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Implement - optimising the use of e-RS for providers

Considerations and advice when using e-RS including: how to access e-RS, referral pathways, Directory of Service, worklist management.

Ensure local referral management pathways support patient choice   

Organisations should ensure local referral management pathways utilise both NHS and Independent Sector Provider (ISP) commissioned services to support patient choice. 

Referring organisations can create the following: 
  • a referral into a directly bookable service - in which case the patient needs to book an appointment before the referral can be processed further or a triage/assessment service - where the referral information is assessed first, without an appointment being pre-booked 
  • an indirectly bookable service – in which case the patients can be referred to providers but appointments cannot be booked directly within e-RS, or a triage/assessment service - where the referral information is assessed first, without an appointment being pre-booked 
  • a triage request - the information will be assessed and actioned (either referring the patient onto an appropriate service or replying to the referrer)
  • an advice and guidance request - advice can be obtained by a referrer from an advice and guidance service, before (or instead of) making a referral

Implementing e-RS 

If you've not implemented e-RS, find out how to get started.

Information on how to access e-RS through web-based professional application can be found in our web-based e-RS onboarding section. If accessing e-RS through integration, via the Application Programming Interfaces (APIs), more information can be found in our integration section.

If you are planning to begin using e-RS for the first time, or if you are an existing user and want to maximise the benefits, visit the e-RS providers webpage for guidance and recommendations based on best practice. 

Points to note:


Ensure capacity is published to e-RS

When no clinic appointment is available for patients to book in e-RS, the referral can be forwarded (via the Manage Your Referral patient application) or deferred (via the professional application) to the patient’s chosen provider to enable the provider to book the patient an appointment. When a referral is forwarded or deferred, it will appear on that provider’s appointment slot issues (ASI) worklist.

While some appointment slot issues are inevitable, it is important that providers manage them in a timely and effective manner to minimise the effects on patients, referrers and their own staff. The impacts of poor ASI management include:

  • patient confusion
  • clinical risks
  • loss of audit trail - cancelling appointment requests
  • relationship with referral to treatment (RTT) clock starts for GP referrals

Review the: 


Setting up Directory of Service

Service providers build and publish their services on the Directory of Service (DOS) within e-RS. This in turn enables referrers to search for and list appropriate services for their patients.

Within the definition of appointment services on the DoS, providers can use the ‘Instructions’ section to relay important information to patients regarding the appointment they have booked. For example “Please ensure you arrive at Outpatients reception at least 15 minutes before your appointment and expect to be at the hospital for up to 2 hours”.

This information is displayed when an appointment is booked on the ‘Appointment Summary’ screen (for referrers), printed on the appointment confirmation letter and displayed onscreen in the Manage your referral patient booking website or the NHS App.

 
The following links may help when setting up services:
Getting the right smartcard role
Someone with a Service Definer (B1107) smartcard role in your organisation can create and manage services. To get the role:
  1. the organisation/location must have an associated Organisation Data Service (ODS) to apply the role to and to enable services to be created. A new code request form should be completed to set up a new location. Any changes to organisation or location data needs to be requested from the ODS team.
  2. The local registration authority (RA) manager can allocate the service definer role.
Determine the right service type

Referral Assessment Services (RAS)

This service type supports complex clinical pathways and helps to reduce demand to elective care services. A RAS maybe created to restrict access to specialist, multiple care pathway or locally commissioned. This allows referrals to be triaged before an appointment is booked for patients using e-RS. 

Clinical assessment service (CAS)

This service type is an intermediate service that allows for a greater level of clinical expertise in assessing a patient than would normally be expected of a referring clinician (such as a GP). This expertise should be used to ensure that patients are directed efficiently and effectively into the most appropriate onward care pathway.

Advice and guidance

Advice and guidance can be offered alongside triage services or those with offering appointments and gives providers the facility to have two-way digital conversation with referring clinicians, which help to support patient care, provides referral management education, and reduces unnecessary hospital referrals. Providers are also able to convert advice and guidance requests to referrals, where authorised and appropriate.

