NHS e-referral Service (e-rs) Frequently Asked Questions for Referrers

NHS e-referral Service (e-rs) Frequently Asked Questions for Referrers Purpose Primary Care colleagues are sometimes faced with situations regarding referrals and may not necessarily know the correct action to be taken. It is encouraged that all users use the NHS e-rs page on Skyline to find solutions as well as the Skyline Forum to ask a question that may not been covered below. This is a working document and will be updated when new situation arise or require further clarification. 1. General Day to Day Primary Care Referring 1.1 Although the patient has been referred through the NHS e-referral Service, I have been asked to send another referral (or a copy of it) via paper; just in case! There is no need to send another referral into the Trust for the patient; this will create a duplicate referral, and will not speed up the referral process. Because the patient has been referred electronically, subject to the patient arranging their own appointment; the hospital will know about your patient. 1.2 How much time does it take to send a paper referral instead of using e-referral Service? The paper process at MYHT is lengthy and encompasses many hands-off elements which could lead to delays; the paper referral flow diagram below demonstrates the process versus the e-referral process: NHS e-referral flow diagram Paper referral flow diagram MYHT Referral Process E-RS V2.docx MYHT Referral Process PAPER.docx 1.3 Under what circumstances is it acceptable to send a paper referral through to MYHT? All Consultant Led services can be referred via the NHS e-referral Service to hospitals across England. At the Mid Yorkshire Hospitals NHS Trust the only exception is referrals for Acute Services. See the Priority Section 1.6 1.9 below. The Referral Letter 1.4 When should I attach the Referral Letter to the NHS e-referral Service? Referral letters should be attached to the UBRN as soon as reasonably possible after the referral has been made so as not to cause any delays in clinical triage. You must also ensure that all supporting clinical information is attached at the same time, if you say you are attaching and do not, the clinician will reject the UBRN back to Primary Care, cancelling the appointment, and requesting the attachment. Checking the Outstanding Referral Letters Worklist on a daily basis will help you identify referral letters that are missing or overdue. Please see the Primary Care Worklist Management below: Primary Care ers worklist management. V0.3 March 17 Page 1 of 6

1.5 How do I amend an NHS e-referral letter after it has already been sent? You can amend the final referral letter through the NHS e-referral System after it has been sent and add further attachments, if required. Practices should not send a new referral or fax a referral through. Process to follow to amend an NHS e-referral SystmOne Practices Retrieve the patient record. Select the 'Referrals' node from the Clinical tree. Select the Referrals Out tab. Right-click on the relevant referral and select Update on Choose and Book. Click Continue Writing. The Choose and Book Referral window is displayed. Make the necessary amendments to the referral. Use the Attach buttons at the foot of the window to add further attachments. Click Send Final Version. To view a previous version of the electronic referral that has been sent to Spine, right-click on the referral and select View Previous Versions. EMIS Practices You can amend, or add more supporting information to a referral but it is important to note that when attaching a referral letter via EMIS Web, you must make any changes, for example, adding test results, via EMIS Web. Do the following: On the Patient s Care Record Referrals tab, select the required referral and on the ribbon, click Edit. The Outbound Referral Details screen is displayed. At the bottom of the screen, click Edit Now and then click OK. The Edit Referral message screen is displayed; click Yes to proceed with editing. On the Generate Choose and Book Letter screen you can: o Edit an existing document, select Referral Letter and edit as required. o Add more attachments (e.g. test results), select Clinical Content and then click Attachments. o Select the document/s required and click Authorise and Send. Priority 1.6 The patient needs to be referred Urgently, should I send a paper referral because it s quicker? No. It is not quicker to send a paper referral to the Trust due to Paper Process in place for Triage. The NHS e- Referral Service is compliant to accept urgent referrals and the Trust is able to receive them via e-rs also. Please use the NHS e-referral Service to send Urgent referrals to the Mid Yorkshire Hospitals NHS Trust. 1.7 I have an Acute referral to send, can this go via e-rs or should I send a paper referral Unfortunately there is no mechanism at this moment for Acute referrals to be accepted via the NHS e-referral Service at the Mid Yorkshire Hospitals NHS Trust. Therefore please continue to follow the Acute Referral process for the service you are referring to. V0.3 March 17 Page 2 of 6

