e-referral Service (e-rs)

e-referral Service (e-rs) Standard Operating Procedure & Troubleshoot Guide NW London This is a working document and is being updated when new situations arise or further clarification is required. 2018.07.26 Final 1 is the most current version. Any further versions will have the latest date produced Page 1 of 16

Standard Operating Procedure This Standard Operating Procedure (SOP) is intended to be a NW London wide SOP; to be in place from 1 st August 2018 to the 1 st October 2018 to support practices in the transition to full implementation of e-rs. This SOP is not intended to replace or supersede any e-rs processes your practice already uses. It is shared purely for reference and support. Training and Access 1. The practice should ensure all referrers in the practice (doctors, nurses, and any other referring clinician) - including locums - know how to use e-rs. This includes training for using SystmOne templates related to e-rs. Links to the online training are below: SystmOne : https://www.youtube.com/playlist?list=plygrg0ll6ez7eikdya5auj2yz9dpsal OM EMIS Web: https://www.youtube.com/playlist?list=plygrg0ll6ez5ac30_khlxapr0psyxme WW 2. The practice should include instructions for e-rs use in staff/locum induction packs. Ensuring effective use of e-rs is particularly important where a practice agrees that occasional locums can make referrals on behalf of the practice. 3. The practice should ensure all referring staff have appropriate NHS smartcard permissions for the e-rs website. Page 2 of 16

Making Referrals 1. Referrers within the practice are to use agreed referral guidance or care pathways and to follow the local RFS pathway (if applicable) when making a referral. 2. The choice conversation is held in the practice between the patient and the referrer prior to the referral being made. 3. For 2WW referrals, the conversation is held in the practice between the patient and the referrer about the reason for the appointment being within two weeks of the referral. It is the responsibility of the GP to ensure the patient understands that they will be seen in two weeks and the necessity for the patient to attend. 4. On some occasions a patient may be unable to attend a 2 week wait appointment (due to a prior engagement) and will inform the GP of this during their appointment. It is the responsibility of the GP to decide the best course of action based on their understanding of what is most appropriate for the patient. A guide to how these occurrences should be treated is outlined in Appendix 1. 5. Defer to Provider is a mechanism which can be used to flag to the Acute Trust that an appointment must be allocated for the patient when there are no appointment slots available on e-rs. See section Worklists and Follow Up Tasks on how to manage these. 6. Referral letters should ideally be attached to the e-rs booking within 24 hours for a 2WW referral and 3 working days for a routine referral. 7. When booking a patient into a Trust service that has a Referral Assessment System (RAS) which will sometimes be listed as a triage appointment on e-rs, the referral is not visible to the Trust until the letter has been attached. For these services, the consultant must triage the patient based on the content of the referral letter. Safety Netting 1. A patient may not able to attend a 2WW appointment due to their personal schedule; the GP should discuss the clinical risk resulting from any decision to book an appointment at a later date. If a patient is to be booked within a timeframe that better suits their availability, a robust safety net mechanism would be that practice sets a reminder that covers this period, and a referral is immediately sent at that point. 2. Outlined in Appendix 2 - Suspected cancer referrals and e-rs is a process whereby a patient who is unable to attend in the 2-week wait timeframe can book their own appointment through Manage My Booking when they are next available. 3. Alternative safety net processes to ensure 2WW patients have been booked and attended their appointment would be to: a. Call the patient b. Call the hospital c. Keep a spread sheet record of all two week wait referrals made. Page 3 of 16

Worklists and Follow Up Tasks 1. GPs, practice staff and administration staff can monitor the e-rs work list for changes in referral status the appointment shows as unbooked until the patient has been booked in and the provider has confirmed. 2. The worklist should be checked on a daily basis to process tasks that can be completed without GP/referrer input, and to monitor the status of patients referrals. Further information is outlined in Appendix 3. Referrals are classed as follows: a. Booked b. Not Yet Booked c. Cancelled by Provider d. Cancelled by Patient e. Defer to Provider 3. If a referral is cancelled by a Provider (e.g. it is deemed the referral is not suitable for secondary care, the Provider will select the relevant reason using free text if needed. Providers should contact patients and send letters to GPs separately outside of e-rs as part of the referral management process. 4. Finding no appointment slots available for a chosen service(s) may influence a GP/patient s choice of provider. The GP and patient should discuss whether there is a preference to choose another provider with booking slots available. Should the patient still choose a specific hospital/consultant where no appointments are available then the practice should use the Defer to Provider option. 5. Defer to Provider is the mechanism whereby the Acute Trust undertakes to provide an appointment for the patient even though there are no appointment slots available on e-rs. In the event of Defer to Provider in relation to 2 week waits/cancer referrals, the practice should undertake the two following actions: a. Inform the patient that the Trust should get back to them with an appointment within the next 2 working days. If the Trust does not contact the patient they should inform their practice. b. Keep a spread sheet record of all two week wait referrals made. Page 4 of 16

