Independent sector provider guidance

Introduction

Before patients can be referred to an ISP through the NHS e-Referral Service, there are a number of building blocks that need to be in place:

Contract

ISPs must have a contract agreed by one or more NHS Commissioner for each service they want to add e-RS.

Compliance

To have access to e-RS, each ISP must have:

• a HSCN or an internet connection (more information on how to access e-RS through web-based professional application can be found in our web-based e-RS onboarding section)
• an Organisational Data Services (ODS) code
• necessary Information governance assurance

Connect

ISPs will connect to the NHS e-Referral Service using smartcards which will be issued and managed by a sponsoring commissioner.

Commission

ISPs setting up services on the e-RS Directory of Services (DOS) need to have each one commissioned within the system to appear on the primary care menu.

Dedicated support for independent and third sector providers of NHS services that require integration with NHS systems and applications is available through the Application Programming Interface (API) - NHS e-Referral Service.

The starting point for all providers looking to use e-RS is to consider:

• where will services be delivered?
• which service model is most appropriate?
• how patients will book their appointments
• who will manage the administration of referrals and booking?

Where will services be delivered?

All services on e-RS must be set up against the address at which the clinic is held, and each address must have its own unique location code. These codes are called Organisation Data Services (ODS) codes and, within the NHS e-Referral Service, are listed in brackets after each organisation name.

Independent Healthcare Service Provider (IHSP) organisations are setup differently to NHS organisations, as each IHSP has a “HQ” Organisation ODS code, with specific location codes below it.

It is important that the NHS e-Referral Service roles (service definer, provider, clinician etc.) are created under the “HQ” codes and not individual location codes.

Which service model is most appropriate?

Most services on the NHS e-Referral Service allow the referring clinician to refer patients directly, based on their clinical judgement and the supporting information in the directory of services. In other cases, it may be appropriate to use a referral assessment service (RAS) or clinical assessment service (CAS) model.

A RAS offer a facility which supports complex care pathways, such as gastroenterology and cardiology, where it's not always clear whether a patient needs a consultant appointment or a diagnostic test. A RAS set up by the provider will ensure patients' referrals are triaged correctly.

Find out more about referral assessment services.

A CAS 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, for example, a GP. This expertise should be used to ensure that patients are directed efficiently and effectively into the most appropriate onward care pathway.

Learn more about clinical assessment services.

How patients book their appointment is dependent on whether the service is set up as directly or indirectly bookable (DBS or IBS). The ability to offer a DBS system is determined by whether the provider’s Patient Administration System is able to support the messaging exchanges required with the NHS e-Referral Service.

Directly Bookable Services (DBS)

Patients can book and manage their own appointments either:

• At their referring practice (e.g. GP Surgery)
• Via the Manage Your Referral (MYR) online patient application
• By ringing The Appointment Line (TAL)

Appointments will be booked straight into the Provider’s PAS, which will also register new patients. Any appointment changes made in e-RS will be updated automatically in the PAS.

Indirectly Bookable Services (IBS)

Patients can only book their appointment by contacting the service/clinic they are referred to. Within the directory of service, clear instructions must be given to the patient on how to book their appointment including the times that they can call to make their booking.

The provider has to book the appointment into the NHS e-Referral Service and their PAS separately. Any changes to appointments must be updated in both the NHS e-Referral Service and PAS to ensure that information is kept up to date.

To understand who needs to be given a smartcard and the appropriate roles, providers need to consider the following:

Appointment booking

• If offering a DBS, this is done online and into PAS automatically
• If offering an IBS, booking staff will be needed

Clinical triage

• referrals must be reviewed by an appropriate clinician
• a process must be in place to do this
• the NHS e-Referral Service supports online triage processes
• if a referral is not considered clinically suitable for the service it will need to be managed
• the patient will have an appointment that needs cancelling or rearranging

Appointment/referral management

• appointments can be changed either by the patient or the provider
• how they can be changed is dependant on the service set up (DBS or IBS)
• providers will need to chase referrers where patients have an appointment, but the referral letter has not been attached yet.

Once an ISP has its ODS code(s) and a HSCN or an internet connection, a smartcard – with relevant roles on it – will be needed for each user. A Registration Authority (RA) Sponsor can provide smartcards and will add/remove roles as appropriate. ISPs will need to work with their (main) commissioner to identify a RA sponsor.

The most relevant  e-RS smartcard roles are listed in the table 

Providers should review the supporting information and technical guidance available within NHS e-RS business roles.