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Paper switch off implementation pack
The paper switch off implementation pack is a step-by-step guide to support the delivery of e-Referral Service (e-RS) Paper Switch Off (PSO) in a local health community.
Standard Contract for 2018/19
The Standard Contract for 2018/19 requires the full use of the e-RS for all consultant led first outpatient appointments.
From 1 October 2018, providers will only be paid for activities resulting from referrals made through e-RS.
The Paper Switch Off programme (PSO) has been launched to provide support for the health communities in readiness for the contract change.
This is a step-by-step guide to support the delivery of Paper Switch Off (PSO) in a local health community.
It gives the recommended approach to the project, from establishing project governance and set-up, to business process change, along with the associated guidance, templates, or sample documents from PSO pioneer trusts gathered to date. Items marked with a * should be considered as essential.
It may be possible to do some of the activities at the same time or in a different order to suit your local project requirements. It may also not be necessary to carry out each activity depending upon your current starting point and level of e-RS utilisation.
If you require further information on any of these projects, then please contact your relevant NHS Digital Implementation Manager (contact details at the end of this pack.) They will then progress your request.
To deliver a successful PSO project, the following stakeholders must be engaged with:
- Provider Trusts and CCG to lead the PSO project
- LMC and GP leads, CSU to provide advice
The following documents and webpages will assist you:
Before your project starts:
- review PSO pioneer trust lessons learnt report
- ensure executive level buy-in and ideally appointed as project SRO
- review and confirm your Paper Switch Off go-live date with all stakeholders, including NHS Digital IBC Lead and NHS England Regional Implementation Manager
- agree your project governance - the resources below will help
Sample kick-off meeting agenda
Template TOR project board
Template TOR steering group
Template risks and issue log
Sample R&I log
Template highlight report
Develop a PID/project brief:
Develop your local project and action plan.
Note: On the template tabs, Type A is recommended for providers over 80% utilisation, Type B for providers with less than 40% utilisation.
CCGs will need to be involved and deliver activities supporting all action plans.
Decide on your PSO approach. Some projects with lower utilisation are implementing PSO specialty by specialty, whereas the ones already at higher e-RS use are tending to do PSO for all services at the same time.
Continue to review management information available locally, on the e-RS website and Power BI reports.
Develop local reporting approach to monitor progress and monitor paper referrals.
Agree the level of support and way of working with your NHS Digital Implementation and Business Change contact.
Identify any relevant case studies appropriate to your particular status.
Planning and discovery
Identify gaps in your business process compared to best practice guidance.
Produce baseline of services that need to be added to e-RS to support e-RS publishing services CQUIN.
Identify current Appointment Slot Issue (ASI) position and agree associated actions to improve. Ensure the CCG are aware of the position as they can help with communications and GP expectations.
Agree whether e-RS Advice and Guidance services need to be implemented - see our A&G guidance.
Identify any further internal and external stakeholders to be involved in your PSO project.
Ensure key CCGs are fully engaged and part of the PSO project. Critical activities they are responsible for and can support are:
- communications with GP practices
- engagement with LMCs
- identifying and providing any training requirements (link with NHS Digital as appropriate)
- addressing any issues with specific GP practices
- ongoing monitoring and reporting of PSO, and any support necessary for specific practices not following process
- support the review of DOS, critical to ensuring minimum re-direction occurs
- technical readiness and delivery of IT infrastructure
- awareness of cross-border trust PSO plans and activity
- agreeing and implementing the payment process in line with the standard contract
Begin to deliver the activities detailed in your PSO project plan.
Make all services available to book on eRS. The following resources may be helpful:
- Outpatient Pathway modelling instructions
- Example Two Week Wait mapping
- Sample notification of 2WW going live
- e-RS Advice and Guidance (A&G) services to be implemented (if agreed) - see our A&G guidance
- formulate and agree rigorous process for managing closed/changing/new PAS clinic code
Implement the agreed plan to reduce Appointment Slot Issues.
Add all named clinicians to e-RS - see our named clinician guidance.
Formulate and agree training strategy.
Access the e-RS training environment.
Deliver training to any staff requiring a refresh/new training. Support from NHS Digital, if required. Contact email@example.com for help.
The following sample materials developed by Kings are available:
- advocacy referrals on e-Rs
- consultant triaging
- consultant retain-rebook appointment
- cancelling/rescheduling appointments
- how to redirect an appointment
Develop training protocol for new starters - clinical and administrative.
Develop a joint local communications and engagement plan between provider and CCG to provide regular update on progress to all stakeholders. For example:
- letter to be sent from Trust Executive Team/Medical Director to advise staff of the upcoming improvement work
- a section for e-Referrals to be allocated in the organisation's newsletter/communications/extranet
- communication of updates, such as new services available on e-Referrals and training
The communications toolkit contains advice and sample documentation.
GP communications are essential, and should at minimum cover the following points.
Liaison via CCG to LMC’s advising of e-Referral project prior to direct communication with GP’s*.
This is to ensure their awareness of the project, acknowledge any concerns they may have and work through queries together to ensure their support. It is also opportunity to seek their advice on best mode of communication with Primary Care.
Continue to complete and review all project progress reports, delivery against milestones, utilisation and ASI reports.
When utilisation approaches the desired level for PSO (such as when it's feasible to implement a paper returns process), the project will enter the final PSO project stage and prepare for switching off paper.
Complete and continue to review the PSO readiness checklist.
Review and sign off the formal date for implementing Paper Switch Off status ie. all referrals for first consultant OP appointments will not be actioned and returned to the referrer.
Agree any local list of exclusions from this PSO project if necessary, taking the standard contract guidance into account. Sherwood exclusions here.
Refine any SOPs, access policy and contingency plans and ensure sign-off. e-RS Standard Operating Procedures sample.
Agree and ensure exec/clinical sign off of the process to follow for returning paper referrals*. This is a mandatory requirements as defined in the standard contract guidance.
Continue to communicate the PSO switch off date to all GP practices, and support their queries.
Consider, co-ordinate and deliver regional communications with trusts in the same local geographic area, sharing knowledge and your timescales for Speciality Go Lives/Full PSO via CCGs.
Ensure detailed data analysis is completed. See our data quality guidance.
Business as usual
Paper Switch Off status is now in place. The provider will return all paper referrals for first consultant OP appointments to the relevant GP practice.
Implement revised SOPs and ensure ongoing BAU activities carried out, such as continual training, new services added to DOS, addressing any paper referrals that continue to be received.
Ensure the Trust, CCG and practices Business Continuity Plan is updated for PSO and is fully communicated. Download a sample e-RS Standard Operating Procedures and continuity plan.
CCGs continue to monitor progress in line with the usual contract management processes and the Improvement and Assessment Framework.
From October 2018, CCG to ensure payment for referrals made in line with the standard contract.
Every NHS Organisation has an assigned e-RS Subject Matter Expert (SME) to support your e-RS implementation, projects and answer any specific queries.
Contact firstname.lastname@example.org to find out your e-RS SME. Each NHS England Region has been assigned a Regional Programme Manager to support Paper Switch Off.
To be put in contact with the relevant lead, please email email@example.com.
For up to date news on e-RS, please sign up to the bulletin.
The e-Referral Service roadmap shows:
- system enhancements
- when they're being delivered
- deadlines for the levers and incentives for using the service
Contact us at firstname.lastname@example.org.
We'd like to know if this pack has been helpful in delivering your PSO project, and whether you have any suggestions on how it could be improved.