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Research - optimising the use of e-RS for providers

In this section you will find best practice solutions for service providers, the NHS Choice Framework which sets out  patients' rights to choice in healthcare, also included shared decision making, patient initiated follow-ups.

Best practice

Review the NHS Long Term Plan to find out more on:


Clinical responsibilities

Current General Medical Council (GMC) Good Medical Practice (2013) guidelines state that, where there is any delegation by a clinician regarding the care of a patient, the clinician will still be responsible for the overall management of the patient. Review the clinical responsibility when delegating roles guidance.

In relation to e-RS, the clinician remains responsible for the clinical consequences whenever they delegate responsibility for referring, accepting, redirecting or rejecting e-RS actions or activities to a non-clinician.


NHS Choice framework

Patients have the right to make choices about the services commissioned by NHS bodies and to information, and support to make these choices. The options available to them will develop over time and depend on their individual needs.


Personalised care or shared decision-making

Personalised Care will benefit up to 2.5 million people by 2024, giving them the same choice and control over their mental and physical health that they have come to expect in every other aspect of their life. The universal personalised care: Implementing the Comprehensive Model confirms how we will do this by 2023/24. It is the action plan for the rolling out personalised care across England .


Patient initiated follow up

To give patients and their carers the flexibility to arrange their follow-up appointments as and when they need them, NHS England and NHS Improvement are supporting providers to roll out patient initiated follow-up Patient Initiated Follow-up (PIFU).

Follow-up appointments are not made through e-RS


Referral pathways

There are different clinical referral pathways with e-RS supports meaning patients and their carers have more control and greater choice over how and when they access care. e-RS are empowering patients to book their own follow-up care as and when they need it, providing the option of telephone or video consultations where appropriate, and working with GPs to enable access to earlier expert advice advice and guidance.

Implementing these interventions, as well as taking steps to address reasons patients might miss their scheduled appointments, helps to deliver a more personalised model of outpatient care whilst also supporting elective recovery


Referral to treatment (RTT) reporting

In England, under the NHS Constitution, patients ‘have the right to access certain services commissioned by NHS bodies within maximum waiting times,or for the NHS to take all reasonable steps to offer a range of suitable alternative providers if this is not possible’. The NHS Constitution sets out that patients should wait no longer than 18 weeks from GP referral to treatment. Review the referral to treatment guidance for more information.


Priorities and operational planning guidance

Priorities and operational planning guidance reconfirms the ongoing need to recover the core services and improve productivity, making progress in delivering the key NHS Long Term Plan ambitions and continuing to transform the NHS for the future. More information can be found in the 2022-23 Priorities and Operational Planning guidance and the 2023-24 Priorities and Operational Planning guidance.


NHS England’s elective care and transformation programme 

The Elective Care Transformation Programme is leading transformative change by the NHS doing things in a different way. This is to make sure patients needing planned care see the right person, in the right place, first and every time, and get the best possible outcomes, delivered in the most efficient way.


NHS Futures Outpatient Recovery and Transformation Platform joint guidance

The NHS e-Referral service (e-RS) is a referral management and electronic appointment booking system which allows for the booking and managing of appointments by professionals and patients in England. Review the e-RS guide for secondary care doctors which details the considerations for doctors in secondary care to take into account when implementing e-RS. 

e-RS is currently used for most referrals by GP practices into consultant-led first outpatient appointments but, until 2019, its full use was not required by the NHS Standard Contract as detailed in the e-RS GPs guide (section 16) .

The e-RS offers a variety of benefits to patients as well as professionals and the wider NHS, particularly regarding the clarity and security of information.


NHS Standard Contract (choice and referral)

NHS England - NHS Standard Contract states that the provider must describe and publish all acute GP referred services in e-RS through a Directory of Service, offering choice of any clinically appropriate team led by a named consultant or Healthcare Professional as applicable.

The Provider must, in respect of services which are directly bookable:
  • use all reasonable endeavours to make sufficient appointment slots available within e-RS to enable any service user to book an appointment
  • ensure that it has arrangements in place to accept referrals via e-RS where the service user or referrer has not been able to book a suitable appointment

NHS Standard Contract (Mental Health Providers)

The NHS Standard Contract 202223 Primary and Community Mental Health Services  states the Provider must use reasonable endeavours to describe and publish all mental health GP referred services in e-RS through a Directory of Service, offering choice of any clinically appropriate team led by a named consultant or Healthcare Professional, as applicable


Realising the e-RS benefits

Find out the how different user, clinical governance and patient experience all benefit from e-RS being used.

Last edited: 19 February 2024 3:44 pm