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NHS E-REFERRAL SERVICE MATURITY MODEL

MAXIMISING THE BENEFITS

Select an organisation type

Level 3Mainstream

Established NHS e-Referral Service leadership

working in partnership with primary care colleagues

Complete view and understanding of NHS e-

Referral Service utilisation across all

specialties

Local IT service fully supports NHS e-Referral

Service. High spec desktops.

All clinicians have smartcards

Secretary, proxy clinician led.

Some Clinicians review online A&G on >50% of

services. Process

People & Organisation

Information

Technology

Level 1Basic

No defined NHS e-Referral Service leadership

and limited awareness

Low levels of information reacting to demand &

capacity issues

Minimum specification for NHS e-Referral Service on

selected desktops. Smartcards available to

admin staff only. Minimum support from Local IT

High proportion of paperonly referrals (no NHS e-

Referral Service)

Level 2 Limited

NHS e-Referral Service leadership (both

management and clinical) established

Understanding of available performance information

Reliable high spec machines in defined business areas.

Some clinicians have smartcards. Lack of

ownership from Local IT

Centralised, proxy led, paper process. Minimal A&G Services.

Proactive NHS e-Referral Service leadership –

regular updates and events to promote the service and benefits throughout LHC.

Continuous Planning / Mgmt routinely matches demand &

capacity

Local IT gives high priority to NHS e-Referral Service.

Service available in all work areas. System access (smartcards) managed

proactively

Majority of clinicians review online – paperless process.

A&G on all appropriate services. Majority Named

clinician services

PerformanceUtilisation = national average

Majority DBS Services>50% services published

slot issues 10-15%

Utilisation > national average>90% DBS Services

>90% services published slot issues 5-10%

Utilisation 90%.or above100% DBS Services

100% services publishedSlot issues <4%

Utilisation < national averageMajority IBS Services

<50% services publishedSlot issues >15%

Service Provider

SERVICE PROVIDER MATURITY MODEL

Level 4Optimised

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Select an element to

explore

Level 1Basic

High proportion of paper only referrals (no NHS e-Referral

Service)

All providers in England offering services to the NHS should have them published on the national Directory of Services, to ensure referrers can access all available services when referring patients via NHS e-Referral Service

Level 2 Limited

Centralised, proxy clinician led, paper process. Minimal

A&G Services

Where a centralised team of booking/ medical records clerks are accessing NHS e-Referral Service on behalf of clinicians, many benefits are being lost. Printing and distributing referrals and collating responses from consultants is time-consuming and expensive for a provider organisation. Further, centralised reviewing inhibits the use of Advice and Guidance

Level 4 OptimisedMajority of

Clinicians review online – paperless

process. A&G on all appropriate

services. Majority named clinician

servicesWhere this level is being achieved the following benefits can be expected:• Revenue Generation• Improved Patient Care• Improved Patient

Satisfaction• Improved Convenience

for Clinicians• Less Resources

required in the booking process

Level 3 Mainstream

Secretary, proxy clinician led. Some Clinicians review

online A&G on >50% of services

Where NHS e-Referral Service is being used, on behalf of clinicians, by secretarial staff, some benefits are not being realised. Printing and collating referral letters and responses can be time consuming. This is especially true where a trust is utilising Advice and Guidance and referrals to Named Clinicians. A better solution would be to encourage clinicians to use the system directly.

Process


Information

Technology

Performance

SERVICE PROVIDER

to continue click the level that best describes how you use NHS e-Referral Service

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1. PROCESS

Steps to improve maturity rating

Are your services published?• Work with service managers and clinical leadership within the trust to define and publish individual

services • Build up a complete directory of all services that your trust offers

More information and help regarding creating and refining services can be found in the document ‘Creating and Maintaining Services in the Directory of Services’

Does your Directory of Services accurately describe the services that you offer? • Ensure that referrers can find your services under the correct Specialty and Clinic types • Map services to ALL appropriate clinic types – DO NOT use the ‘Not Otherwise Specified’ clinic

type as a ‘catch all’ • Build a comprehensive list of SNOMED clinic terms into each service

More information on optimising your Directory of Services can be found in the document ‘Creating and Maintaining Services in the Directory of Services’

Are your services Directly Bookable?• The majority of patient administration systems are able to integrate with NHS e-Referral Service

enabling appointment slots to be booked via GP practices, The Appointments Line or the Patient Web Application. Speak to your PAS supplier for more information.

Service Provider

Training to support the setting up of services is available on the NHS e-Referral Service website

Level 1 High proportion of paper only referrals (no NHS e-Referral Service)

• Fall in Revenue - if local referrers cannot find your services they may choose to refer their patients to other providers whose services appear on the DOS

• Poor patient experience – patients choosing to be seen within your organisation cannot take control of their appointment and are disadvantaged compared to patients choosing a hospital/ service that is available on the national menu.

• More Resources required for arranging appointments for patients

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Dis-benefits

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2. PROCESS


A centralised process relies on all referrals being printed and then distributed to the relevant consultant, probably via their secretary. Generally this would entail referrals being sent in the internal post; sometimes to another site.

A more streamlined and better way of working would be to have each specialty/business area keeping review of referrals within their group. For example medical secretaries accessing referrals then collating responses and accepting, rejecting or re-directing as dictated by the responsible clinician. This would also bring online reviewing into the specialty and offer clinicians the chance to see the system working, hopefully generating some interest.

One of the biggest complaints from referrers is the inability to refer to named clinicians using NHS e-Referral Service. NHS e-Referral Service has supported referrals to named clinicians since 2005. Where an organisation accepts paper referrals to named clinicians they should also accept them electronically.

• Ensure all medical secretaries have smartcards and are added to relevant workgroups• Ensure that their desktop has a smartcard reader and is of an adequate specification to enable

connection to, and use of, NHS e-Referral Service • Ensure access to training and support to enable them to understand how the system works• Clearly define processes to ensure referrals are accepted/rejected/redirected as appropriate and

in line with local access policy

Service Provider

Training on making referrals to Named Clinicians is available on the NHS e-Referral Service website

Level 2 Centralised, proxy clinician led, paper process. Minimal A&G Services

• Improved ability to track referrals – less chance of referral letters getting lost in transit to consultant

• Time Saving – keeping referrals within the specialty will cut down on the time taken to accept or reject or redirect referrals. Where changes do have to be made this will help with the referral to treatment time

• Improved Convenience for Clinicians – referral letter available at all times within the department

• Improved Patient Care – faster turnaround where patients are incorrectly referred

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Benefits



3. PROCESS

Steps to improve maturity rating• Look at services on a specialty by specialty basis

• List those that do not offer named clinician referring and those that do not offer advice and guidance

• Identify those services which potentially could and work with the consultants and business managers concerned to highlight the benefits

• Organise lunch-and-learn or drop-in sessions where clinicians can view the system and see for themselves how simple it is to access and review their referrals

Meanwhile:-• Ensure all clinicians have smartcards • Ensure that all clinician work areas have access to a PC with a smartcard reader and that the

machine is of a sufficient specification to enable optimum connection to and use of NHS e-Referral Service.

• Ensure all clinicians have access to training and support to enable them to understand how the system works and realise the benefits of reviewing online

Service Provider

• Improved ability to track referrals – no missing referral letters

• Confidential exchange of information between referrer and receiving clinician

• Improved Convenience for Clinicians – referral letter access from any point via N3

• Improved Patient Care – faster turnaround where patients are incorrectly referred.

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Benefits

Level 3 Secretary, proxy clinician led. Some clinicians review online A&G on >50% of services



4. PROCESS Service Provider

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Level 4 Majority of Clinicians view online – paperless process. A&G on all appropriate services. Majority Named Clinician services

Benefits

• Revenue Generation• Publishing your services on the national Directory of Services enables referrers, both locally and from out of area, to find those services.

• Improved Patient Care • Faster access to services - appointment booked at or soon after decision to refer• Correct diagnostics performed – by including required investigations and referrer alerts in your Directory of Services you can help referrers to

ensure that patients are arriving with the correct clinical testing done beforehand – this will also help ensure that patients are not delayed on the referral to treatment pathway

• Improved Patient Satisfaction • Patients will be able to choose you as the provider of their care, a date and time of appointment that suits them and how they book that

appointment.• Improved patient satisfaction at the very beginning of the patient pathway helps build a positive image of you as a provider

• Improved Convenience for Clinicians • Electronic access to referral letters enables clinicians within your organisation to access those letters and review referrals from any point via

N3

• Less Resources required in the booking process• With directly bookable services, patients can book their appointments via the internet, telephone appointments line or even in the GP practice,

dramatically reducing staffing within provider booking offices. Further, patients can cancel and rebook without needing assistance from hospital staff.

• A well planned and informative directory of services will help cut down on rejections and re-directions saving time and staffing resources.

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Level 1Basic

No defined NHS e-Referral Service leadership and

limited awarenessEvery organisation should have defined NHS e-Referral Service leadership both clinical and managerial. Having no defined leadership will result in a patchy/ad-hoc approach within the organisation. This will result in an inconsistent approach across specialties, leading to more admin resources required to support processes. Ensure all clinical and admin team members fully understand their role in the process. This will facilitate a clearer understanding of the features (new and existing) and how these can be utilised to benefit the organisation.

Level 2 Limited

NHS e-Referral Service leadership (both management

and clinical established)

If your organisation has defined NHS e-Referral Service leaders from both management and clinical staff it is important to ensure that both have defined goals within the organisation.Fundamental to the successful implementation of NHS e-Referral Service is a clear strategic direction endorsed by the trust board. Do the NHS e-Referral Service leads fully understand the benefits to be realised by streamlining processes and aiming for full electronic booking within the trust? Do they have a process to communicate and promote this to the board?

Level 4 Optimised

Proactive NHS e-Referral Service

leadership – regular updates and events to promote NHS e-

Referral Service and benefits throughout

LHC•Where this level is being achieved the following benefits can be expected:

•Basis for benefits focused deployment/ redeployment of NHS e-Referral Service with formal support from Trust board

•Clarity of Processes within organisation

•Closer Working with primary care colleagues

•Comprehensive messages about benefits for all

Level 3 Mainstream

Established NHS e-Referral Service

leadership working in partnership with

primary care colleagues

The best chance of success lies in working together within your local health community.

A provider organisation can have a perfect directory of services and an outstanding willingness to work to the highest processes but in order to realise the full benefits of NHS e-Referral Service they will need commitment from all other stakeholders within the community.

.

Process


Information

Technology

Performance

SERVICE PROVIDER


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1. PEOPLE & ORGANISATION


• Identify a NHS e-Referral Service lead from the appropriate management team

• Ensure the person appointed can work at a senior enough level to engage with and influence clinicians and service managers as well as key board members where appropriate

• Ensure the person appointed fully understands operational processes and policy responsibilities in order to see how NHS e-Referral Service can be utilised positively to benefit the organisation

• Identify a NHS e-Referral Service Clinical Lead to work with the NHS e-Referral Service lead and to help influence clinicians within the organisation. This person will deal with any decisions that have a clinical bearing and that may affect patient safety.

• The clinical lead needs to set a good example by using the NHS e-Referral Service system as it was intended to be used and thereby realise the benefits that they can share with other clinical colleagues..

Level 1 No defined NHS e-Referral Service leadership and limited awareness

• No Clearly identified business owner to work in partnership with other LHC stakeholders

• No Board Level understanding of the benefits available to the organisation

• Diversity of processes within different clinical areas and with no expert problem solving resource

• No business owner for whole organisation Directory of Services which may lead to inconsistent and unreliable information, disengaging referrers

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Dis-benefits

Service Provider





• NHS e-Referral Service needs to be written into the annual business/strategic plan in order to legitimise the work being undertaken by the NHS e-Referral Service leadership.

• Ensure that all staff members and clinicians are aware that the organisation has defined NHS e-Referral Service leaders, what their responsibilities are and how to contact them.

• If you are part of a large organisation set up nominated “super-users” within each work area and outline a clear structure of roles of responsibilities.

• Fix regular meetings for all leaders and super-users to share information, problems and good practice throughout the organisation. Ensure a line of communication to and from the Trust board.

• Encourage key staff to sign up for the NHS e-Referral Service Bulletin by visiting the NHS e-Referral Service Website http://systems.hscic.gov.uk/ers/signup. The bulletin is emailed to subscribers and contains information on new guidance, policy issues, future functionality, planned outages etc.

• Once you have a defined internal structure, set up an operational user group with key leaders from CSU and local Clinical Commissioning groups or practices..

