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NHS e-Referral Service


The NHS e-Referral Service (e-RS) combines electronic booking with a choice of place, date and time for first hospital or clinic appointments. Patients can choose their initial hospital or clinic appointment, book it in the GP surgery at the point of referral, or later at home on the phone or online.

Top tasks

Live service information and alerts
Important future changes to e-RS - find out more about the NHS e-Referral Service (e-RS) making changes to its URLs by early June 2019
Reports and statistics - including weekly utilisation reports
If you're a patient, book or manage your e-referral - visit NHS.UK if you've been referred to a hospital or clinic through the NHS e-Referral Service. NHS staff can find out how to help patients to manage their referral online.

All 150 acute hospital trusts and GP practices have made the move to sending and receiving all first outpatient referrals through the NHS e-Referral Service (e-RS).

Important future changes to the NHS e-Referral Service

e-Referral Service (e-RS) will be making changes to its URLs by early June 2019. This includes new URLs for the Professional Application, the Patient Application (MYR – Manage Your Referral), messaging, API endpoints, as well as all Partner Test systems. Find out more here.
·This will link to a new page titled ‘Important future changes to the NHS e-Referral Service’ – see first document attached for the details on this page.
·Another page that links from the one above (see documents) that contains all of the technical information


Paper switch off

The Standard Contract for 2018/19 requires the full use of the eRS for all consultant-led first outpatient appointments. From 1 October 2018, providers will only be paid for activity resulting from referrals made through eRS.

The GP contract includes a further investment of £10 million in practices, to support full implementation of e-RS, to make it available at every GP practice by October 2018.

NHS England has issued guidance for managing referrals. The guidance and a set of frequently asked questions (FAQs) is aimed at commissioners (CCGs and NHS England), GP practices, and all providers of acute consultant-led outpatient services which accept referrals from GP practices.

New e-RS guidance for GPs   

Joint guidance on the use of the NHS e-Referral Service 2018 has been launched for GPs to ensure that they get the most out of the NHS e-Referral Service. The guidance has been developed jointly by NHS Digital, NHS England and the BMA GP committee.

The guidance includes advice to GPs on encouraging patients to look after their own bookings and appointments through the Manage Your Referral website. This means patients will be able to manage their appointments 24/7, allowing them to check, cancel or change their bookings around the clock.

Dr Farah Jameel, BMA GP committee executive team IT lead, said: “The e-Referral Service, when used effectively, can be beneficial not only for patients, by giving them more control over their healthcare pathway, but also for GPs and the wider NHS by streamlining the whole referral process and offering a consistent approach across the health service.

“The guidance we developed with NHS England supports practices in outlining a number of ways they can use e-RS to improve patient experience, as well as addressing some of the issues raised by our members.”

Find out the latest paper switch off (PSO) dates for NHS Trusts.

Payment Authentication

To comply with the terms of the NHS Standard Contract from 1 October 2018, a new process for commissioners and providers to confirm compliance was introduced. This is called Payment Authentication.

On 21 September 2018, NHS Digital facilitated two webinars on behalf of NHS England to provide more information about this revised approach.

Watch the webinar for commissioners

Watch the webinar for providers

The impact of paper switch off

The University Hospitals of Morecambe Bay NHS Foundation Trust has reviewed a sample of 100 e-Referral Service (e-RS) referrals against 100 paper referrals to understand the patient benefits. From an analysis across 20 clinical specialities, the findings revealed that on average patients received an appointment 8 days faster when referrals were made via e-RS. Find out more.

Resources to help you with paper switch off

Video case study

This case study shows how Yeovil District Hospital NHS Foundation Trust achieved paper switch off in November 2017. It highlights the trust's approach to paper switch off and their top tips.

The first trust in the West Midlands achieving Paper Switch Off is Sandwell and West Birmingham Hospitals NHS Trust. 

Sally Sandel, Senior Commissioning Manager at Sandwell and West Birmingham CCG said: “The trust has worked really hard to achieve this and it’s also a real demonstration of partnership working between the trust, the CCG, the CSU and primary care. Recognition needs to be given to GP practices across the CCG footprint that actively attended e-RS training and came on board with e-RS much earlier than required. The CCG and the trust will continue to work together to address any ongoing issues and pressures, through regular meetings and through our e-RS user groups, where any concerns GP practices have can be raised, discussed and resolved.”