1.8 If I can t send Acute referrals through e-rs; what about 2WW Urgent Suspected Cancer referrals, should I send a paper referral for those too? No. The MYHT is able to accept 2WW referral through the NHS e-referral Service. All 2WW services are indirectly bookable and the Appointment Request paperwork is not given to the patient. The process includes for practices to email through the UBRN to cab.cancerreferrals@midyorks.nhs.uk. If you are not familiar with the 2ww process; please speak to other colleagues from GP practices, email cab.cancerreferrals@midyorks.nhs.uk, use the Forum on Skyline; as the NHS e-referral Lead for MYHT will be able to answer this for you or contact other primary care colleagues who may be able to resolve your query. The Trust is in very early discussions around moving from IBS to DBS for 2WW. Further information regarding this will follow in due course. 1.9 The GP wants me to upgrade the referral from Routine to Urgent; should I just send in a paper referral instead? No. Please see Using the NHS e-referral Service section below; point 1.17 Named clinician 1.10 I have been asked to send a named clinician referral but I can t find the consultant listed on e-rs; shall I send a paper referral instead? No. If you are unable to locate the name of the clinician, there may be a very valid reason for this; such as retirement, maternity leave, absence (temporary/long term) etc. Please use the Skyline Forum as the NHS e- Referral Service Lead for the Trust has access and will be able to answer your question. Equally other colleagues from GPs may also have the answer! If it is found that the clinician should be enabled to receive named clinician referrals via e-rs this can be rectified immediately by the NHS e-referral Lead at the Trust. 1.11 I have been requested to send a paper referral direct to the Consultant and not use e-rs; is this correct No. All referrals to Consultants for a first outpatient appointment, whether they are generic referrals to any Consultant, or a named Clinician Referral due to clinical need should be sent through the NHS e-referral service. If the letter is to expedite an appointment for a patient it should be clearly marked as an Expedite Letter and state the patients UBTN below the salutation, and sent to the ABC Appointment Centre, NRU Pinderfields. Using the NHS e-referral Service 1.12 I am unable to locate the service that I need to send the patient to, what am I doing wrong and what should I do? There could be a couple of reasons why the service is not displaying: There could be an age restriction on the service, so your patient may be too young or too old. The priority (for some providers) may not be supported, for instance not all Independent Sector Providers (ie Spire, Nuffield, Yorkshire Eye Clinic) support Urgent referrals Have you tried using the SNOMED term to search for the service? If you use this type of search the results returned are suitable for the age and gender of your patient as well as the reason for the referral. If you are still unable to locate the service use the Forum on Skyline; as the NHS e-referral Lead for MYHT will be able to answer this for you; or other primary care colleagues may be able to resolve your query. V0.3 March 17 Page 3 of 6

1.13 How do I know when a referral on the Deferred to a Provider worklist list has been rejected? Referrals flow through worklists depending on their status. Therefore following a booked appointment and the referral letter attached the UBRN will be waiting for triage on the Referrals for Review Worklist in Secondary Care (the primary care worklist is Awaiting Booking/Acceptance). Depending on the outcome of triage determines the UBRNs location, if rejected by the secondary care clinician it will fall onto the Referrer Action required worklist for management by Primary Care, which includes contacting the patient as duty of care has passed back from Secondary care to Primary Care. If the referral has been accepted by the clinician, whilst it is not visible, it will be accessible via the Patient Enquiry; but duty of care is now with the Provider. 1.14 I can see that the referral on e-rs has been rejected, should I just send a paper referral? No. The referral has been rejected by the Clinician for a clinical reason; and this clinical reason needs to be actioned. The referral should be managed in e-rs. Therefore using the same UBRN the action should be carried out as using the same UBRN which retains RTT Clock Start Date. However, you must remember to contact the patient regarding this as their appointment was cancelled when the referral was rejected. Also the change may result in a change to service/hospital they have been referred to; and wider choice options provided. 1.15 I sometimes receive telephone calls from hospitals about patients who have been referred through e-rs but I can t help as I don t know anything about e-rs; what should I do? Hospitals ring practices if they have an issue with a patient s referral, and can be for a couple of reasons; such as Missing referral letter Possible duplication Issue with a named clinician Adding additional services or hospital sites Therefore it is important that e-rs is embedded across many staff within the practice rather than left for one or two people to manage. Identify additional resources within your practice; such as Administration, Receptionist etc to learn and understand e-rs; these staff could review the worklists on a daily basis also. Requesting training to further your understanding and knowledge of the NHS e-referral Service. 1.16 I can see the history of the UBRN; but no comments that I often hear people talk about; what am I doing wrong? Using your mouse click on the Date or the Action you wish to view, further information relating to that action will be displayed to the right hand side. 1.17 I have viewed the history of the UBRN and can see the comments, but I have no idea what they mean? Most of the actions should be self-explanatory; such as Create Request, Add Referral Letter, Book Appointment, Reminder Letter Sent, Defer to Provider. Where the action allows the provider, patients or TAL to add free text comments to that Action, deciphering these comments can be quite a challenge. At MYHT the aim is to provide clear, concise and standard comments for Primary Care with information relating to what action has been taken by the Trust; therefore the standard comment is: Action Comment Meaning Record ASI Contact Referral added to PAS, clock start date 01/01/2017 The Trust has received the UBRN and a referral has been added to the Patient Administration System with the clock start date of 01 January 2017. This enables the Trust to manage the patient. Record ASI Contact Referral already on PAS, The Trust received the UBRN back in November and a referral V0.3 March 17 Page 4 of 6