Level 2 NHS e-Referral Service leadership (both management and clinical) established

• Strategic plan supported by board to give import to ongoing work to improve processes and outcomes

• Good practice sharing and problem solving throughout the organisation and local health community

• Representation from all teams will help ensure that no specialties or clusters become dis-engaged through lack of support

• Closer working with primary care colleagues will initiate improved understanding of services and processes that translate into better pathways for patients

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Benefits

Service Provider

Return to maturity delReturn to Maturity Model


http://systems.hscic.gov.uk/ers/signup



• Support your commissioning organisations’ NHS e-Referral Service Leads in their efforts to obtain director level support to formalise NHS e-Referral Service as part of their own strategic delivery goals. Ensure that NHS e-Referral Service is on the agenda at contract management meetings.

• Organise joint events with NHS e-Referral Service leads from Primary Care. Ensure that these events are targeted at both administrative and clinical stakeholders. It may be that different events are organised for target audiences Spread the word about benefits that have been realised and could still potentially be realised

throughout the entire community Share good practice and solutions to problems that have been raised by others within the community Resolve to overcome perceived problems together as a community, for the benefit of all users and, of

course, patients

• Work jointly with other teams across the community – Planned Care, Referral to Treatment leads, Cancer and Urgent Care leads, to ensure that they understand how the NHS e-Referral Service system can be utilised to help them achieve their targets and benefit patients.

Level 3 Established NHS e-Referral Service leadership working in

partnership with primary care colleagues

• Comprehensive messages about benefits for all

• Clear ownership within the LHC preventing disengagement due to a lack of support and understanding

• Representation from all business areas will forge closer joint working and place NHS e-Referral Service on the agenda within other workstreams – planned care, referral to treatment, urgent care etc

• Better experience for patients when referrals are sent with certainty to the right services with the right information and testing performed ahead of consultation

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Benefits

Service Provider




In total, 30 benefits were documented for Service providers, including revenue generation, cost savings and time and resource savings. In order to realise those benefits, clear leadership and responsibility for NHS e-Referral Service must be defined. Incidental benefits will then be realised and can be seen below:-

• Basis for benefits focused deployment/ redeployment of NHS e-Referral Service with formal support from Trust board

• Clarity of Processes within organisation• Many organisations have a wide range of processes across different specialties and business areas. Good NHS e-Referral Service leadership will

enable teams to share best practices and clearly define processes that work across all areas. This in turn will enable organisations to use their workforce more flexibly.

• Good practice sharing and problem solving throughout the organisation and the local health community• Ability to minimise diversity of processes within different clinical areas and apply expert problem solving• Foundation for clear structure to roll out new features and upgrades• Representation from all teams ensuring that no specialties fall behind or become disengaged through lack of support

• Closer Working with primary care colleagues• Clearly identified business owner to work in partnership with other LHC stakeholders• Improved understanding of services and processes that translate to better pathways for patients• Clear ownership within the local health community preventing disengagement due to lack of support and understanding

• Comprehensive messages about benefits for all• Representation from all business areas will forge closer joint working and place NHS e-Referral Service on the agenda within other workstreams –

planned care, urgent care etc

Level 4 Proactive NHS e-Referral Service leadership – regular updates and events to promote NHS e-Referral Service and benefits throughout LHC

Service Provider

Benefits



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Level 1Basic

Minimum specification for NHS e-Referral

Service on selected desktops.

Smartcards available to admin staff only. Minimum support

from local ITNHS e-Referral Service is a technically robust application. Outside of planned downtime (upgrades to the system), in the 12 month period January to December 2013 the system was available 99.7% of the time. It does however rely on local stakeholders having systems and processes in place to support their users. It is imperative that you identify the responsible IT personnel within your organisation.

Level 2 Limited

Reliable high spec machines in defined

business areas. Some clinicians

have smartcards. Lack of ownership

from local ITNHS e-Referral Service needs to be available at any point in the provider organisation where individuals involved in the administration and clinical care of outpatients may work. Clinicians need to be registered on the Spine User Directory in order to have services allocated to them and in which they are named. For all of this to work, Local IT need to fully support the process and ensure the system works for all users within the organisation

Level 4 Optimised

Local IT gives high priority to NHS e-

Referral Service. NHS e-Referral Service

available in all work areas. System access (smartcards) managed

proactively

Level 3 MainstreamLocal IT service

fully supports NHS e-Referral Service.

High spec desktops. All

clinicians have smartcards

With the right support from local IT, high spec desktops available in key working areas, and a cohort of clinicians armed with their own smartcards you are well on the way to providing the optimum technical environment to enable best use of the NHS e-Referral Service system.

Talk to users to see if there are any persistent issues that need to be addressed and ensure they all know who to contact for ongoing support.

Process


Information

Technology

Performance

SERVICE PROVIDER


Where this level is being achieved the following benefits can be expected:

•Confidentiality & Security•Convenience• Reduction in inappropriate referrals and support for Referral to Treatment monitoring

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1. TECHNOLOGY

Steps to improve maturity ratingEnsure that all desktops within departments and areas that support the outpatient process have access to NHS e-Referral Service. • If you work in an area that would benefit from more support from IT, be proactive – start to build an IT audit of the

desktops in the area; which work well, which do not work at all due to smartcard reader issues or error messages when attempting to access NHS e-Referral Service?

• Where you have persistent problems with access to the application, keep a log to present to the IT support team. • The ‘NHS e-Referral Service Install Reference Document’ gives guidance on preparing local desktops for running the

NHS e-Referral Service web application. The document contains guidance for desktop infrastructure & recommended minimum PC specification, installation of the Identity Agent, connectivity and common technical and performance issues. Ensure your IT support team have access to this and that desktops in your work area meet or exceed the minimum specification.

Does your organisation have a recognised Registration Authority (RA) Manager and sufficient RA Agents?• The RA Manager within an organisation has a responsibility to ensure that all individuals who need access to Spine

connected services, such as NHS e-Referral Service have had their identity rigorously checked and that they are assigned appropriate access.

• Access is via a smartcard and a passcode. This is generally administered by nominated RA Agents. Organisations should have sufficient RA Agents to ensure proficient and timely support to users.

• All staff who are involved in the administration and clinical care of patients within the outpatient setting should have smartcards. They should be assigned roles and workgroup access to enable them to manage patients referred into the services for which they have responsibility.

Level 1 Minimum specification for NHS e-Referral Service on selected desktops. Smartcards available to admin staff only. Minimum support from local IT

More Resources required:-• To support users who

cannot consistently access the system. due to IT/desktop issues

• Where the right staff do not have smartcards or the correct roles or inclusion in relevant workgroups there is a need to pass work around to other colleagues.

Inconvenience• Where the system is not

working, as expected, on all desktops, staff will not be able to complete work without considerable inconvenience

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Dis-benefits

Service Provider



2. TECHNOLOGY

Steps to improve maturity ratingThe best chance of making NHS e-Referral Service the everyday method of referral for your local health community is to ensure that local referrers have access to your clinicians in the same way they feel they have access via paper referring. To facilitate this you need to consider the following:-

• Enabling “Named Clinician” Referring• Offering Advice and Guidance within services• Encouraging online reviewing of referrals by clinicians within your organisation.

To make these features available to referrers successfully, provider clinicians need to be registered on the Spine User Directory and be issued with a smartcard.

Named Clinician services require a PAS system that is configured to support this functionality. Do you know who to contact to find out if your PAS supports this and how to escalate this if the answer is no?

Successful implementation and use of NHS e-Referral Service requires enthusiastic and committed support from your local IT Service Desk. If this is not the case in your organisation then you need to ensure that the NHS e-Referral Service Leads work with the senior responsible manager within IT. Together they need to devise a support structure where local IT Service personnel respond quickly and proficiently to problems raised by users of the system.

They need to know the difference between local issues and national (program) issues; how to escalate problems that they cannot fix themselves; how to contact the National NHS e-Referral Service implementation team for site specific support.

Level 2 Reliable high-spec machines in defined business areas. Some clinicians have smartcards. Lack of ownership from local IT.

Confidential exchange of information:-

• Where clinicians are using the system directly they are able to receive patient information quickly and securely

Reduction in inappropriate referrals

• Advice and Guidance enables clinicians to specify the best clinical pathway based on real information about the patient

Supports RTT Monitoring• Advice and Guidance

enables clinicians to deliver appropriate tests BEFORE commencing referral process

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Benefits

Service Provider



3. TECHNOLOGY


Ensure that all areas that are frequented by users of the system (consulting rooms, theatre, mess rooms etc) have desktops with a setup that enables users to access the system.

Busy consultants are much more likely to use the system if it is available whenever they have time to use it. Clinicians report that they can take a folder of referral letters with them and work on them as they move around the hospital. If the system is available at key points throughout the hospital then all a user needs is their smartcard.

Registration should be managed effectively – remember SMARTCARDS DO EXPIRE!

Make sure that the registration authority representatives within your organisation manage the process proactively. Manage users on the basis that their smartcards will expire from time to time and ensure that they are re-certificated BEFORE that happens.

Local IT should be “plugged in” to the national team at Health and social Care Information Centre in order to manage new releases of NHS e-Referral Service and new releases of their operating system and local PAS software that may affect NHS e-Referral Service.

There is nothing more likely to switch off users than a system that is suddenly unavailable. This, teamed with a lack of knowledge of who to contact, quickly results in a clinician who reverts to paper or a booking clerk that heads for the PAS. Make sure that your Local IT recognise that NHS e-Referral Service is an essential business system that needs to be available at all times, for all users, to enable patients to book appointments, clinicians to access clinical information, and administrators to manage patients into your organisation..

Level 3 Local IT service fully supports NHS e-Referral Service. High spec desktops.

All clinicians have smartcards.

• Convenience Flexibility for clinicians to review referrals throughout their whole working environment

• Confidentiality and Security – referral letters are not transported throughout the hospital or hospital sites so less chance of them becoming overlooked or lost.

• Better Patient Care – clear audit trail ensures that fewer referrals go missing or unseen and ensures all patients are appointed.

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Benefits

Service Provider



4. TECHNOLOGY

• Confidentiality and Security

• Where clinicians are using the system directly they are able to receive patient information quickly and securely

• Referral letters are not transported throughout the hospital or hospital sites so less chance of them becoming overlooked or lost.

• Better patient care where a clear audit trail ensures that fewer referrals go missing or unseen and ensures all patients are appointed

• Convenience

• Flexibility for clinicians to review referrals throughout their whole working environment

• Reduction in inappropriate referrals and support for Referral to Treatment monitoring

• Clinicians using the system themselves enables the organisation to offer Advice and Guidance and to specify the best clinical pathway based on real information about the patient

• Advice and Guidance also enables clinicians to deliver appropriate tests BEFORE commencing referral process

Level 4 Local IT gives high priority to NHS e-Referral Service. NHS e-Referral Service

available in all work areas. System access (smartcards) managed proactively.

Benefits

Service Provider



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Level 1Basic

Low levels of information reacting

to demand and capacity issues

Where an organisation does not use available information to aid them with planning there will inevitably be mis-matches in capacity and demand. This, in turn, may lead to initiative sessions and even waiting time breaches.

Level 2 Limited

Understanding of available

performance information

NHS e-Referral Service has a number of reports that will provide an overview of NHS e-Referral Service activity within your organisation. These reports provide different views and will highlight issues where referrals are not being managed efficiently. This will enable you to target those areas of the trust that need extra support

Level 4 OptimisedContinuous

Planning/Management routinely matches demand and capacity

Level 3 Mainstream

Complete view and understanding of

NHS e-Referral Service utilisation

across all specialtiesYou should by now understand how to interrogate the available information provided on the NHS e-Referral Service website and within the application, to highlight areas of concern with regard to processes within your organisation and to help you with capacity and demand planning. If slots are not available – patients and their GPs cannot book themselves. This will lead to extra work and cost to manage these referrals.

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Information

Technology

Performance

SERVICE PROVIDER


Getting the balance between capacity and demand right will facilitate the organisation in realising the following benefits::

Cost saving

Support for Referral to Treatment pathway

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1. INFORMATION


Do you know how to access the national Booking and Slot Issues reports?

These reports are collated and updated by the Health and Social Care Information Centre (HSCIC). They can be found on the NHS e-Referral Service website

• The weekly booking report shows:-

the percentage of NHS e-Referral Service utilisation against your average monthly activity (Quarterly Activity Return (QAR)). Does this match what you believe is your current utilisation and if not – why not? Are some services missing? Are you appointing all NHS e-Referral Service referrals within NHS e-Referral Service (specifically ASIs). If some services are IBS – are you reporting the appointments within NHS e-Referral Service?

DBS/IBS percentage split. Why are some services IBS? When last did you look at the IBS position?

• The Slot Issues Report shows the total number of slot issues in any given week for your organisation. It enables you to drill down by specialty.

