm) - .dcm

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.

To convert file types which are not support by e-RS please refer to the 'Attachments - converting files to formats' guidance.

Multiple files up to a limit of 5MB each (unlimited number of files permitted) through the web-based e-RS portal and using APIs. If attaching files through GP integrated systems the total size is limited to 5Mb.

Each worklist must be reviewed and acted upon appropriately. The actions available for each referral will depend on the referral’s history. When an initial referring user accesses the worklist tab they will be presented with a dashboard type format.

Referring clinician

At the top of the screen, the ‘Show referrals for:’ information line will only be displayed to referring clinician users. Other referring users will not see these options. 

The ‘Show referrals for:’ radio button will be automatically defaulted to ‘Me’ on entering the worklist tab.

This means the referring clinician will see referrals in the worklists for which they are the referrer for the organisation they have logged in under.

Changing the radio button to show referrals for ‘My organisation’, will display the total number of referrals in the worklist for the organisation the user has logged in under.

Referring clinician admin/Referring admin

On the worklist home screen, a referring clinician admin or referring admin user will see the total number of referrals for the organisation the user has logged in under. Users will notice that the ‘Show referrals for:’ information line isn't displayed.

Worklists

Users will have six worklists tiles presented.

When a worklist is selected, the associated worklist tile will present a blue line at the bottom of the tile box. This indicates which worklist information is currently being displayed.

Filtering

Selecting any of the worklist tiles will open the worklist and display a filter pane on the left side of the screen.

The options that will be shown in this filter area will be dependent on the referral information available in each worklist.

For example, if only ‘Routine’ and ‘2 Week Wait’ referrals are in the worklist results, then only these options will be available to be selected to filter on.

When filters are selected, these will be applied to the list automatically and will be retained whilst the user remains on the worklist.

The filters will not be retained if the user moves between other worklists, moves between tabs, for example, moving to reports and back again, or logs out and logs back in again.

When filters are selected, a ‘Filters applied’ label appears detailing how many results are being shown from the number of referrals available on the worklist. In the screen example above, there are five referrals out of 27, which are being displayed.

There is an option to ‘Clear all filters’ which returns the user to the original data set.

The filter panel can be hidden to allow further screen space to view the worklist information.

The filter panel can be reintroduced by selecting ‘Show filters’.

Referral data

Column sorting

The column headers can be sorted by selecting the arrows next to the heading titles.

Any sorting applied will be retained if the user moves to a different e-RS screen and then returns. For example, actions a referral and returns to the worklist.

Selecting UBRNs

When a UBRN is selected from a worklist, the user is taken to the referral summary screen where information can be viewed or actions performed. *See the exclusions on this in the Advice and Guidance worklist information below.

Notification badges

In the UBRN column, there are 2 notification badges:

‘New’ badge – this will appear next to any referrals that have arrived on the worklist since the user last viewed it and where no action from the organisation has been taken. This badge will be displayed on the following worklists:

• Rejected/triage response

• Incomplete

• Advice and Guidance

• Assessment returned/Cancelled/DNA

Once the referral has been selected, either by the logged in user or by someone else in the same organisation, the badge will be removed and the count in the worklist tile updated.

If the required action is taken, the referral will be removed from the worklist and the worklist tile count updated.

‘Overdue’ badge – this will appear on the ‘Letters outstanding’ worklist next to any referral for which the clinical information is overdue.

Routine referral letters should be attached within three days of the referral being created, one day for urgent and one day for two Week Wait.

If information is not attached after this time period, the ‘Overdue’ badge will be displayed.

Once a letter is added to a referral, it will be removed from the worklist and the count on the ‘Letter outstanding’ worklist tile updated.

Patient name

If a patient name is too long for the column on this worklist, the user can hover over the name for the full name to be revealed as a tooltip.

Locked referral

If a referral is locked, the name of the user is displayed below the locked UBRN.

The lock indicates that another user within the organisation is working on that referral. If you click the UBRN of the locked referral, a message similar to one below will be displayed.

A lock symbol can also appear if the last user to click on the UBRN within the worklist did not use one of the options available for managing that referral. For example, if after selecting the UBRN, the user closed the browser. The options that should be used are 'Cancel' or 'Go back to worklists'. Such referrals can be locked for upto 30 minutes.

Updating worklists

To the right of the worklist screen, information is shown detailing when the worklists were last updated.

When users select a referral to either perform an action, or review information, and then return to the worklist, the information will automatically be refreshed.

The blue ‘Refresh’ link can be selected to retrieve the latest worklist information at any time.

Export to Excel

When a worklist is selected the user will notice an ‘Export to Excel’ option to the right of the screen. All referring users will be able to export the information displayed on the worklist into an Excel format.

The example above shows how the worklist would look when exported into Excel. The information displayed is exactly what the user was viewing on the worklist. From here, the user can print or save the information.

Add/remove columns

When a worklist is selected the user will notice an ‘Add/remove columns’ option on the right side of the screen. From here a drop-down arrow can be selected. This reveals tick boxes. The user can select which column headings to display or hide from here.

Things to note:

• the columns available to select are based on those displayed in the active worklist

• the columns not shown on this reveal are mandatory and cannot be removed (for example, UBRN, patient name, priority and status)

• to add or remove columns, select the required tick box and select ‘Save’

• any changes are saved permanently and remembered

NOTE: All worklists should be monitored regularly.

Worklist Tiles

Users will have six worklists tiles presented. The 'Referrer Action Required' worklist has been removed and these referrals separated into three new worklists:

• Rejected/triage response

• Incomplete

• Assessment Returned/Cancelled/DNA

This worklist shows referrals that have been rejected and/or returned to the referrer with advice.

Status: Rejected

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.

Status: Triage Response

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

Review and action accordingly.

This worklist shows referrals that have been created but no referral letter has been attached. The count will be the total number of referrals that require letters attaching since the user last viewed the worklist. 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.

In the image example above, there are 15 letters outstanding, with nine of them being overdue.

Once the appropriate action is carried out, either by the logged in user or somebody else in the same organisation, the count will be updated.

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

Referrals on this worklist are draft referrals which have had clinical information attached but have not been completed within the GP system.

Before the incomplete referral can be processed you will need to ensure that a duplicate referral has not been created. This can be done in two ways:

1. Using the Patient tab, you can search by UBRN or patient's NHS number and access the Patient Activity List (PAL). This will reveal all of the patient’s referrals and you can check for duplicate referrals.
2. Check for a duplicate referral within your GP software system – this can be used if you think that the duplicate referral may have been managed outside of e-RS.

From both the Incomplete worklist and PAL a user can select the UBRN which will direct them to the Referral summary screen. There they will have the option to either cancel the request or select a service for patient's referral.

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.

Referrals displayed on this worklist have had an assessment recorded against them, a UBRN cancelled, or a DNA recorded.

The worklist will show the status of the referral and any reason associated to the status.

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.

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.

This worklist shows referrals that have not been booked since shortlisting, or a referral that has been deferred to a provider, or a referral that has had an appointment cancelled and is awaiting booking by the provider or patient.

Booked referrals, whether to indirectly bookable services or directly bookable services, will not be presented on this worklist.

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.

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

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.