Support with e-rs referral If you are unable to make referral using ers for any reason do the following steps: 1. Click on the web address below using internet explorer (do not use Chrome): https://nww.ebs.ncrs.nhs.uk/ 2. If you cannot logon to the website for any reason then reboot your practice machine 3. If this still does not work, if you have access to another PC in the practice please try to process the referral 4. If you are still experiencing issues contact the IT service desk (especially if it is a 2WW referral) 5. In the meanwhile assign a task to yourself with the patient details and with details of the referral. This will assist in trying to do the referral again. Kindly note if your referral is urgent please contact your CCG lead to communicate with the Acute Trust to try and find an alternative way of making the referral. Page 5 of 16

Paper Referral Return Process (PRRP) 1. The PRRP process runs from 1 st August 30 th September and will support acute Trusts and referrers (practices) to embed the e-rs process during this period. Hospitals will highlight to CCGs any Practices that continue to refer using alternative methods. CCGs will continue to support practices through training and engagement to use e-rs. 2. A PRRP is outlined in Appendix 4; this process will be closely followed by each of the five NW London Acute Trusts from 1 st August to 30 th September. After 1 st October the Trusts will continue to contact the practice to send the referral via e-rs should the practice not have used e-rs in the first instance. 3. The practice should ensure that there is a practice generic inbox available for the referral return process. NWL CCGs have supplied details of generic GP Practice inboxes to the acute Trusts in NWL; with the intent that they be used only for the referral return process, or in the event of a clear clinical need when other routes are not available. GP Practices should notify their CCG of any changes to these addresses. 4. The generic inbox e-mail address is to be checked at least once a day, during the practice working day (normally Monday to Friday excluding bank holidays), for any acute Trust messages on returned referrals or defer to provider received referrals potentially twice a day or more frequently dependent on the size of the practice and the number of referrals made. Contacts and IT failsafes 1. If you are unsure if the e-rs system is working correctly please initially check the NHS Digital e-rs live status at https://digital.nhs.uk/services/nhs-e-referralservice/live-service-information-and-alerts. 2. Details of the key people in CCGs and in the Acute Trusts (Gatekeepers) are available in Appendix 5. Please use your CCG ers contact (CCG Gatekeeper contact) in the first instance for any query about the running of the system, rather than directly contacting the Acute Trust contact. 3. E-mails regarding individual patients should not be sent to individual Acute Trust contacts because of the clinical risk of the e-mail not being picked up in a timely manner. 4. In the event of a practice IT system going down preventing the use of e-rs, Practices should follow their existing business continuity plans. In addition, the Practice should contact the NWL IT service desk: a) Tel: 0203 350 4050 b) Email: nwlccg.servicedesk@nhs.net to inform them they will not be able to make referrals via e-rs. 5. In addition the IT service desk will inform the CCG Gatekeeper who in turn informs the Acute Trusts Gatekeepers; an alternative method to send referrals will be temporarily put in place until the problem has been fixed. Page 6 of 16

