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Guidance on how the NHS e-Referral service (e-RS) can support the management of referrals during outpatient recovery

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As the NHS moves into a recovery phase following the COVID-19 pandemic service providers must continue to ensure that services remain available on e-RS to refer into. This includes use of advice and guidance and triage services (Referral Assessment Service - RAS), which allow GPs/referrers to seek specialist advice and avoid unnecessary referrals.

The information below will help providers to support the management of referrals during the outpatient recovery period.

Using provider worklists to safely manage referrals

Providers should closely monitor the ‘Appointments for Booking’ worklist which displays all referrals (UBRNs), including those that have had their appointment cancelled, either by the referrer, the assisted digital service line or the patient themselves via the Manage your referral website or NHS App. Referrals are displayed in order of their clinical priority. In addition to appearing on this worklist, the referral will also be visible on the referring practice’s worklist, so they can also see that an appointment has been cancelled and needs to be re-booked.

All referrals that are cancelled will appear on the appointments for booking worklist, so it is important, while many appointments are being cancelled, that providers manage this worklist carefully.

If providers are receiving an increased number of referrals (UBRNs) on the Appointments for Booking and Appointment Slot Issues (ASI) worklists it is recommended that worklist filters are used to limit the list of referrals (UBRNs) displayed. For example, filtering the worklist by a specific specialty, location and/or service will reduce the number of referrals being returned. Use 'Reset all filters' to return to the original view or select an alternative filter.

Find out more information about worklist filters.

All referrals that are remaining on an e-RS worklist must have been added to the provider’s waiting list/patient tracking list (PTL) and clinically triaged to ensure one of the following:

  • they are clinically appropriate for the service they have been referred into
  • if possible, advice could be offered back to the referrer so that the patient can more appropriately be managed in primary care
  • the referral priority does not need to be changed
  • the patient’s care will not be adversely impacted by the extended wait

Referrals remain on the provider worklist in e-RS until the earliest of three events occurs. Either:

  • an appropriate action is recorded on e-RS to manage the referral (for example, appointment is booked from the ASI worklist)
  • an appointment date passes (Referrals for Review worklist only)
  • 180 days pass with no action since the unique booking reference number (UBRN) last 'entered' the worklist

Where providers follow the guidance for managing and minimising appointment slot issues they will have a complete record of all referrals within their patient administration system (PAS), even where they have been unable to book an appointment through e-RS within the 180 days window. Providers should also review the Elective Care Intensive Support Team 'Rapid Improvement Guide for the management of ASIs' which can be found on the Futures NHS Collaboration platform (login required). 

Providers should utilise the weekly worklist drop-off extract (EBSX12) to ensure all referrals are being managed. This extract includes all referrals, from the previous reporting week, that have dropped off any provider worklist after 180 days of no activity since it arrived on the worklist.

Find out more about the EBSX12 extract.

 

Finding a referral via the Patient Enquiry

The 'Patient Enquiry' for provider organisations returns advice or referral requests with which the user/organisation has a relationship. Historically certain requests were excluded from this.

July 2022 change:

​Given the current long waiting lists, the time the advice or referral information is available to providing users is now causing issues meaning workarounds are being used.

This change allows advice requests and referrals that would previously not have been visible in the ‘Patient Enquiry’ due to having been closed or cancelled more than 6 months ago, to now be displayed. For example, an advice request which was closed more than 6 months ago, or a triage request which was ended more than 6 months ago.

The advice or referral information for all referrals is now available on the provider’s ‘Patient Enquiry’ up to 18 months/550 days from the date of the last activity on the advice or referral (by any appropriately authorised e-RS user in that organisation).

Use of instructions in the directory of services (DoS)

Within the definition of each service on the DoS, providers can use the ‘Instructions’ section to relay important information to patients. These are then displayed on the ‘Appointment Summary’ screen (for referrers) and printed on the appointment confirmation when a patient books their appointment or displayed onscreen in the Manage your referral patient booking website or the NHS App.

Providers should use the instructions section to advise patients of the next steps or how their appointment will be delivered, whether via telephone or online consultation, for example. Where the patient booking window is used to start booking patients into the future, this section can be used to advise patients of what will be happening with their appointment.

e-RS extracts

The EBSX02 extract is available daily to support providers with the daily management and planning of outpatient referrals, including appointment slot issues or monitoring cancellations, etc.

Remember: that the e-RS extracts are a snapshot of a day’s referral activity and are not intended to replicate worklists; e-RS worklists are dynamic, changing throughout the day as referrals enter and exit the worklist.

The EBSX12 worklist drop-off is available via the information analyst role – the extract will contain any referrals, from the previous reporting week, that have dropped off any provider worklists, after 180 days have elapsed of no activity.

Find out more about the reports and extracts.

Referral to treatment reporting

It should be remembered that e-RS is a referral and booking tool; it is not a waiting list and should not replace trusts’ usual recording and monitoring processes with regards to tracking patients’ referral to treatment times (RTT). Where patients are being managed from any e-RS worklist, for example, the appointment slot issues (ASI) worklist, they must also be recorded on the trust’s patient administration system (PAS) and reported on RTT returns to NHS England and Improvement.

Further guidance can be found in the:

Cancelled and un-booked appointments

Where trusts have a backlog of un-booked patient referrals in e-RS, it is likely that they will be on either the Appointments Slot Issue (ASI) worklist (new referrals) or the appointments for booking worklist (previously booked or triaged referrals).

If possible, the appointment booking should be carried out within e-RS as this maintains the full audit trail and allows the referrer to monitor patient referrals and appointments.

All referrals received should be promptly triaged and captured on the trust’s patient tracking list (PTL) and should therefore be booked in order of clinical priority and date of receipt of referral.

Using the ‘Book/Send For Triage’ option from either the ASI or Appointments for Booking worklists, providers can book/re-book the referral into the same service to which it was originally referred or create a new shortlist if the referral needs to be moved to a different service. At this point the provider can book an appointment for the patient or create a new appointment request letter, sending the details to the patient for them to select and book their own appointment via the online patient website (Manage your referral – MYR), via the NHS App or by calling the appointment line.

Remember: patients will receive an automated reminder letter when a referral has been made into any e-RS appointment service and which does not have an appointment booked. For providers, a reminder letter will be sent to the patient where, for example, a referral has been triaged within a Referral Assessment Service (RAS) or converted from an authorised advice request, and the onward referral request has not been booked or deferred into a bookable service. In addition, where a previously booked appointment has been cancelled by a provider and is waiting to be rebooked, the patient will also receive a reminder letter.

Providers should consider this alongside any other correspondence sent to patients to ensure they only receive a reminder letter from e-RS where it is appropriate, for example, where the patient has been involved or is aware they are being onward referred by the provider. If robust, clinically safe processes are in place for contacting patients for whom providers  are responsible for making their appointments, they may like to consider ‘turning off’ the sending of a reminder letter when submitting an onward referral request.

Last edited: 24 February 2025 8:05 am