Analysing the above information is the first step in understanding how your organisation is performing. Your trust information team should be able to help you set up templates to enable you to order the data to meet your needs.

Level 1 Low levels of information reacting to demand and capacity issues

• Overuse of high cost initiative clinical sessions – lack of planning will lead to “fire-fighting” approach which will involve expensive extra clinical sessions.

• Potential Waiting time Breaches - Failure to plan capacity and demand may lead to delays in the referral to treatment pathway and potential breaches

• High level of Appointment Slot Issues – Where appointments are not available for patients to book, the process to appoint those patients is time-consuming and resource intensive

Dis-benefits

Service Provider

Return to maturity del To support you in understanding the data available in NHS e-Referral Service, please see the document ‘Reports and Extracts in NHS e-Referral Service’



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2. INFORMATION

Steps to improve maturity ratingNHS e-Referral Service contains a series of reports which show provider organisations various aspects of NHS e-Referral Service activity. These include:-

• Activity by referrer - break down by Commissioning Organisation and at specialty level will enable you to see where referrals are coming from and will highlight those specialties which are receiving high volumes of activity from out of area.

• Assessment Centre Analysis – Lists all CAS services that your organisation provides and activity in each.

• Future Slot Utilisation – Broken down to service level, this report shows the total slots published (by priority) to NHS e-Referral Service, against number of slots booked. This is a simple service profile which will show the ratio between priorities, how many slots are available for patients and helps you to plan appropriate capacity to meet demand. This report is available on a weekly basis from NHS e-Referral Service.

• Referral Analysis – shows total number of referrals, broken down by priority and commissioning organisation

• Service Activity – Lists all services published by your organisation. Broken down by specialty this report gives information on IBS/DBS, Appointments Booked, Appointments Due, Appointments Attended, Appointments DNA’d, Rejected Cancellations, Displaced, Appointment Cancellations by: Patient, Provider and Other This report provides a wealth of information on how NHS e-Referral Service is being managed in your trust and highlights those specialties/ services that would benefit from support.

• Service Referral Analysis – enables a high level view of whether referrals are being reviewed. Where referrals are not being reviewed and accepted an organisation will see an increase in patients arriving for inappropriate appointments. This report also shows total number of Advice and Guidance requests and responses by service.

Level 2 Understanding of available performance information

• Capacity Issues Highlighted – Transparency of capacity issues.

• Visibility of appointment slots – Future Slot Utilisation enquiry or report enables Service Provider to monitor and offset ASIs

• High level view of services and demand from all areas – enables better capacity planning and helps target problem services to prevent breaches and high cost initiatives

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Benefits

Service Provider



3. INFORMATION


Where patients attempt to book an appointment and no appointment is available, the UBRN can be deferred straight to the provider where it will appear immediately on their Appointment Slot Issue (ASI) Worklist. The worklist will enable you to filter the information and see immediately where your capacity hotspots are. This will indicate if there are not enough appointment slots given to NHS e-Referral Service and can be used in conjunction with the Future Slot Utilisation report to help you to drill down to the relevant clinic templates and spot gaps in capacity (holidays, study leave etc).

For a more robust solution, problem specialties need to be proactively planned. The Elective Care Intensive Support Team can provide support on how to use their Capacity and Demand Toolkit. They have dedicated and experienced Business Managers who can demonstrate the model and answer your questions,

http://www.nhsimas.nhs.uk/intensive-support-team/

Avoid Breaches:-

• Watch out for potential problems with patients who persistently cancel and rebook. Be proactive – your PAS should be able to highlight those patients and enable you to work with them to find solutions

• NHS e-Referral Service will allow you to refer DNA patients back to the referrer, but be careful that those patients are not being booked again later without a new clock start.

• Where consultants are reviewing online, make sure they are aware of the difference between a direct referral and an onward referral from a CAS. Make sure the CAS referrers know about IPT forms and that those receiving the referrals in your trust know how to deal with this.

• WORK WITH YOUR COMMISSIONERS to ensure that all referrers, both in practice and in intermediate services know how the commissioned pathway works and what their responsibilities are to help the trust achieve its Referral to Treatment targets.

Level 3 Complete view and understanding of NHS e-Referral Service

utilisation across all specialties

Cost saving• Get capacity and demand

right and patients can book appointments outside of the trust which will free up booking resources within the trust.

• Total cost of processing a referral via DBS is significantly lower than that of a paper based referral process.

Resources • NHS e-Referral Service

supports the Referral to Treatment requirements. Clock Starts are automatically registered on PAS which reduces effort in maintaining the audit trail

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Benefits

Service Provider



http://www.nhsimas.nhs.uk/intensive-support-team

4. INFORMATION

With NHS e-Referral Service capacity Issues are Highlighted - Whilst this may be seen as a dis-benefit by some, highlighting capacity issues is the first step to resolving mismatches in capacity and demand. NHS e-Referral Service has a number of reports that will help providers to identify capacity hotspots and enable them to target those areas. Getting the balance between capacity and demand right will facilitate the organisation in realising the following benefits:-

• Cost Saving

• The Acute Services Contract dictates that patients cannot be rejected on any grounds other than clinical. Where capacity problems exist and are not dealt with, an organisation will have to resort to high cost initiative clinical sessions. Proactive use of the reports available within NHS e-Referral Service will help your organisation to avoid this “fire-fighting” approach to outpatient management.

• Where appointment slots are available for patients to book, a trust should see a significant reduction in the resources required to book and change appointments.

• Support for the Referral to Treatment pathway

• NHS e-Referral Service supports Referral to Treatment. Clock starts are automatically registered and patients are appointed immediately. An average of 9 days can be cut out of the pathway when compared to paper referrals. .

Level 4 Continuous Planning/Management routinely matches demand and capacity

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Benefits

Service Provider



Level 1Basic

Utilisation <national average. Majority

IBS Services <50% services published.

Slot issues >15%

There are many benefits to be realised from streamlining processes. Better utilisation enables an organisation to work towards one process and cuts down the workload of those who have to support both manual and electronic referral processes. This is true throughout the whole organisation and affects both clinical and admin staff. IBS Services, lack of services and slot unavailability prevent the organisation from improving utilisation and releasing those benefits.

Level 2 Limited

Utilisation = national average. Majority

DBS Services >50% services published. Slot issues 10-15%

There comes a point at where utilisation can stagnate. Ensure that you have all your services available for referrers to book into.You will reach the tipping point where the majority of referrals into your organisation are coming via NHS e-Referral Service, therefore enabling you to streamline your processes and start to truly see the benefit then you need to ensure that problems at your end of the pathway are not dis-benefitting referrers or patients at the other end.

Level 4 Optimised

Utilisation 90% or above. 100% DBS

Services. 100% services published.

Slot issues <4%

Level 3 Mainstream

Utilisation >national average. >90% DBS

services. >90% services published. Slot issues 5-10%

If more than 90% of your services are published and available for booking then much of the hard work has been done and you should be realising many benefits from NHS e-Referral Service. If utilisation is not as high as you would hope and you are still receiving a proportion of your referrals on paper, it is time to work with the Commissioner, local commissioning groups and practices and help promote the benefits to all. But first – you should look at getting slot availability firmly under control..

Process


Information

Technology

Performance

SERVICE PROVIDER


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Full utilisation of NHS e-Referral Service, with direct booking and little or no slot issues is the key to releasing the maximum benefits from using NHS e-Referral Service

1. PERFORMANCE

Steps to improve maturity rating• Why is Utilisation so low?

• If the majority of your services are IBS then patients may be overlooking your organisation when they are presented with a choice of appointments via the internet or TAL. The vast majority of patient administration systems are able to integrate with the NHS e-Referral Service system. Speak to your PAS supplier for more information.

• What is the reason for not publishing all of your services? The Acute contract states that all services must be published on the national menu. If referrers cannot find your services then they may decide to refer their patients to another organisation.

• A full list of Specialty & Clinic Types is available on NHS e-Referral Service Website. Use this spreadsheet as a starting point to ensure that all of your services are published and mapped appropriately.

• Use your NHS e-Referral Service clinical lead to help influence any clinicians who are reticent about publishing their services.

• Slot issues are not caused by NHS e-Referral Service they are simply highlighted. The NHS e-Referral Service Website has a section on Slot Availability, including a list of simple measures to reduce appointment slot issues and information on how to get support from the DH Elective Care Intensive Support Team

Level 1 Utilisation <national average. Majority IBS Services <50% services published.

Slot issues >15%

• Increased Workload – where the provider organisation is receiving only a proportion of their referrals via NHS e-Referral Service there is a need to maintain a manual process for paper referrals alongside processes for electronic referrals

• Poor patient experience –where patients cannot book an appointment their experience is very poor.

• Potential lost revenue – Patients given a list of potential providers cannot book an appointment at your organisation via the internet or TAL and would have to make a separate call regarding an appointment

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Dis-benefits

Service Provider



2. PERFORMANCE

Steps to improve maturity ratingIf the majority of your services are DBS then you have the potential to make ALL services DBS. • Keeping services as IBS does not fix slot availability problems it simply masks the problem. • Referrals can only be rejected on clinical grounds, so whether the referral is coming to you via paper, via

the Defer to Provider route or via DBS, your organisation has a duty to provide the patient with an appointment.

• DBS enables your organisation to utilise The Appointments Line or Patient Web Application to free up resources currently used for booking appointments.

Why are some services not published?• Work with the specialty to find solutions to their perceived problems. Work with consultants to help them

develop their directory of services. Remember this is a two-way process, the administrator may well be the NHS e-Referral Service expert but the consultant is clearly the expert on the services they provide.

• If it is because clinicians fear that the wrong patients will be booked into their services then discuss Advice and Guidance or Clinical Assessment Services with them.

• Direct to list or day surgery services CAN be published. Remind clinicians that they will review ALL referrals before making a decision to Accept, Reject or Re-direct into an alternative service.

Publish ALL slots to NHS e-Referral Service • Do not be tempted to hold back slots to service the paper referrals and ‘defer to provider’ referrals.• Use Slot Reservation to ensure you have slots for booking ASI Worklist referrals, rebooking of

cancellations and re-directions. • Look at extending polling on a service by service basis. For example, having a Dermatology Acne

service polling at the same rate as an Orthopaedic Hip service simply doesn’t make sense.

Level 2 Utilisation = national average. Majority DBS Services >50% services published. Slot issues 10-15%

• Less Resources required in the booking process – DBS services can be booked via the internet, TAL or even in the GP practice, dramatically reducing staffing within provider booking offices.

• Revenue Generation – Publishing your services on the national Directory of Services enables referrers from out of area to find those services.

• Improved Patient Satisfaction – enabling patients to take control of the booking of their appointment at the very beginning of the process promotes a positive image of your organisation.

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Benefits

Service Provider



3. PERFORMANCE

Steps to improve maturity ratingSlot issues will disengage referrers.

• Even 5% slot issues can promote a negative image of your organisation to referrers and patients alike. If your organisation receives an average of 5,000 referrals per month and slot unavailability is 5%, then in real terms that is:-• 250 patients each month who cannot book an appointment at your organisation and either choose a different

provider or enter into the Defer to Provider process• 250 patients each month who begin their referral process with a negative experience whilst trying to get an

appointment• Up to 250 referrers who see capacity problems at your organisation

• It may be that one simple measure will address slot unavailability – the document ‘Managing and Minimising Appointment Slot Issues’ on the NHS e-Referral Service website may point you in the right direction.

Work out a joint plan with your Commissioner, Local commissioning group or GP Practice colleagues to promote NHS e-Referral Service in your local community

• Ensure that referrers can feed comments to your organisation when they have problems with services or slot availability. LISTEN to and RESPOND to that feedback. If you work with your local referrers they are much more likely to feel positive about using the system to refer their patients.

• Keep an eye on rejections and redirections. If one service has many then you need to look at that service in the DOS and see if it can be improved. Ensure that you communicate changes to services to all referrers within your local health community

• Plan joint events where clinicians can talk to clinicians.

Level 3 Utilisation >national average. >90% DBS services. >90% services published. Slot issues 5-10%

• Less Resources required in the booking process – At 90% utilisation you should see a dramatic reduction in the resource required to book appointments.

• Revenue Generation – with more than 90% of services published there should be a noticeable increase in referrals from out of area.

• Improved Patient Satisfaction – ensuring that there are enough appointments for patients to choose a slot that is convenient to them greatly improves their perception of the referral process

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Benefits

Service Provider



4. PERFORMANCE

Full utilisation of NHS e-Referral Service, with direct booking and little or no slot issues is the key to releasing the maximum benefits from using NHS e-Referral Service.