APPENDIX 1 Page 7 of 16

APPENDIX 2 Page 8 of 16

APPENDIX 3 Page 1 of 4 Page 9 of 16

APPENDIX 3 Page 2 of 4 Page 10 of 16

APPENDIX 3 Page 3 of 4 Page 11 of 16

APPENDIX 3 Page 4 of 4 Page 12 of 16

APPENDIX 4 Page 1 of 2 Paper Referral Return Process- For 2WW Referrals (For the period between 1 st August 2018 to 30 th September 2018) The following outlines the Paper Referral and Return Process (PRRP) for 2WW referrals. This process will operate as follows: 1 st August 2018 31 st August 2018 During this period Trusts will accept 2WW referrals made outside of e-rs, but will request the practice that in future referrals are made using e-rs. Practices will be asked not to reissue the referral via e-rs. The Trust will be notifying their CCG that the non e-rs referral has occurred. The CCG will then be responsible for liaising with the GP practice to understand why the referral has not been made via e-rs and to support the GP practice in resolution of any issues with making the referral via e-rs. 1 st September 2018 30 th September 2018 During this period any 2WW GP referrals made outside the e-referral Service will automatically be rejected, with the referrer being notified within one working day of the rejection and advised the referral should instead be made via e-rs. The hospital will follow up with the GP Practice to ensure the referral has been re-submitted via e-rs. Page 13 of 16

APPENDIX 4 Page 2 of 2 Paper Referral Return Process- For Urgent & Routine Referrals (For the period between 1 st August 2018 to 30 th September 2018) The following outlines the Paper Referral and Return Process (PRRP) for routine and urgent referrals. 1 st August 2018 30 th September 2018 The hospital will reject routine and urgent non e-rs GP referrals and will notify the GP that the referral has not been accepted. The GP will be advised the referral should instead be made via e-rs. This process will take place within two working days of receipt of the referral. The hospital will share information on referrers who have made referrals in to the Trust outside of e-rs weekly with the relevant CCG lead for the referring GP practice. The CCG will then be responsible for liaising with the GP practice to understand why the referral was not made via e-rs and to support the GP practice in resolution of any issues with making the referral via e-rs. Paper Referral Reject Process For all GP referrals From 1 st October 2018 onwards The following outlines the Paper Referral and Return Process (PRRP) for GP referrals of all types (2WW / Urgent / Routine) from 1 st October 2018 onwards. Hospitals will reject all GP referrals received outside of e-rs from 1 st October 2018. The hospital will notify the GP Practice and ask them to re-refer via e-rs. Page 14 of 16

APPENDIX 5 Page 1 of 2 Key Contacts: IT Issues In the event of a practice IT system going down so they cannot use e-rs then the GP business continuity plan comes into play. The Practice should contact the NWL IT service desk: a) Tel: 0203 350 4050 b) Email: nwlccg.servicedesk@nhs.net to inform them they will not be able to make referrals via e-rs. CCG GateKeepers **Your CCG contact is the first port of call for issues regarding ers.** Organisation Name Email Address Brent CCG Brent GP Locality Manjit Gill BrentGPLocality@nhs.net mangit.gill@nhs.net Central London CCG Ealing CCG Hammersmith and Fulham CCG Harrow CCG Hillingdon CCG Hounslow CCG West London CCG Monika Truszczynska Rebecca McCaw Network Relationship Managers Team Coral McNeilly Nathaniel Whiting Eva Amalathas Kirstie Neale Vince Makin Sabrina Tobias Chanel Herdman West London Primary Care Team m.truszczynska@nhs.net rebecca.mccaw@nhs.net Ealccg.networkmanagers@nhs.net nwlccgs.hfprimarycare@nhs.net coral.mcneilly@nhs.net nathaniel.whiting@nhs.net e.amalathas@nhs.net nomaan.omar@nhs.net thh-tr.bookingcentre@nhs.net kirstie.neale@nhs.net vince.makin@nhs.net sabrina.tobias@nhs.net chanel.herdman@nhs.net wlccg.e-rs@nhs.net Page 15 of 16

APPENDIX 5 Page 2 of 2 Trust GateKeepers **Your CCG contact is the first port of call for issues regarding ers. If contacting the trust contact below please also notifying the CCG lead by copying them into any correspondence.** Organisation Name Email Address Imperial Ruby Sultana Damien Bruty ICHC-tr.eRS@nhs.net Chel West Nicola Burgess ers.pso@chelwest.nhs.uk LNWH Vinod Chauhan vinod.chauhan@nhs.net Hillingdon Vijaya Kololgi GP Hotline vijayalakshmi.kololgi@nhs.net thh-tr.bookingcentre@nhs.net Brompton Tina Kay T.Kay@RBHT.nhs.uk Page 16 of 16