Considerations when creating a service

Service name - the service name is the most important part of defining services effectively on the Directory of Service because, it enables referrers to easily identify the most relevant services, regardless of the provider. Ensure acronyms are not included in the service name. For example, RAS or DBS, as this detail is visible to the patient and can cause confusion.

The format for service name which should be used by all service providers is:

Service description-Department name (Optional)-Organisation name-ODS org code

It is important that the service description portion of the service name is as meaningful and specific as possible (within the 100-character limit) so that referrers and patients can select the most appropriate choice of service to create a shortlist.

In the case of primary care services, commissioners need to specifically choose (commission) which services they wish to appear to their referring organisations.

Gloucestershire Hospitals NHS Foundation Trust utilises the Patient Booking Window functionality within some of their services to support them to manage capacity and to ensure the patients receive the ‘right care’, in the ‘right place’, at the ‘right time’, regardless of the source of their referral.

Setting up a patient booking window in these services supports the Trust in ensuring patients are offered appointments within the correct timeframe once the clinical team have reviewed their referral.

The Trust have already seen several benefit from using the Patient Booking Window.

This has allowed teams to protect slot capacity for those patients who require an urgent appointment and ensure patients are not able to book out of date order. It also stops patients booking into short notice, cancelled appointments, before their referral has been received and reviewed. In some areas, where there is a high number of patients waiting for an appointment, utilising the patient booking window functionality allows the Trust to gatekeep slots for internal use, prior to e-RS patients being booked in. This approach allows e-RS patients to manage their own appointments, but within the constraints that the Trust has created.

Patient administration system migrations

Guidance for service provider organisations on how to amend or replace a patient administration system (PAS).


Worklist management

The provider worklists tab lets you manage your workflow. It functions in the same way for all the different worklists available. There is a Worklist Type drop down list that allows you to select from list below:

  • Referrals for Review
  • Advice & Guidance Request
  • Appointments for Booking
  • Appointment Slot Issues
  • Displaced Appointments
  • Indirectly Booked Appointments to Cancel in PAS/EPR
  • Outbound Referrals
  • Outstanding Referrals Letters
  • Rejected Cancellations

Within each worklist are a number of filters which allow users to specify which information they want to see at that time. These filter option can be hidden if more space is require on the screen.

Appropriate members of the clinical or administration teams must monitor worklists on a daily basis, to support effective management of referrals. Review the worklist information.

How to deal with common issues experienced by users of the Path to Live/test environments

There are occasions where users need to perform transactions on NHS systems which are not "real". These may include deployment testing of new systems/versions or perhaps as part of live incident resolution.

Review the guidance if any of the following issues are being experienced: 

  • Common roles in e-RS and how they’re used
  • Connecting to e-RS
  • Valid e-RS roles for each organisation type
  • Define services in e-RS
  • Slot polls and service details
  • Setting up workgroups

Actions and points to note for worklist management

Appointment for Booking worklist

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 telephone appointments line (TAL) 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.

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.

Referrals remaining on the worklist

All referrals on e-RS worklists should be 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
Appointment slot issues

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), where they have been unable to book an appointment through e-RS. 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 must 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 – (N3/HSCN connection required for this link)

Cancelled and un-booked appointments

Where trusts have a backlog of referrals with un-booked appointments 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, triaged referrals or converted Advice Requests).

If possible, the appointment booking should be carried out within e-RS as this maintains the full audit trail, allows the patient to see their appointment online or via the NHS App 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 ‘Update/Book’ 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 example, a reminder letter will be sent to the patient:

  • When they have been referred to an appointment service, but not yet booked an appointment,
  • When 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.
  • When a referral with a booked appointment has been rejected. The patient will be advised to contact the person or organisation who referred them

Please note, where a previously booked appointment has been cancelled and is waiting to be rebooked, the patient will NOT receive an e-RS reminder letter. If it is the provider who has cancelled the appointment, it is their responsibility to inform the patient that their appointment has been cancelled.

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: 14 September 2023 3:27 pm