Cancel Request Patient booked outside NHS e- Referral Service clock start date 01/11/2016 Total free text was already to the Patient Administration System with the clock start date of 01 November 2016. This enables the Trust to manage the patient. Patients who are booked outside of the NHS e-referral service at MYHT are done. 1.18 I ve made a mistake when referring, I ve selected general clinics and I ve just found out that there is a dedicated service I can refer to, what should I do? From the Awaiting Booking/Acceptance worklist, locate the UBRN, checking that the referral status is Not Yet Booked or from the Patient tab, enter the UBRN or NHS number and check the Appointment column contains a - Dash. If an appointment has been booked you cannot proceed any further. If an appointment has not been booked, click on the UBRN and from the actions dropdown list select Update/Book; you are presented with the Appointment Search screen; bottom right, select Service Selection; bottom right select Search Criteria. You are now on the very familiar page of the Service Search Criteria. Proceed to amend as required and process as you would normally. 1.19 The GP wants me to upgrade the referral from Routine to Urgent; how do I do this? Follow 1.17 above. General 1.20 I need to speak to someone at the Trust about a patient s referral, who should I contact? If you wish to speak to someone about your patient s appointment or referral for Mid Yorkshire Hospitals Trust, please contact Access Booking and Choice Call Centre on 0844 822 00 22; the ABC Call Centre are available Monday to Friday from 0900hrs until 1700hrs and colleagues are able to help you with your query, or if they are unable to assist they will transfer you onto the Booking Clerk for that Specialty who may be better placed to deal with your query. There is no requirement to contact secretaries at the Trust regarding your patient s referral or their First Outpatient Appointment or Follow-up Appointment. 2 Patients 2.1 Patients contact our GP practice as they haven t heard anything from the hospital regarding their appointment If the patient is referred during their consultation with the GP and the patient leaves the practice with the information to book their appointment, it would be beneficial if the patient also left with the FAQ Leaflet for Patients referred via the NHS e-referral Service which should reduce the number of patients contacting your practice: MYHT FAQ for Patients Leaflet - Prima If the patient is referred after their consultation, and the Appointment Request is put in the post, it would be helpful to also send a copy of the FAQ s Leaflet for Patients. V0.3 March 17 Page 5 of 6

Using the NHS e-referral Service (not your clinical system) go to the Awaiting Booking/Acceptance worklist or perform a patient enquiry (using either NHS or UBRN) and view the history of the UBRN which informs you what has happened so far. Please see the Worklist Management paper separately. Do not Cancel the UBRN Create another UBRN Send another referral to the hospital Send a paper referral to the Trust Do Nothing, other than advise the patient: o Check the worklist to find the patient and explain (subject to being deferred to provider) that the hospital is aware that the patient is waiting and that due to their clinical priority they are seen in chronological order, which means patients who were referred before them will be seen first. 2.2 The GPs in our practice don t use e-rs to refer patients; it s the secretaries who make the referral, is there any further information that could be provided to the patient? It can be quite difficult for secretaries to make referral on behalf of GPs because they may not be fully aware of the patients clinical background and whether they could be referred into an Independent Sector Provider (ie private providers such as Spire, Nuffield) offering NHS services. Also the Patient Choice discussion may not have taken place and therefore that patient not fully informed of their Constitutional Rights under the Patient Choice Agenda. If you have any doubts about clinically suitable services for your patients, please speak to the referring GP. Please ensure that referrals are made to sub-specialised clinics correctly, as inappropriate referrals into a General Clinics will be rejected back to primary care for further management. The more information you provide the patient it becomes less likely that they will contact the GP practice. 3 Training 3.1 I really don t feel confident or up to speed with e-rs, who should I contact for training? NHS Digital provide training and education materials to support organisations using the NHS e-referral Service http://content.digital.nhs.uk/referrals/referrer/training 3.2 There seems to be only me in the practice that can manage e-rs; but I am due to go on holiday soon, and I am concerned that I will return to a lot of queries around e-rs and patients? It is important that e-rs is embedded across many staff within the practice rather than left for one or two people to manage. Identify additional resources within your practice; such as Administration, Receptionist etc to learn and understand e-rs; these staff could review the worklists on a daily basis also. V0.3 March 17 Page 6 of 6