• Less Resources required in the booking process• ALL appointments should now be being made via TAL, the internet, or even in the GP practice. • This should have a dramatic impact in reducing staffing within provider booking offices.

• Increased Revenue• With 100% of Services published on the national Directory of Services, referrers countrywide have access to your services. This

should by now have translated into increased revenue from out of area referrers. • Remember NHS e-Referral Service is the shop window through which to advertise your services. Keep on top of your DOS, make it

simple and straightforward. Map those services correctly so that referrers who are not familiar with your organisation can clearly see whether your service is suitable for their patient.

• Improved Patient Satisfaction• Involving patients in decisions about their care and treatment is key to promoting patient satisfaction. In this day and age where we are

used to organising our lives around busy careers, children, parents or just simply around our leisure activities; we have come to expect that we are in the driving seat when organising appointments. How many GP Practices now have online booking for appointments? Online prescription renewal?

The NHS 2010-2015 five year plan has clearly aligned patient experience and satisfaction with a slice of secondary care income. Good patient experience is a must. Patients want a say in when they are treated and where they are treated. Ensuring that your services are visible, accessible and that appointments are available, will ensure that your organisation meets patients’ expectations at the very beginning of their journey.

Level 4 Utilisation 90% or above. 100% DBS Services. 100% services published. Slot issues <4%

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Level 3Mainstream

Established NHS e-Referral Service leadership working together with providers and

commissioners

NHS e-Referral Service fully supports the commissioners

business objectives by providing timely reports of

activity across their referrers

Local IT service fully supports NHS e-Referral Service business process

Consistent, GP Practice initiated referralProcess


Information

Technology

Level 1Basic


limited awareness

Only partial data available due to low utilisation. Does

not support future commissioning

Technology only meets minimum specification for NHS e-Referral Service . Smartcards available for

appropriate staff

Low NHS e-Referral Service Uptake - less than 30% of practices utilising NHS e-

Referral Service for majority of referrals

Level 2 Limited



NHS e-Referral Service data gives indicative referral trends but not complete

picture

Technology fully supports NHS e-Referral Service

business process

NHS e-Referral Service used by or on behalf of the majority of practices

Proactive leadership – regular updates and events to promote NHS e-Referral

Service and benefits throughout LHC

Information from NHS e-Referral Service supports

demand planning and informs future service needs

Local IT gives high priority to protect NHS e-Referral

Service availability

Electronic only GP initiated referrals

PerformanceUtilisation = national average>50% eligible Primary Care

services published

Utilisation > national average>90% eligible Primary Care

services published

Utilisation 90%.or above100% eligible Primary Care

services published

Utilisation < national average<50% eligible Primary Care

services published

Commissioner

COMMISSIONING ORGANISATION

Level 4Optimised


explore

Level 1Basic

Low NHS e-Referral Service Uptake - less

than 30% of practices utilising

NHS e-Referral Service for majority

of referralsAt this level, the likelihood is that there is some utilisation by individual referrers, in some practices. This translates to no uniform picture of referrals throughout the local health community. With no standard processes and referral practices, it will be difficult for commissioners to see referral trends and focus effort on those practices who require additional support.

Level 2 Limited

NHS e-Referral Service used by or

on behalf of the majority of practices

Mixed economy of CCG and practice proxy referrers handling referrals for those clinicians not using NHS e-Referral Service themselves. CCG staff or practice staff having proxy GP access rights

Level 4 Optimised


Revenue Generation

Improved Patient Care

Improved Patient Satisfaction

Improved Convenience for Clinicians

Having a fully auditable referral trail for patients, with the ability to see where a patient is within the referral process

Level 3 MainstreamConsistent, GP

Practice initiated referrals

Where the GP or practice staff (on behalf of the GP) are initiating referrals on NHS e-Referral Service, from within the practice, following the decision to refer, and in consultation with the patient, many benefits are being realised.

Process


Information

Technology

Performance



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1. PROCESS

Steps to improve maturity rating• Do you understand the reasons for low utilisation in your practices?

• Use the weekly booking report to identify which practices have low utilisation. • Make contact with the practice and identify key responsible NHS e-Referral Service user for

individual practicesMore information and help with access to CCG and Practice level booking reports can be found on the NHS e-Referral Service Website

• Are your GPs aware of the financial benefits that can be realised by using NHS e-Referral Service?

• If you currently have a Locally Enhanced Service payment to encourage the use of NHS e-Referral Service by practices ensure the terms fully understood.

• Reduction of stationery and postage costs as part of the automated booking process. • Ensure the practice managers are aware and informed of the benefits to their practice by

increasing utilisation

Commissioning Organisation

Level 1 Low NHS e-Referral Service uptake - less than 30% of practices utilising

NHS e-Referral Service for majority of referrals

• Two tier service to patients – some patients have a faster access to services; whilst other patients have to wait for the referral to arrive at the hospital for an appointment then sent to the patient

• Difficulty in facilitating choice if the provider is not local – GP unaware of what services are provided across different organisations if the patient chooses to go out of the area

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Dis-benefits



2. PROCESS

Steps to improve maturity rating• Understanding why some practices are not attempting to use NHS e-Referral Service.

• Make contact with the practice and identify key responsible NHS e-Referral Service user for individual practices to make future communication with the practice more effective in relation to NHS e-Referral Service

• Share good referral process models across practices – where a practice has a particular issue with using NHS e-Referral Service for some or all of their referrals, find a model that will fit their needs

• Consider using a clinical champion who is prepared to accompany the Organisation Lead to practice meetings or Clinical Commissioning meetings and give some clinical perspective/value to NHS e-Referral Service.

• Do you have a referral management centre in place to process referrals on behalf of practices?• Issues to consider

• Is choice being offered to all patients where appropriate?• Is the waiting time clock start being delayed?• Is this having a financial impact on the commissioning organisation?• Remember an Inter Provider Transfer minimum data must be sent to the provider for each

patient.

• Are all your practices aware of the Responsibilities and Operational Requirements for the correct use of NHS e-Referral Service?

• Discuss with practice managers how they can implement all referrals being initiated from within the practice setting, tailoring processes to accommodate practice requirements.

This guidance document ‘Best Practice Guidelines’ can be viewed on the NHS e-Referral Service website.


Level 2 NHS e-Referral Service used by or on behalf of the majority of practices

• Improved Patient Care – faster access to services;

• Improved Convenience for Clinicians - Greater GP visibility of primary care services

• Improved Patient Experience – • Greater confidence in the

process which reduces anxiety

• Access to real Choice – all clinically appropriate providers available for patient to select

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Benefits



3. PROCESS

Steps to improve maturity rating• Work with the practice to ensure they have a process to ensure ALL referrals are initiated

through NHS e-Referral Service, that both meets the individual practice requirements and addresses patient satisfaction.

• Share good referral process models across practices• Help practices to understand how NHS e-Referral Service can be utilised to facilitate

choice and realise the benefits that high utilisation of NHS e-Referral Service brings.• Show them ways to work flexibly to facilitate different referrers and their processes.

• Ensure the users are aware of the other functions within NHS e-Referral Service that can enhance their referral process and that may prevent inappropriate referrals which may result in rejections or redirections:

• Use of Advice and Guidance• Use of “SNOMED” terminology to search for appropriate services.


Level 3 Consistent, GP Practice initiated referrals

• Improved Patient Care – patients involved in their referral with their GP or GP Practice staff.

• Improved convenience for clinicians and practice staff – access to the national Directory of Services and further access to the patient referral audit trail to ensure patient is treated appropriately

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Benefits



4. PROCESS

• Revenue Generation• Easier accessibility to Primary Care or local Commissioned services, if utilised would generate a cost saving

• Improved Patient Care – • Faster access to services; - appointment booked at or soon after decision to refer• The waiting time clock start is captured for patients booked through NHS e-Referral Service – this will also help ensure that patients

are treated within the expected referral to treatment time

• Improved Patient Satisfaction • Patients will be able to choose the provider of their care, a date and time of appointment that suits them and how they book that

appointment.• Improved patient satisfaction at the very beginning of the patient pathway helps build a reassuring picture of the provider and whole

referral process

• Improved Convenience for Clinicians • Greater GP visibility of Primary Care services• Having a fully auditable referral trail for patients, with the ability to see where a patient is within the referral process.


Level 4 Electronic only GP initiated referrals

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Benefits



Level 1Basic


limited awarenessEvery Clinical Commissioning Group/CSU should have defined clinical and managerial leadership. Having no defined NHS e-Referral Service leadership will lead to a patchy/ad-hoc approach within the local health community. Practices need to know where to go for support and help within their wider organisation. As commissioners it is imperative to have a clear understanding of the end to end referral process. Proactive clinical leadership is a must if local clinicians are to be encouraged to adopt new ways of working.

Level 2 Limited

NHS e-Referral Service leadership (both management

and clinical) established

If your organisation has NHS e-Referral Service leads from both management and clinical staff it is important to ensure that both have defined goals for NHS e-Referral Service within the organisation. Do the identified manager and clinician promote the utilisation throughout the local health community? Does the lead clinician set a good example by using the system as it was intended to be used? Are they realising benefits that they can share with other clinical colleagues?

Level 4 Optimised

Proactive NHS e-Referral Service

leadership – regular updates and events to

promote NHS e-Referral Service and benefits

throughout LHC

Improved Patient Satisfaction

Less Resources required

Resource to support practices

Supports patient complaint investigations


Clearly identified business owner

Level 3 Mainstream

Established NHS e-Referral Service

leadership working together

with providers and

commissioners

The best chance of success lies in working together with clear leadership and ownership within the commissioning organisation. There are agreed methods of communication both with practices and other health organisations within the Local Health Community.

Process


Information

Technology

Performance



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1.PEOPLE & ORGANISATION

Steps to improve maturity rating• Identify a NHS e-Referral Service lead from the appropriate management team who is responsible for NHS e-

Referral Service

• Ensure the person appointed can work at a senior enough level to engage with clinicians and managers as well as feeding back to the board where appropriate

• Ensure the person appointed fully understands operational processes and policy responsibilities in order to see how NHS e-Referral Service can be utilised positively to benefit all stakeholders

• Develop and agree a process for practices and GPs to feed back and to raise queries about NHS e-Referral Service

• Identify a NHS e-Referral Service clinical lead to work with the NHS e-Referral Service lead to help influence clinicians within the local health community.

• Ensure that the practice managers and GPs are aware of who to contact in their wider organisations regarding NHS e-Referral Service.

• Ask practices to identify a key responsible NHS e-Referral Service user to ensure communication from the commissioning organisation goes to the correct person within the practice and that other users within the practice have a recognised “in-house” contact.



• Practices unsure of who to approach with NHS e-Referral Service issues This could result in practices wasting time trying to get answers to what is and what isn’t available on NHS e-Referral Service

• Multiple methods of referral for practices– Several methods and routes to making referrals to different organisations causing confusion to some referrers.

• Difficulty in facilitating choice if the provider is not local – GP unaware of what services are provided across different organisations and how to access them if the patient chooses to go out of the area

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Dis-benefits





• Ensure that all staff members and clinicians are aware that the organisation has defined NHS e-Referral Service leaders, what their responsibilities are and how to contact them.

• Ensure there is an effective method of communication with GPs and practices regarding any new services that have been commissioned on NHS e-Referral Service, to ensure new community services are visible and utilised and to share information, problems and good practice throughout the commissioning organisation

• Once you have a defined internal structure, set up an operational user group with key leaders from the CSU and local Clinical Commissioning Groups or practices

• Encourage key practice staff to sign up for the NHS e-Referral Service Bulletin by visiting the NHS e-Referral Service Website http://systems.hscic.gov.uk/ers/signup. The bulletin is emailed to subscribers and contains information and links on new guidance, policy issues, future functionality, planned outages etc.

Does your NHS e-Referral Service lead communicate with other local organisations?

• Is there effective regular communication with other local commissioners and providers? If not then consider setting up a Local Health Community meeting.


Level 2 NHS e-Referral Service leadership (both management and clinical) established

• Good practice sharing and problem solving throughout the organisation and local health community

• Clarity of Processes within the organisation and across the wider health community

• Resource to support practices in finding flexible benefits focused solutions

• Less Resources required – time saved by the practices if they know who to contact

• Foundation for clear structure to roll out new features and upgrades

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Benefits






• Support your contracted providers in their attempts to obtain director level support to formalise NHS e-Referral Service as part of their own strategic delivery goals. Ensure that NHS e-Referral Service is on the agenda at contract management meetings.

