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NHS e-Referral Service - support for professional users in response to the coronavirus (COVID-19) guidance

The following information identifies different ways the NHS e-Referral Service (e-RS) can help organisations manage patients’ referrals during the current situation related to coronavirus (COVID-19)


As the NHS moves into a recovery phase following the COVID-19 pandemic, referrers and other healthcare professionals need to continue to make referrals using the NHS e-Referral Service (e-RS). To allow this, secondary care providers must continue to ensure that services remain available on e-RS to refer into. This includes use of specialist advice, including advice and guidance and triage services (Referral Assessment Service - RAS), which allow referrers to seek specialist advice and avoid unnecessary referrals.

This will enable referrals to remain visible, ensure patient safety, and enable providers to manage patients’ referrals and their care in the most appropriate way. As per existing practice, this will also enable the transfer of clinical responsibility from primary to secondary care and allow patient clock starts to be recorded for the purposes of referral to treatment (RTT) and cancer performance monitoring.

Continuing to acknowledge that providers will be managing referrals in different ways, NHS Digital has updated the following guidance which details various features of e-RS that can help referrals and advice requests to be managed safely, triaged and processed according to clinical priority.

Secondary care providers should review this guidance and ensure that the most appropriate features within e-RS to allow Primary Care to make referrals and seek specialist advice to maximise outpatient recovery plans.

Allowing routine referrals to continue to be made

In 2020 new functionality - the patient booking window - was introduced in e-RS to allow providers to set a ‘booking window’ for each clinical priority that a service supports. 

As part of the management of routine and urgent capacity, providers can ensure patients are able to book a future outpatient appointment within a specified booking window, for the priority of the referral.

This functionality can help providers manage which referrals they will accept with a booked appointment (for example, urgent and two week wait) and which they would prefer to manage from the ‘Appointment Slot Issues’ (ASI) worklist (for example, routine), allowing them to triage the referral and book the appointment when ready to do so.

Patient booking window scenario 1

A provider can make their urgent priority appointment slots available within the required timescale (to allow urgent referrals to still be booked, if required) and set their ‘Routine Booking Window’ to start after the end of the polling range. This would ensure that the service is still visible to referrers for any routine referrals, but that they would all come to the provider as ASIs, to be triaged and recorded on the patient tracking list (PTL) and then managed at a future date.

Below is a diagram showing slots available in e-RS only: 

Diagram showing when an e-RS appointment can be booked when the booking window is applied

Patient booking window scenario 2

Having used the patient booking window as per scenario 1, providers can make further use of this feature to reintroduce routine appointment slots for patients and referrers to book into directly. This reduces the admin overhead of continuing to manage referrals as ASIs.

Before doing this, it is important that providers understand the size of their waiting lists to determine an appropriate date from when new appointments can be offered on e-RS for routine referrals. The patient booking window can be reviewed and adjusted accordingly as waiting times are reduced.

Below is a diagram showing how a provider can reintroduce routine appointment slots to e-RS, taking their current waiting list into account ( and still allow urgent or 2WW appointments to be booked). 

Diagram showing when an e-RS appointment can be booked when the booking window is applied to manage PTLsUsing the patient booking window as above is recommended rather than  reducing the e-RS slot polling range to zero.

Important points to note if continuing to set the polling range to zero: 

  • setting a polling range to zero will remove ALL appointments of every priority from each service this change was applied to
  • even when reducing slot polling to zero days, if an appointment is cancelled in either e-RS or PAS (and not the actual clinic slot in the clinic template on PAS), and an appointment is cancelled ‘today’ that slot will still be visible to patients (who have already been accepted into that service) to re-book into until the next overnight poll 

Remember – if appointments for routine referrals need to be cancelled, then using the patient booking window functionality will ensure that those referrals cannot be rebooked, either by the patient, their referrer or the appointments line, outside of the routine appointment ‘window’, for example, into appointment slots within the booking window defined for urgent appointments. 

However, the provider can rebook, if required (as in this example), any cancelled routine referral into an urgent priority slot.

Find out more about the patient booking window.

Advice and guidance

e-RS advice and guidance allows referring clinicians to seek specialist advice from provider clinicians, allowing consultants and other hospital clinicians to provide support to referrers in relation to a patient’s condition. Use of specialist advice helps to reduce unnecessary hospital referrals and minimise the need for face-to-face appointments.

As part of outpatient recovery, use of specialist advice should continue to be considered ahead of any referral being made, where appropriate, so that only those referrals that are clinically necessary at the present time are made to providers. Advice back to referrers from provider clinicians should, wherever possible, maximise management of patients in primary care.

New functionality has now been introduced which allows a provider clinician to convert an e-RS advice and guidance request into a referral, if they have been authorised to do so by the referrer and it is clinically appropriate to do so.

Find out more information about converting an advice and guidance request

Remember – e-RS now allows providers to set-up ‘Advice Only’ services which may help providers to manage the current situation. Setting up these service types at specialty level would support consultants and other clinicians to share the response process.

Find out more by reviewing the advice and guidance toolkit.

Referral Assessment Services (RAS)

e-RS/Referral Assessment Services (RAS) allow the referrer to send a referral to the provider clinician to enable them to assess the clinical information and/or triage the patient, prior to (or instead of) booking an appointment. RAS should only be used as part of a clinical pathway, where it adds value to the patient. Responsibility rests with the provider for managing the patient’s onward pathway and communicating with the patient, so they know what to expect, especially where waiting times are extended.

Providers can use RAS as part of any outpatient pathway and when combined with the use of 'Service Restriction' this allows the onward appointment to be booked within e-RS. For example, a referral is triaged and can be onward referred and booked into either a face-to-face appointment or a telephone/video appointment which (by being restricted) is only available to the provider via e-RS.

Find out more on Referral Assessment Services and Restricted Services

Remember - providers need to be aware that, as with any onward/refer-on pathway, once a restricted service has been shortlisted by any form of triage or pathway service, then the patient (via manage your referral website, the NHS App or the appointment line) is potentially able to see the details of the shortlisted service(s) and could therefore book or amend their appointment.

Please contact if you would like more information on how to set-up outpatient pathways using restricted services functionality.

Telephone/video assessment service

e-RS has been updated to allow providers to set-up telephone/video appointment services. The telephone or video appointment date/time should be agreed with the patient and the process clearly explained, so that the patient understands what method the clinic will be using to contact them. For example, via telephone or an online consultation.

Further guidance on how e-RS can support the management of referrals during outpatient recovery

Review the following support information from our guidance page:

  • Using provider worklists to safely manage referral
  • Clinical referral review and triage
  • Use of instructions in the directory of services (DoS)
  • e-RS extracts
  • Referral to treatment reporting
  • Cancelled and un-booked appointments

Last edited: 18 August 2021 4:14 pm