Paper switch off programme and documents


Working with referrers, providers and commissioners, we've created a guide to support the delivery of paper switch off in a local health community. You can also download the referenced documents.

Paper switch off


The Standard Contract for 2018/19 requires the full use of the NHS e-Referral Service (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. This will support local health communities to plan for the paper switch off for elective referrals.

The new 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 new 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. 

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

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).

Successful paper switch off sites

Digital Health hosted an e-RS and paper switch off webinar on 22 September, delivered by NHS Digital, NHS England and also in partnership with Sherwood Forest NHS Trust, which was the first trust in the country to achieve paper switch off. Watch a video recording of the webinar:

NHS e-Referral Service (e-RS) - how will the new Standard Contract impact you-20170922 1037-1 from Katerina Loucka on Vimeo.

Bolton foundation NHS trust are the third trust in the country to achieve Paper Switch Off. In this video, Lisa Galligan-Dawson explains their approach to achieving this, and offers others some tips from their learning along the way:

Documents referenced in the implementation pack

20170515 ERS Letter to Trusts and CCGs
2nd sample generic highlight report template
Advocacy referrals
Automatic email reply example
Cancelling and rescheduling appointments
Consultant retain-rebook appointment
Consultant triaging
CDD e-Referral paper switch off progress report template
CDD sample eRS project risk and issue log
CDD sample PID
Draft FAQs SFHFT electronic referrals (wc 17-05-08)
eRS draft action plan v0.8
eRS draft action plan primary care
eRS draft action plan primary care v0.6 December 2017
eRS paper switch off project plan v0.9
eRS pioneer lessons v1.0
eRS programme board TOR sample
eRS PSO generic highlight report template 
eRS PSO project board ToR
eRS PSO project risk issue log template
eRS PSO project steering group ToR
eRS sample engagement pack 1 June V0.2 draft 
eRS steering group TOR sample
Exclusions from Sherwood and eRS
Frimley specialty waves letter
GP communications - Yeovil flyer
GP email for paper switch off - Yeovil
HEY PaperRejection_Proforma_May2017
How to redirect an appointment
Kings_communication to CCG's re PSO
Kings_ GP bulletin - 2wws on e-RS
Local paper referrals reporting form following PSO by specialty - sample
NHS e-Referral Service draft action plan v0.7 including links
NHS e-Referral Service utilisation data quality v2
Patient case study - Alex Dwiar - Paxton Green Group Practice
Programme board agenda sample
Project initiation document template v2 
PSO highlight report - template 0.1
Sample agenda e-Referrals PSO kick-off meeting v0 2 270417
Sample CCG bulletin messages
Sample data pack
Sample ongoing process - routine paper referrals into a 1st consultant led clinic
Sample pilot phase process - routine paper referrals into a 1st consultant led clinic
Sample process - 2WW and urgent paper referrals 
Sample project plan 3105
Sample project plan 2 3105
Sample report - CCG clinical executive - eRS 
Short form PID template v1 
South sites paper referral notification of paper switch off_ Bromley CCGs
Standard operating procedure (Warrington example)
Switch off readiness checklist
Sample process - 2WW and urgent paper referrals
Standard Operating Procedures
Walsall NEW PSO PG Version

Communication toolkit documents