• Organise joint events with provider organisations, to include secondary care, primary care providers and local clinical commissioning groups/practice users. Ensure that these events are targeted at both administrative and clinical stakeholders. It may be that different events are organised for target audiences• Spread the word about benefits that have been realised and could still potentially be realised

throughout the entire community• Share good practice and solutions to problems that have been raised by others within the community• Resolve to overcome perceived problems together as a community, for the benefit of all users and, of

course, patients• Work jointly with other teams across the community – Planned care leads, cancer and urgent care leads

to ensure that they understand how the NHS e-Referral Service system can be utilised to help them achieve their targets and benefit patients


Level 3 Established NHS e-Referral Service leadership working together

with providers and commissioners

• Comprehensive messages about benefits for all

• Clear ownership within the LHC preventing disengagement due to a lack of support and understanding

• Representation from all business areas will forge closer joint working and place NHS e-Referral Service on the agenda within other workstreams – planned care, urgent care etc

• Better experience for patients when referrals are sent with certainty to the right services with the right information and testing performed ahead of consultation where necessary

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Benefits




• Improved Patient Satisfaction • Patient involvement and choice, with the ability to choose services closer to home.• Improved patient satisfaction at the very beginning of the patient pathway helps build a reassuring picture to the patient • Better experience for patients when referrals are sent with certainty to the right services with the right information and testing performed ahead of consultation

• Less Resources required • Time saved by the practices if they know who to contact within their organisation if they have a problem• Clearly identified business owner to work in partnership with other Local Health Community stakeholders

• Resource to support practices • Supporting practices in finding flexible benefits focused solutions • Good practice sharing and problem solving throughout the organisation and local health community

• Supports patient complaint investigations• Clear lines of communication with other organisations, with a fully auditable history of the referral

• Improved Convenience for Clinicians • Greater GP visibility of Community and Primary Care services• Having a fully auditable referral trail for patients, with the ability to see where a patient is within the referral process.

• Clearly identified business owner • Clear ownership within the LHC preventing disengagement due to a lack of support and understanding• Representation from all business areas will forge closer joint working and place NHS e-Referral Service on the agenda within other work-streams planned care,

urgent care etc


Level 4 Proactive NHS e-Referral Service leadership – regular updates and events

to promote NHS e-Referral Service and benefits throughout LHC

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Benefits



Level 1Basic

Technology only meets minimum specification

for NHS e-Referral Service Smartcards

available for appropriate staff

NHS e-Referral Service is a technically robust application. Outside of planned downtime (upgrades to the system), in the 12 month period January to December 2013 the system was available 99.7% of the time. It does however rely on local stakeholders having systems and processes in place to support their users. It is imperative that you identify the responsible IT personnel that support your organisation.

Level 2 Limited


business process

All users have the correct IT specification set up to effectively access NHS e-Referral Service. All staff have the correct roles on their smartcards. Where appropriate there is integration with the users clinical system or Patient Administration System (PAS).

Level 4 Optimised

Local IT gives high priority to protect NHS

e-Referral Service availability

Less Resources required

Increased staff engagement

Clear documented pathways and processes within the organisation

Confidential exchange of information

Confidentiality and Security

Level 3 MainstreamLocal IT service

fully supports NHS e-Referral Service business process

The IT support department is aware of all the components, both hardware and software, that are required to successfully run NHS e-Referral Service,. There is a defined process for any helpdesk calls that are NHS e-Referral Service related. All smartcard issues that stop a user accessing the service are treated as priority to ensure the user has minimal downtime.

Process


Information

Technology

Performance



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1. TECHNOLOGY


• Do you know what the minimum specification is and how to access this information?

• Is your IT department aware of the minimum specification required to access NHS e-Referral Service, when setting up a new user, whether that is within a practice setting, Information setting or commissioner organisation?

More information and help with ensuring the minimum specification is achieved can be found at on the NHS e-Referral Service website.

• Are staff aware of the Registration Authority process within their organisation?

• Do practice staff know how to register for and where to get a smartcard from?• Do CCG staff know how to register for and where to get a smartcard from?• Is the RA team aware of the business functions that different staff will need to access the correct role

within NHS e-Referral Service?


Level 1 Technology only meets minimum specification for NHS e-Referral Service. Smartcards available for appropriate staff

• Unusable system Practices and providers unable to access NHS e-Referral Service due to incorrect IT set up. This could present as speed issues, or total non access to the system.

• No access to smartcards Staff unable to access NHS e-Referral Service to manage referrals either as a referrer or a provider

• Inconveniencewhere the system is not working, as expected, on all desktops, staff will not be able to complete work without considerable inconvenience

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Dis-benefits



2. TECHNOLOGY


• Ensure each user has access to the correct hardware/ software to ensure they are able to use NHS e-Referral Service.

• Are all the PCs set up to access NHS e-Referral Service across the organisation or at least in all the areas from which clinicians may require to access NHS e-Referral Service? This is not just in the GP practices; NHS e-Referral Service may need to be available within community clinics throughout the local area.

• If there is a problem with accessing NHS e-Referral Service, ensure each user is aware of how to report any technical problems they may encounter.

• Is there a documented clear process for users to follow if there is a problem accessing NHS e-Referral Service from a PC?

• Are the users aware of how to access IT help if required or to report a fault?

• Ensure the local IT team is “plugged in” to the national team at Health and Social Care Information Centre and their regional IT teams in order to manage new releases within NHS e-Referral Service and new releases of their operating system and local PAS software that may affect NHS e-Referral Service.


Level 2 Technology fully supports NHS e-Referral Service business process

• Clear documented pathways within the organisation preventing disengagement due to a lack of support and understanding.

• Less Resources required Time saved by the practices if they know who to contact within their organisation if they have a problem

• Confidential exchange of information - Where clinicians are using the system directly they are able to receive patient information quickly and securely

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Benefits



3. TECHNOLOGY


• Is the supporting IT department aware of future technical upgrades to NHS e-Referral Service to ensure there is not a conflict with any local IT solutions?

• Where a problem is identified that is not a local issue or the IT team are having difficulties sorting do they know where to get extra support?

Sign up to the NHS e-Referral Service Bulletin to ensure you receive the information about any future releases at: Subscribe

• Local IT helpdesks are skilled to recognise smartcard, N3 or NHS e-Referral Service issues to support the end user.

• Ensure end users are aware of the process to report any IT issues with accessing or using NHS e-Referral Service

• Is the RA team aware of the business functions that different staff will need to access the correct role within NHS e-Referral Service?

• Registration should be managed effectively – remember SMARTCARDS DO EXPIRE!

Make sure that the registration authority representatives within your organisation manage the process proactively. Manage users on the basis that their smartcards will expire from time to time and ensure that they are re-certificated BEFORE that happens.

Further information can be found at: Registration Authorities and Smart Cards


Level 3 Local IT service fully supports NHS e-Referral Service business process

• Less Resources required if the IT department is aware of future releases and upgrades it will minimise any potential downtime for end users.

• Staff do not waste time trying to resolve problems or find someone who can resolve the issue.

• Staff engagement End users feel confident that any IT issues will be resolved quickly and efficiently to allow the end user to continue to use NHS e-Referral Service.

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Benefits




http://systems.hscic.gov.uk/rasmartcards

4. TECHNOLOGY

• Less Resources required • Time saved by the practices if they know who to contact within their organisation if they have a problem• When the IT department is aware of future releases and upgrades it will minimise any potential downtime for end users

• Increased staff engagement • End users feel confident that any IT issues will be resolved quickly and efficiently to allow the end user to continue to use NHS e-

Referral Service.

• Clear documented pathways and processes within the organisation• This prevents disengagement due to a lack of support and understanding.

• Confidential exchange of information • Where clinicians are using the system directly they are able to receive patient information quickly and securely• Fully auditable trail, easy to investigate if any complaints come into the commissioners

• Confidentiality and Security • Paper referral letters are not transported from the practices to the hospitals with less chance of them becoming overlooked or lost,

which may result in a delay in the patients care, with possible impacts on the planned care referral to treatment measurements.


Level 4 Local IT service fully supports NHS e-Referral Service business process

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Benefits



Level 1Basic

Only partial data available due to low utilisation. Does not

support future commissioning

Where utilisation is low, referral data from NHS e-Referral Service is not complete. As a result, the commissioner must rely on data from other sources, such as the Secondary User Service (SUS). This data will only be available retrospectively, ie, after the patient has been seen. NHS e-Referral Service data, on the other hand, is available at the end of each month for the month just passed.

Level 2 Limited

NHS e-Referral Service data gives indicative referral

trends but not complete picture

Referral data is still not complete from NHS e-Referral Service as not all referrals are going via NHS e-Referral Service. Commissioners can start to identify referral trends from practices that have high utilisation. Primary care referral data becomes more visible with easy access to the information.

Level 4 Optimised

Information from NHS e-Referral Service supports demand

planning and informs future service needs

Complete view of referral data

Commissioning decision support


Level 3 MainstreamNHS e-Referral

Service fully supports the

commissioners business

objectives by providing timely

reports of activity across their

referrersReferral data is now almost complete from, with only small amounts missing as not all referrals are going via NHS e-Referral Service, Commissioners will start to identify referral trends from practices that have high utilisation. Primary care referral data becomes more visible with timely access to the information.

Process


Information

Technology

Performance



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1. INFORMATION


• Do you have a complete picture of how each practice in your area is performing in terms of NHS e-Referral Service utilisation? • Use the weekly booking report to identify which practices have low utilisation. • Make sure that the key responsible NHS e-Referral Service user in each individual practices is aware of

this figure and how they compare with other practices locally.More information and help with access to commissioner and practice level booking reports can be found at on the NHS e-Referral Service website

• Are local GPs aware of the benefits that can be realised by early access to their referral data? • Practice level data can be useful to practices to understand their referral trends, to identify any potential

training requirements for their GPs.• Consider sending out information to Practice Managers about what data is held in NHS e-Referral Service

and how that data can help them. Ensure they understand that the more that is put through NHS e-Referral Service the better quality of the information available.

NHS e-Referral Service can be used as a tool to support commissioning and information about this can be found in the document ‘Supporting Clinical Commissioning’


Level 1 Only partial data available due to low utilisation. Does not support future commissioning

• Incomplete data The commissioning organisation will have to gather and analyse data from various points

• Practice data Practices do not have referral data available to them to identify their referral patterns

• No access to real time data Activity data available from SUS is more than a month old when it can be accessed.

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Dis-benefits



2. INFORMATION

Steps to improve maturity rating• Utilise the monthly reports and extracts available on NHS e-Referral Service

• This will help you understand:-• Where your patients are choosing to go to - which providers• Referral trends across the practices• High volume specialties• Provider slot utilisation• Early warning of ‘over’ activity against contracts

• Ensure, wherever possible, primary care services are available on NHS e-Referral Service

• This will ensure referrals other than secondary care are recorded, giving a fuller and more accurate picture of referral trends across the commissioning organisation.

• Work with commissioners to ensure NHS e-Referral Service is included in all service specifications when commissioning new community services


Level 2 NHS e-Referral Service data gives indicative referral trends but not complete picture

• Cost saving through more accurate payment checking, both for local services accessed and other services outside of the local boundaries

• Improved referral data– Practices able to understand their referral patterns by practice and individual GP

• Improved Patient Satisfaction – greater patient involvement in their referral with the ability to exercise choice across the NHS

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Benefits

See the document ‘Reports and Extracts in NHS e-Referral Service’ for more information



3. INFORMATION

Steps to improve maturity rating• The Area Team, Clinical Commission group and practices will be able to look at the referral

trends, to help identify future commissioning needs• If there is high volume within a service in a secondary care setting can it be provided and

commissioned within a primary care setting and what would the demand be if a new primary care service was commissioned?

• Commissioners can see if primary care services are being utilised to their maximum, against the contracted community activity.

• Capacity hotspots can be identified• Use the weekly booking report to identify specialty and providers (both secondary care and

primary care) to understand where patients are choosing to go to. • For the commissioner to have an early warning mechanism if referrals are increasing against

agreed contractual levels.• Capacity hotspots may be identified by a rise in the ASI levels and this will give an timely

indication if a provider is struggling with demand.• Early indication of when a patient has chosen to go to a provider outside of the local area.


Level 3 NHS e-Referral Service fully supports the commissioners business objectives by

providing timely reports of activity across their referrers

• Cost Saving through more accurate payment checking

• Improved information to support commissioning decisions

• Faster access to data to enable commissioner to control the flow of referrals to high cost services by offering cost effective community and primary care services

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Benefits

See the document ‘Reports and Extracts in NHS e-Referral Service’ for more informationReturn to Maturity Model


4. INFORMATION

• Complete view of referral data• Maximum use of NHS e-Referral Service will give commissioners access to timely data showing the complete

referral picture from their practices.• Faster access to data to enable commissioners to control the flow of referrals to high cost services by offering cost

effective community and primary care services• Enables practices to access their own data to identify referral patterns. throughout the practice and by individual

referrer

• Commissioning decision support• The ability to understand on a weekly basis, the commissioning requirements of local or specialist services,

enabling the commissioner to commission services to meet the needs of local patients

• Improved Convenience for Clinicians • Greater GP visibility of primary care services• Having a fully auditable referral trail for patients, with the ability to see where a patient is within the referral process.