Read how The Princess Royal University Hospital (PRUH), located on Farnborough Common is part of the King’s College NHS Foundation Trust worked collaboratively to switch-off paper referrals.

GP case studies

“Advice and Guidance is definitely worth using. It's very quick, it's responsive and I can't see a single reason why any one of us GPs wouldn't want to use it for patients.” Dr Dan Dhanushan, New Queen Street Surgery, Whittlesey, Cambridgeshire.

Find out more about what the health community in Cambridgeshire and Peterborough think about the improved e-RS Advice and Guidance function by watching this video:

Dr Chris Markwick’s local trust, County Durham and Darlington NHS Foundation Trust, was one of the first to switch off paper referrals. Find out what he thinks about e-RS.

The East London Health and Care Partnership have produced a video about e-RS and how they feel it has the potential to transform the way they look after their patients.

Clinicians from primary and secondary care describe the enhanced Advice and Guidance function and the new Referral Assessment Service, as well as the broader benefits of e-RS for patients and clinicians.

Implementation pack

The paper switch off implementation pack details the recommended approach to the project, from establishing project governance and set-up, to business process change, along with:

  • associated guidance
  • templates


Communicating your plans effectively has been highlighted as critical. Use this new communication toolkit to help you to plan and deliver your communication activity. If you require further information, contact your NHS Digital Implementation Manager (details are in the implementation pack).

Find out more about paper switch off.

Using the service

If you're a patient, find out more about appointment booking on the NHS.UK website.

Whether you're using e-RS for the first time, or an existing user wanting to make the most of the service, NHS Digital provides a range of material for referrers (such as a general practice), providers (a hospital or clinic) and commissioners.

This demonstration video shows a typical patient journey using e-RS:

This shows how to:

  • create a service
  • raise an Advice and Guidance request and receive responses
  • create a referral
  • a patient makes an appointment online
  • a provider accepts a referral

Benefits of the service

The benefits of e-RS include:

  • cost and time savings
  • fewer missed appointments
  • fewer inappropriate referrals
  • shorter referral to treatment times
  • choice of hospital or specialist
  • choice of appointment date and time

Find out more about the benefits of the service.

Improving the service

We are continually improving the service and many changes have already been made, and more are planned. Find out how the service is improving.

Contact details

Have a question about the e-Referral Service? Please contact

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Further information

  1. internal


    Find out how to integrate systems to enable electronic booking with the NHS e-Referral Service (e-RS), including how to achieve compliance, attain secure coupling and support safe business process interactions.

  2. internal

    Case studies

    Covering lessons learned and personal experiences, these case studies provide an insight into the implementation, benefits and use of the NHS e-Referral Service (e-RS) across primary and secondary care.

  3. internal


    The NHS e-Referral Service (e-RS) is used to make around 40,000 referrals daily. A full record of these is available in the application, with a wealth of information that can be used when making commissioning decisions and managing referrals.

  4. internal


    Find information and training to help you get started with making referrals in the NHS e-Referral Service (e-RS), as well as guidance and help to make the most of the system.

  5. internal


    Information and training for providers using the NHS e-Referral Service (e-RS), as well as guidance and help to make the most of the system. You can also learn about benefits and best practice.

  6. internal

    Reports and statistics

    These reports are intended to be used in addition to local NHS e-Referral Service reports and extracts available from within our application. Each report includes a cover page detailing the contents, and the criteria used for any data analysis.

  7. internal

    Contact the e-Referral Service

    If you're a referrer, provider or commissioner with a general enquiry about the NHS e-Referral Service (e-RS), you can contact us by completing this form. This form is not for patient enquiries.

  8. internal

    Helping patients manage their referral online

    More referrals are being made electronically with the NHS e-Referral Service (e-RS). Using e-RS means practices have the chance to save time by helping patients manage their referral online.

Last edited: 19 February 2019 3:43 pm