Level 4 Information from NHS e-Referral Service supports demand planning and

informs future service needs

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Benefits



Level 1Basic

Utilisation < national average

<50% eligible Primary Care

services publishedThere are many benefits to be realised from streamlining referral processes for the clinicians and commissioners. Better utilisation enables the organisation to work towards one process and cuts down the workload of those who have to support both manual and electronic referral processes. This is true throughout the whole organisation and affects both clinical and admin staff

Level 2 Limited

Utilisation = national average

>50% eligible Primary Care

services published There comes a point at where utilisation can stagnate. Ensure that all services available for referrers to book into.You will reach the tipping point where the majority of referrals from your organisation are going via NHS e-Referral Service, thereby enabling you to streamline your processes and start to truly realise all of the benefits, you need to ensure that primary care services and ALL local secondary care services are published and available to referrers

Level 4 OptimisedUtilisation 90% or

above100% eligible primary care

services published

Cost Saving

Commissioning decisions and target support


Better Patient Experience

Level 3 MainstreamUtilisation >

national average>90% eligible Primary Care

services published

If utilisation is not as high as you would hope and referrers are still sending a proportion of referrals on paper, it is time to work with the providers, and practices to help promote the benefits to all. If more than 90% of eligible services are published and available for booking then much of the hard work has been done and you should be realising many benefits from NHS e-Referral Service.

Process


Information

Technology

Performance



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1. PERFORMANCE


• Why are some practices performing well and others not utilising the system? • Use the weekly booking report to identify which practices have low utilisation. • Use the GP Practice maturity model to ascertain where practices need help and decide how the

commissioner can facilitate that help.

More information and help with access to commissioner and practice level booking reports can be found on the NHS e-Referral Service website

• Are your GPs aware of the local primary care commissioned services or how to access them? • Are your commissioned primary care services available on NHS e-Referral Service?• How are GPs informed of any new Primary Care services that have been commissioned and are

available? Do you have one dedicated channel of communication for informing referrers?

• Do you use the community contract for Primary Care services?• Publishing services on the Directory of Services is a requirement for providers within the NHS Standard

Contract


Level 1 Utilisation < national average. <50% eligible Primary Care services published

• Two tier service to patients – some patients have a faster access to services; whilst other patients have to wait for the referral to arrive at the hospital for an appointment to be sent to the patient

• Difficulty in facilitating choice if the provider is not local – GP unaware of what services are provided across different organisations if the patient chooses to go out of the area

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Dis-benefits



2. PERFORMANCE


Why are GP practices not referring all they can through NHS e-Referral Service?• Does your local acute trust have all their services published to NHS e-Referral Service?• This issue should be identified to the commissioners, as this is a requirement of the NHS Standard Contract• Providers should NOT remove services due to lack of capacity. Commissioners should work together with their

providers to find solutions; commissioning alternative services, Advice and Guidance, Clinical Assessment Services etc.

Why are some primary care services not published?• Work with the service to find solutions to their perceived problems. • If it is because clinicians fear that the wrong patients will be booked into their services then discuss Advice and

Guidance or Clinical Assessment Services with them. • Remind clinicians that they will review ALL referrals before making a decision to Accept, Reject or Re-direct into

an alternative service.


Level 2 Utilisation = national average. >50% eligible Primary Care services published

• Cost Saving - Savings can be made if Community and Primary Care services are fully utilised reducing referrals to acute trusts


• Improved Patient Satisfaction – patient involvement and choice

• Improved Convenience for Clinicians - Greater GP visibility of ALL services, both secondary and primary care

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Benefits



3. PERFORMANCE


Work out a joint plan with local providers, commissioning group or GP Practice colleagues to promote NHS e-Referral Service in your local community

• Ensure that referrers can feed comments to the provider organisation when they have problems with services or slot availability. Encourage the providers to LISTEN to and RESPOND to that feedback. If you work with your local health community they are much more likely to feel positive about using the system to refer their patients.

• Keep an eye on rejections and redirections from your providers. If one service has many then you need to look at that service in the DOS and see if it can be improved. Ensure that you communicate changes to services to all referrers within your local health community

• Plan joint events where clinicians can talk to clinicians.

• Are your GPs and referrers aware of the benefits that can be realised by using NHS e-Referral Service?

Use the GP Practice Maturity Model with your practices to promote good practice and the associated benefits.


Level 3 Utilisation = national average. >50% eligible Primary Care services published

• Real time data to support Commissioning decisions


• Improved Patient Satisfaction – patient involvement and real choice in both where and when they are seen

• Less Resources required for booking appointments for providers by use of direct booking

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Benefits



4. PERFORMANCE

• Cost Saving• Cost saving through more accurate payment checking. • Easier accessibility of primary care or local commissioned services, if utilised would generate a cost saving• Less resource required in booking appointments where providers utilise direct booking

• Commissioning decisions and target support• The ability to understand on a weekly basis, the commissioning requirements of local or specialist services, enabling the commissioner to commission services

to meet the local patients needs• The Referral to Treatment clock start is captured for patients booked through NHS e-Referral Service – helping to ensure that patients are treated within the

planned care pathway

• Improved Convenience for Clinicians • Greater GP visibility of primary care services• Having a fully auditable referral trail for patients, with the ability to see where a patient is within the referral process.

• Better Patient Experience• Faster access to services - appointment booked at or soon after decision to refer• Involving patients in decisions about their care and treatment is key to promoting patient satisfaction. In this day and age where we are used to organising our

lives around busy careers, children, parents or just simply around our leisure activities; we have come to expect that we are in the driving seat when organising appointments.

The NHS 2010-2015 five year plan has clearly aligned patient experience and satisfaction. Good patient experience is a must. Patients want a say in when they are treated and where they are treated. Ensuring that your services are visible, accessible and that appointments are available, will ensure that your organisation meets patients’ expectations at the very beginning of their journey. NHS England will support commissioners a move to paperless referrals in the NHS by March 2018 so that patients and carers can easily book appointments in primary and secondary care.


Level 4 Utilisation 90% or above. 100% eligible primary care services published

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Benefits



Level 3Mainstream

NHS e-Referral Service leadership both management

and clinical, working in partnership with

commissioning colleagues.

Complete view of practice information used to identify

referral patterns within practice

. Practice IM&T Lead supports NHS e-Referral

Service. Local IT recognise importance of service and respond promptly to issues

Referrals generated on NHS e-Referral Service, by admin

or GP, with patient involvement

Advice & Guidance used for some services

Process


Information

Technology

Level 1Basic


limited awareness

Low levels of NHS e-Referral Service referral information

available within practice

IT issues disengage referrers. Limited or no

support from Local IT Service. Not all clinicians

registered on spine

Very limited use of NHS e-Referral Service within

practice – High proportion of paper referrals

Level 2 Limited

NHS e-Referral Service leadership

(admin/management) established

NHS e-Referral Service referral information available

Reliable high spec machines in some areas but ongoing adhoc IT issues disengage referrers. All clinicians have

smartcards.

Referrals generated on NHS e-Referral Service, by admin staff, either within practice or by local referral management

centre - no patient involvement

Proactive management and clinical leadership both at

both practice and CCG level to promote NHS e-Referral Service and benefits within

the CCG.

Information used in conjunction with other practices to identify

commissioning opportunities



All appropriate referrals generated on NHS e-Referral Service, by GP, with patient

involvement Advice and Guidance used

wherever appropriate

Performance 50-70% of referrals via NHS e-Referral Service

90% of eligible referrals are made via NHS e-Referral

Service

100% of eligible referrals via NHS e-Referral Service. Ongoing engagement to encourage providers to

publish missing services

Less than 50% of referrals via NHS e-Referral Service

GP Practice

GP PRACTICE

Level 4Optimised

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explore

Level 1Basic

Very limited use of NHS e-Referral Service within practice – High

proportion of paper referrals

There are many benefits to referrers and their patients from the use of NHS e-Referral Service. However, in order to realise those benefits it is important that NHS e-Referral Service is adopted as THE referral method for all referrals generated by the practice. Working two systems for referrals is cumbersome and reduces the scale of benefits. Workarounds, though seemingly helpful to some within the practice, will disbenefit others within the process.

Level 2 Limited

Referrals generated on NHS e-Referral Service, by admin staff, either within practice or by local

referral management centre - no patient

involvement For patients to benefit fully from the NHS e-Referral Service process it is imperative that they are involved in the referral process and consulted regarding their care. Sending patients a list of “Choices”, selected at random and included on an appointment request may well tick the boxes in terms of practice performance but with a little more effort the process could benefit all parties

Level 4 Optimised

All appropriate referrals generated on NHS e-Referral

Service, by GP, with patient involvement

Patient Experience

Improved Patient Care

Greater Clinical Confidence

Cost/Resource Optimisation

Level 3 Mainstream

Referrals generated on NHS e-Referral Service, by admin or GP, with patient

involvementPatients involved in the referral process; making informed decisions about their care is the most beneficial use of the NHS e-Referral Service system within practice. Patients will benefit from the referrer’s knowledge of the system and the services available. Make sure that everyone in the practice who uses NHS e-Referral Service knows how to find information on services and how best to find the services they need for their patients.

Process


Information

Technology

Performance

GP PRACTICE


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1. PROCESS


What are the main reasons for low utilisation in your practice?

• Is it simply a lack of engagement from referrers and admin staff?• Did the practice attempt to adopt NHS e-Referral Service/Choose and Book in the past with a poor response from

those involved?• Are GPs and Practice Manager aware of the benefits that can be realised by using NHS e-Referral Service?

Implementing NHS e-Referral Service in your practice

To implement NHS e-Referral Service within your practice referral process it is important to ensure that support is available. Referrers and Admin staff will need training. IT equipment will need to be checked and in some cases upgraded or replaced. Your Clinical Commissioning Group /CSU should have a NHS e-Referral Service Lead who will be able to organise this or put you in touch with the relevant people.

Improving utilisation in your practice

If uptake of NHS e-Referral Service within your practice is patchy – that is, one or two GPs use the system for some of their referrals, then it could be that you can still begin to realise the benefits of NHS e-Referral Service by finding a solution that works for ALL referrals. The Clinical Commissioning Group/CSU NHS e-Referral Service Lead should be able to put you in touch with practices who are using the system successfully, to work out what processes or steps might work in your practice.

GP Practice

Level 1 Very limited use of NHS e-Referral Service within practice – High proportion of paper referrals

• More resource required to support patients who are waiting to hear from providers. • “double” appointments

where the patient has booked to “see the doctor” to chase up referral

• Chasing providers on behalf of patients

• Slower access to services for your patients against those patients who are referred electronically and get sooner appointments

• No access to national Directory of Services inhibits Choice process

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Dis-benefits

Training to support referrers through the referral process is available on the NHS e-Referral Service website,



Level 2 Referrals generated on NHS e-Referral Service, by admin staff, either within

practice or by local referral management centre - no patient involvement

2. PROCESS


Within the practice

• Keep the patient fully informed of the process• Remember, the patient has a right to choose the Place, Date and Time of their appointment. Do not make selections

on their behalf. Discuss with them the choices available either locally or further afield• Whilst you do not have to book the appointment within the practice, at the very least, a patient should leave the

practice with an appointment request and an understanding of how to proceed to book their appointment – via the Internet or by telephoning The Appointments Line. Check out your local libraries – many offer a service to help patients use the NHS Choices website to compare providers and to access the Patient Web Application to book an appointment.

Centralised Process

• Whilst centralised referral management centres are far from ideal, there is no reason why processes cannot be improved to ensure that patients are getting the service and overall experience that they deserve.

• DO NOT make choices on behalf of patients and post out appointment requests or booked appointments. The NHS Constitution clearly states that patients are entitled to choice of Date, Place and Time for their first outpatient appointment and information to support that choice. This workaround clearly does not support that right.

• Speak to patients directly to ensure they understand the system and that their preferences are taken into account with any referral.

Ensure that vulnerable patients leave the practice with a booked appointment wherever possible. NHS e-Referral Service is the ideal referral method for those patients who are likely to struggle to understand information sent to them in the post, either from practice, central referral teams or direct from providers.

• Better overall patient experience – The point of referral is often a very anxious time for patients. Involving them in decisions and steering them through the process reassures concerned patients

• Improved Patient Care – faster access to services

• Cost Saving - saving of stationery and postage/fax costs to the practice

• Less “double” appointments where the patient has booked to “see the doctor” to chase up referral

• Greater visibility of where the patient is in the process – less chasing of provider for answers

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Benefits

GP Practice



http://www.nhs.uk/

Level 3 Referrals generated on NHS e-Referral Service, by admin or GP, with patient involvement

3. PROCESS


Common complaints from GP Referrers are around the time it takes to log on to the NHS e-Referral Service system to refer a patient. “There simply isn’t time!” is the customary cry.

Most GPs will refer one or two patients in a day. This will involve a few minutes extra for each referral in order to search for and discuss with patients their referral and Choice options.

There have been improvements to the Clinical Information screen and many practice clinical systems integrate with NHS e-Referral Service to enable referrers to automatically transfer details from the patient record, to the NHS e-Referral Service system, without having to enter them separately. In fact, used properly, this can cut down the time required elsewhere in practice to complete the referral process. Many GPs report that they now complete the referral information during the consultation. Using the system this way avoids building up a list of referrals to dictate later and at the same time frees up admin resources.

Remember, the appointment does not need to be booked during the consultation but taking the time to involve the patient in the referral process will pay dividends in terms of improved patient satisfaction. Longer term the practice should see a reduction in resource required to chase up referrals on behalf of patients who are anxiously waiting to hear from the hospital.

• Best possible patient experience – Involving patients in decisions about their care and enabling them to make informed Choices with their GP is “Gold Standard” patient care

• Resource saving – changing referral processes to capture information from the clinical system to automatically produce the referral letter will free up resources within the practice

• Greater clinical confidence – that the patient will be seen in a service and within a timescale which meets the clinical need.

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Benefits

GP Practice



Level 4 All appropriate referrals generated on NHS e-Referral Service, by GP, with patient involvement

4. PROCESS

• Patient Experience• The point of referral is often a very anxious time for patients. Involving them in decisions and steering them through the process reassures concerned

patients • GP discussing decisions about their care with patients and enabling them to make informed Choices provides the best possible experience for patients who

are being referred

• Improved Patient Care• Patients referred via NHS e-Referral Service will generally have faster access to services. With the appointment booked during or soon after consultation,

the patient will save the time it takes for a traditional paper referral to be dictated, produced, checked and transported to the hospital. Most hospital providers operate a different process for paper referrals where the consultant will review the referral letter BEFORE the patient is appointed

• Greater Clinical Confidence• Where the GP is involved in the NHS e-Referral Service referral process, they can be confident that the patient will be seen in a service and within a

timescale which meets the clinical need.• As a dynamic system NHS e-Referral Service provides visibility of where the patient is in the process without the practice having to chase provider for

answers

• Cost/Resource Optimisation • Saving of stationery and postage/fax costs to the practice. • Less “double” appointments where the patient has booked to “see the doctor” to chase up referral• Changing referral processes to capture information from the clinical system to automatically produce the referral letter will free up resources within the

practice

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Benefits

GP Practice



Level 1Basic


limited awarenessHistorically practices that implemented NHS e-Referral Service were encouraged to nominate a clinical lead to support the practice manager throughout the implementation. Having identified leadership, both clinical and administrative/managerial will make a huge difference in resolving potential issues that practices may encounter, both during implementation and once they reach a mature business as usual status.

Level 2 Limited



For NHS e-Referral Service to work successfully across the whole practice, everyone using the system needs to feel involved in decisions about processes and services. NHS e-Referral Service Leadership working in conjunction with CCG colleagues will ensure that the practice has a voice in decisions made outside of the practice that affect their patients.

Level 4 Optimised

Proactive NHS e-Referral Service leadership both

management and clinical at both

practice and CCG level to promote

service and benefits within CCG

Defined leadership will help ensure that problems are tracked and resolutions identified quickly and effectively. Closer working with commissioner and local provider colleagues will initiate improved understanding of services and processes that translate into better pathways for patients.Supports Clinical Commissioning Working

Level 3 MainstreamNHS e-Referral

Service leadership both management

and clinical, working in

partnership with commissioner colleagues.

In a practice setting, NHS e-Referral Service is traditionally seen as a referrer function it can be used to promote services that are provided by individual practices and the Clinical Commissioning Group. For this to work successfully, all practices within the group need to be utilising the system for referrals into the services.

Process


Information

Technology

Performance

GP PRACTICE

to continue click the level that best describes how you use the NHS e-Referral Service

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• Identify a NHS e-Referral Service lead from the management team within practice. A larger practice, especially where the practice operates from more than one location, should identify “super users” at all sites.

• Identify a Clinical lead to engage with all clinicians within the practice to ensure that they understand the benefits to their patients and to the practice by adopting NHS e-Referral Service as part of the referral process.

• Ensure that the people appointed fully understand operational processes and policy responsibilities in order to see how NHS e-Referral Service can be utilised positively.

GP Practice

• Business owner to work with other LHC stakeholders. This will lead to the practice having no “voice” within the Local Health Community in terms of services that are available.

• Limited or no awareness of new functionality and local initiatives

• No structure to resolve issues and promote best practice

• Diversity of processes will increase the workload and prevent the practice from realising the benefits that NHS e-Referral Service can offer

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Dis-benefits



Level 2 NHS e-Referral Service leadership (admin/management) established



• Establish a working relationship with the CCG/CSU NHS e-Referral Service Lead• Make sure that NHS e-Referral Service appears regularly on practice meeting agendas.• Does the clinician heading up NHS e-Referral Service set a good example by using the NHS e-

Referral Service system as it was intended to be used? Are they realising benefits that they can share with other clinical colleagues?

• Aim to share good practice and discuss any issues encountered so that colleagues do not become disengaged

• Encourage key practice staff to sign up for the NHS e-Referral Service Bulletin by visiting the NHS e-Referral Service Website http://systems.hscic.gov.uk/ers/signup. The bulletin is emailed to subscribers and contains information and links on new guidance, policy issues, future functionality, planned outages etc.

• Establish a mechanism to educate users with regard to such topics as new functionality, known issues/resolutions, search methods, local services

• Ensure there is an effective line of communication from local providers (secondary and primary care) regarding any new services that have been published and commissioned on NHS e-Referral Service

GP Practice

• Defined leadership will help ensure that problems are tracked and resolutions identified. Working in conjunction with other local referrers and commissioners will give your practice a voice in local service decisions

• Closer working with commissioners and local provider colleagues will initiate improved understanding of services and processes that translate into better pathways for patients

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Benefits




Level 3 NHS e-Referral Service leadership both management and clinical, working in partnership with commissioner colleagues.



• Working as a Clinical Commissioning Group, NHS e-Referral Service can help with many initiatives to look at referral patterns and realise opportunities to generate high quality and cost effective alternatives. For this to work the Clinical Commissioning Group needs to place NHS e-Referral Service on the agenda and identify key staff (clinical and managerial/admin) to lead this.

• Working in partnership with Commissioning colleagues, ensure that all new services are defined, published and commissioned on the Primary Care Menu.

• Liaise with the CSU/CCG NHS e-Referral Service Lead to see what training and support is available to ensure that any services provided are managed appropriately and safely.

• For this initiative to work successfully, all practices within the group need to work together to form a central provider admin. NHS e-Referral Service enables this to happen remotely – all clinicians and admin can access services provided from their own working environment

GP Practice

• Supports Clinical commissioning Working – local services for local patients on the primary care menu will enable clinical commissioners to save on higher cost secondary care services and generate revenue.



• Improved Convenience for Clinicians – referral letter access from any point via N3

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Benefits



Level 4 Proactive NHS e-Referral Service leadership both management and clinical at both practice and CCG level to promote NHS e-Referral Service and benefits within CCG.


In total, 30 benefits were documented for GP Practices, including cost savings and time & resource savings. Just as important to note, are the many benefits available for their patients. In order to realise those benefits, clear leadership and responsibility for NHS e-Referral Service must be defined. Incidental benefits will be realised as a result of that and this page focuses on those benefits:-

• Defined leadership will help ensure that problems are tracked and resolutions identified quickly and effectively• Clear ownership within the practice preventing disengagement due to lack of support and understanding• Better understanding of new features and how practice can utilise those features• Access to training and education

• Closer working with commissioner and local provider colleagues will initiate improved understanding of services and processes that translate into better pathways for patients

• Supports Clinical Commissioning Working – local services for local patients on the primary care menu will enable clinical commissioners to save on higher cost secondary care services and generate revenue. Using NHS e-Referral Service will enable commissioners to improve efficiency:-



• Improved convenience for Clinicians – referral letter access from any point via N3

GP Practice

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Benefits



Level 1Basic

IT issues disengage referrers.

Limited or no support from Local

IT Service. Not all clinicians

registered on spineNHS e-Referral Service is a technically robust application. Outside of planned downtime (upgrades to the system), in the 12 month period January to December 2013 the system was available 99.7% of the time. It does however rely on local stakeholders having systems and processes in place to support their users. Clinicians need to be registered on the Spine User Directory (SUS) in order that their name appears as a registered referrer within the practice.

Level 2 Limited

Reliable high spec machines in some areas but ongoing ad-hoc IT issues

disengage referrers. All clinicians have

smartcards.NHS e-Referral Service needs to be available at any point in the practice where individuals involved in the administration and clinical care of patients are working. Alongside clinicians, support staff need access to the system and consequently need to be registered on the spine and issued with smartcards. They may need differing roles and a practice sponsor will be able to identify these roles..

Level 4 Optimised

Local IT gives high priority to protect

NHS e-Referral Service availability

Convenience

Confidence

Time Saving

Better Patient Care

Level 3 Mainstream

Practice IM&T Lead supports NHS e-Referral Service.

Local Service desk recognise

importance of service and respond promptly to issues. Having high spec, reliable IT equipment will improve the experience for all stakeholders, GPs, support staff AND patients. A proactive IM&T Lead within practice will help enormously to resolve common issues quickly. It is clearly very important therefore that the IM&T lead has a very good understanding of the system, its components, and where responsibility lies when problems need to be escalated.

Process


Information

Technology

Performance

GP PRACTICE


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Level 1 IT issues disengage referrers. Limited or no support from Local IT Service. Not all clinicians registered on spine

1. TECHNOLOGY


The most important first step is identifying key people and organisations/departments that have a responsibility to support your practice. In most cases this will be the CCG or it may have been outsourced to the CSU. In some cases there may be a service level agreement for the local trust to support practices and in some this support has been outsourced to the practice clinical system supplier.

Currently the CCG will have overall financial responsibility for most practice IT and the CCG should want you to succeed and improve your NHS e-Referral Service utilisation. • Start by building an IT audit of the desktops (particularly those in patient facing areas and those used by

secretarial staff), not forgetting branch surgeries. Do they have smartcard readers? Do they meet the minimum specification as documented on the NHS e-Referral Service website

Who takes care of Smartcard Registration for the practice? Does the practice have a nominated sponsor? • Overall management and responsibility for access to the NHS Spine lies with the Registration Authority (RA)

Manager. This is likely to be a senior member of the IT or Information Governance teams within the CCG or CSU. It is their responsibility to ensure that all staff issued with smartcards have had their identity rigorously checked and that they are assigned appropriate roles.

• RA Managers are supported by RA Agents who can add users to the spine user directory and issue smartcards.• Users are nominated by Sponsors. Sponsors will decide who needs access to what areas of the spine from a

local business perspective. For example, they might decide that secretaries within the practice need access to clinical information on NHS e-Referral Service, but that receptionists only need to see demographic and appointment details.

GP Practice

• More resources required to support users who cannot consistently access the system due to IT/desktop issues.

• Inconvenience - Where staff do not have access to the system or to the correct smartcard roles then work will be passed around. Many practice staff work part-time hours and this will lead to backlogs and delays

• System unavailability - Where clinicians are not registered on the Spine, they are not registered as referrers and referrals cannot be initiated either by them or on their behalf on NHS e-Referral Service.

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Dis-benefits



Level 2 Reliable high spec machines in some areas but ongoing ad-hoc IT issues disengage referrers. All clinicians have smartcards.

2. TECHNOLOGY


The best way to make NHS e-Referral Service the everyday referral method within practice is to ensure that the system works, for everyone who needs to use it, wherever they are working, both in the main practice or in a branch surgery.

• Having identified the right contacts and any IT issues you face, pull together a joint plan to address the problems and manage that plan. Be persistent – if the CCG want you to use the application, they need to provide you with the support you require.

• Does the practice have an IM&T lead? Ensure that at the very least there is a nominated staff member who deals with all issues regarding IT and that this person understands the need for NHS e-Referral Service to be available at all times and in all areas.

• Where you have persistent problems with access to the application, keep a log to present to the IT support team. This will enable you to escalate the issues within the CCG or CSU and get the resolution you require.

Smartcard issues

• Many practice clinical systems now require smartcard access. This is because they integrate with NHS e-Referral Service and other national applications – Electronic Prescriptions, GP Links etc.

• Practice support staff; secretarial, admin and management all need access to the system to support clinicians and patients to ensure they can access the information required without having to resort to phoning providers for updates.

• It will help enormously if there is a dedicated sponsor, within the practice, who can quickly and easily unblock cards and that knows who to contact to escalate problems to get a fast resolution.

Does your clinical system integrate with NHS e-Referral Service? Do you know how to use the integrated system and any benefits that might bring? Contact your clinical system supplier for more information

GP Practice

Convenience

• One stop support – where practices are organised and know who to contact, much time is saved in resolving issues

• Supports cross-site working. The ability to use NHS e-Referral Service from any site where there is access to the internet and appropriate security encourages flexible working and offers a degree of resilience in the event of localised problems.

• Where the system is reliably available on all desktops, eg, all consulting rooms, clinicians are more likely to use NHS e-Referral Service for all appropriate referrals

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Benefits



Level 3 Practice IM&T Lead supports NHS e-Referral Service. Local Service desk recognise importance of service and respond promptly to issues

3. TECHNOLOGY

Steps to improve maturity ratingIn order to get the service you require from your IT Service Desk, they need to understand the importance of the system within your practice. NHS e-Referral Service should be embedded as a core system required for you to manage and care for patients. Work with your CCG NHS e-Referral Service Lead and/or your CSU lead to ensure that this message is fed into and understood by the Head of IM&T. Meanwhile:-

• Clearly identify the components of the system and responsibility for those components. For example:-• An integrated system – the first port of call in the event of an issue is likely to be the clinical system supplier.

But do not be fobbed off with the immortal words “This is a NHS e-Referral Service issue”. If this truly is a “NHS e-Referral Service issue” the likelihood is that the problem will persist if you try to replicate the action on the web-based NHS e-Referral Service system.

• If there is a known national problem, the problem will be reported on the NHS e-Referral Service Service Status page which is accessible to all users with an N3 connection.

• The NHS e-Referral Service website also has details of any planned outages, that is times the system will be unavailable in order for upgrades to be implemented or tested. The outages are infrequent and usually take place after 8.00

• Further information on resolving technical issues and escalating problems is detailed on the NHS e-Referral Service website

Remember, a good understanding of the system will enable you to give the right information to your IT Support Team. This should enable them to give you the first-class service you require to keep the system running reliably.

GP Practice

Better Patient Care

• Referral history can be seen more quickly - Medical records for patients moving practice can take time (5-6 weeks from London, 1-2 weeks in LHC, with NHS e-Referral Service patient referral history can be seen before the full medical record arrives.

• Clear audit trail ensures that fewer referrals go missing or unseen and ensures all patients are appointed.

• Automatic integration between practice clinical system and national NHS e-Referral Service system

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Benefits



http://nww.connectingforhealth.nhs.uk/servicemanagement/status/cab/details/

Level 4 Local IT gives high priority to protect NHS e-Referral Service availability

4. TECHNOLOGY

• Convenience• Where the system is reliably available on all desktops, eg, all consulting rooms, clinicians will be able to use NHS e-Referral Service for all

appropriate referrals• Supports cross-site working. The ability to use NHS e-Referral Service from any site where there is access to the internet and appropriate

security encourages flexible working and offers a degree of resilience in the event of localised problems• Effective sponsoring of users to make certain they have the correct roles allocated to their smartcards will allow all practice support staff to

use the system to assist clinicians and patients. This also enables work to be shared effectively. This is especially important in an environment where many staff have part-time roles.

• Confidence • for Clinicians and support staff using the system and the IM&T Lead within the practice that the system will run reliably and be available to

all who use it, whenever and wherever they wish to use it.

• Time Saving • One stop support – where practices are organised and know who to contact, much time is saved in resolving issues.• Where one system is used to support the referral process then the practice will benefit from all practice staff knowing where patients are

within the process.• Ensuring that all users can consistently access the system will save time and effort in the longer term.

• Better Patient Care • Referral history can be seen more quickly - Medical records for Patients moving Practice can take time (5-6 weeks from London, 1-2 weeks

in LHC, with NHS e-Referral Service patient referral history can be seen before the full medical record arrives.• Clear audit trail ensures that fewer referrals go missing or unseen and ensures all patients are appointed.• Automatic integration between practice clinical system and national NHS e-Referral Service system.

GP Practice

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Benefits



Level 1Low levels of NHS e-

Referral Service referral information


Information on referrals via NHS e-Referral Service is available to practices on a monthly basis. That is, real figures in a timely manner rather than relying on historical data after patients have attended or been discharged. Ensuring that all referrals are NHS e-Referral Service referrals will increase the accuracy of this “early” data.

Level 2 Limited

NHS e-Referral Service referral

information available.

“Real time” referral data is available through NHS e-Referral Service but it may not be complete if all referrals are not going via NHS e-Referral Service.

Reports are generated on a regular basis by the NHS e-Referral Service system. As opposed to enquiries, reports are static sets of data that are automatically created on a monthly basis..

Level 4 Optimised

Information used in conjunction with

other CCG practices to identify

opportunities for better

commissioning

Improved referral data

Better understanding of patients communication choices

Improved patient satisfaction

Improved convenience for clinicians

Level 3 Mainstream

Complete view of practice

information used to identify referral patterns within

practice.

Where the majority of referrals are via NHS e-Referral Service, you have a clearer picture of referral trends from the practice. Practice management can now start to analyse the information. This will enable them to carry out peer reviews on referral trends and identify any potential training needs.

.

Process


Information

Technology

Performance

GP PRACTICE


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Level 1 Low levels of NHS e-Referral Service referral information available within practice

1. INFORMATION


As a practice do you know how to access reports and what referral information is available to you within NHS e-Referral Service?

• Practice level data can be useful to help you understand your referral trends, both at practice and individual referrer level. This can help to identify any potential training requirements among referrers.

• The data can also be used to analyse referral trends to inform Locality Commissioning decisions for the Clinical Commissioning Group

Remember the more referrals that go via NHS e-Referral Service the more complete the picture of referral trends and data for your practice. If only a small number go via the NHS e-Referral Service, then this will not enable you to realise the benefits to your practice as only partial data will be available.

More information and help with access to commissioner and practice level booking reports can be found in the document ‘Reports and Extracts in NHS e-Referral Service’

GP Practice

• Incomplete data if utilisation is low, the practice will have to gather and analyse data from various points

• No Clear picture of referral data to identify their referral patterns to support Practice Based Commissioning decisions

• No access to real time data - Activity data available to commissioners from SUS is more than a month old when it can be accessed

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Dis-benefits



Level 2 NHS e-Referral Service referral information available

2. INFORMATION


Identify and understand which reports and enquiries are available within NHS e-Referral Service. Decide what will be of the most use to your practice and how the information can be used

• Information on reports and enquiries for referrers can be in the document ‘Reports and Extracts in NHS e-Referral Service’

This document will give you details of all available reports and extracts and how to access and use them. They include:-

• .

GP Practice

• Improved referral data– Practices able to understand their referral patterns by specialty and individual referrer.

• Understanding patients communication choices -Ability to understand how your patients are choosing to book their appointments, via telephone or via web. This may help inform future marketing strategies and services the practice offers.

• Improved understanding of local services and providers with use of extracts to see numbers of referrals modified and cancelled

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Benefits



Level 3 Complete view of practice information used to identify referral patterns within practice

3. INFORMATION


• Do the GP’s use the reports to understand their own referral trends

• Are any clinicians within the practice referring to secondary care when there is a practice endorsed primary care alternative? This may identify a training need, or it may simply identify referral patterns, ie, where one clinician within the practice has a special interest they may see more patients with certain conditions

• GP’s can review where their patients have chosen to go to, how they are booking their appointments, via telephone or via web. Again, this information can help with future commissioning decisions.

• Where all practices within a Clinical Commissioning Group analyse this information then a clearer picture of referral trends throughout the local community will be available. This should inform future commissioning

• Where there is high volume of referrals to a service within Secondary Care setting, that could potentially be offered in the local community, Clinical Commissioning Group will have a clearer picture of the demand for the service.

• Where those services already exist, Commissioners can see if they are being utilised to their maximum, against the contracted community activity

GP Practice

Availability of information on the use of services increased – Practice and commissioning group benefit from improved visibility of the services that are being used and can amend commissioning accordingly.

Supports the development of alternative referral pathways – allows Clinical Commissioning Group to introduce GP with Special Interest (GPSI) services and other Primary Care treatments

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Benefits



Level 4 Information used in conjunction with other CCG practices to identify opportunities for better commissioning

4. INFORMATION

• Improved referral data• Practices able to understand their referral patterns by specialty and individual GP• Enquiries that can be run in real time, and monthly reports, accessible by all clinicians within NHS e-Referral Service

• Better understanding of patients communication choices –• Ability to understand how your patients are choosing to book their appointments, via telephone or via web. This can help inform

future marketing strategies and services the practice offers

• Improved patient satisfaction • Greater patient involvement in their referral with the ability to exercise choice across the NHS, for services not just to secondary

care

• Improved convenience for clinicians • Greater GP visibility of primary care services• Having a fully auditable referral trail for patients, with the ability to see where a patient is within the referral process

• Improving Commissioning decision support• The ability to understand the commissioning requirements of local or specialist services, enabling the Clinical Commissioning

Group to provide or commission services to meet the local patients needs, in a range of different settings

GP practice

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Benefits



Level 1Less than 50% of

referrals via NHS e-Referral Service

If performance is low within practice due to resistance from some GPs then the process section of this model will help. Practices will realise more benefits when they achieve a single system for referrals and that system is NHS e-Referral Service.

Where utilisation is low because referrers cannot find the services they wish to refer their patients to then click here for steps to improve.

Level 2 Limited

50-70% of referrals via NHS e-Referral Service Services

provided by practice or in conjunction with local commissioning

are not publishedIf 50 – 70 percent of your referrals are being generated on the NHS e-Referral Service system then you are using the system well and are familiar with how to find services relevant to your patients’ condition and needs. There are however still a considerable number of referrals that are being sent via paper. Check out the referral audit steps on Level 1 of this category to see where improvements can be made.

Level 4 Optimised

100% of eligible referrals via NHS e-

Referral Service. Ongoing

engagement to encourage providers to publish missing

services

Convenience

Confidence

Time Saving

Better Patient Care and Increased Patient Satisfaction

Level 3 Mainstream


Service

. By now the practice should be realising many of the benefits of a single referral process. That final push to 100 percent electronic referring will pay dividends in terms of a reduction in time and effort spent managing two referral systems.

.

Process


Information

Technology

Performance

GP PRACTICE


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Level 1 Less than 50% of referrals via NHS e-Referral Service

1. PERFORMANCE


Collate information from all referrals that are sent via paper:-

• Referrer• Provider• Service• Available on NHS e-Referral Service – Yes/No

Where the service is available via NHS e-Referral Service, find out why that particular referral was sent this way. Is it because the referrer couldn’t find the service? Let them know where the service is or contact the provider to let them know that the service is difficult to find. Did they have problems with the system on that particular day? Were they simply too busy/running late and thought this was an easier option. If so then find a workaround that suits your practice to enable busy clinicians to delegate generating the UBRN when it simply is not possible to complete it there and then.

Where the service is not available via NHS e-Referral Service then contact the provider to ask why? Enlist the help of your CCG/ CSU NHS e-Referral Service Lead or commissioner to influence the provider.

Work with your Commissioning colleagues to ensure all services that you refer to are available on NHS e-Referral Service.

GP Practice

• More resource required to support patients who are waiting to hear from providers. • “double” appointments

where the patient has booked to “see the doctor” to chase up referral


• Slower access to services for your patients against those patients who are referred electronically and get sooner appointments

• No access to national Directory of Services inhibits Choice process

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Dis-benefits



Level 2 50-70% of referrals via NHS e-Referral Service Services provided by practice or in conjunction with local commissioning are not published

2. PERFORMANCE


• Find out from referrers why they do not use the system for a proportion of their referrals – Are there misconceptions around certain types of referrals – Urgent priority for example?

• Look for patterns:-

• Is it a particular referrer – perhaps with a lost or expired smartcard? This is easily resolved, smartcards can be replaced or re-activated via the RA Agent. Your practice IM&T Lead should be able to help.

• Is it referrers who tend to work in branch surgeries? Find out what problems they are encountering or perceiving. If they cannot access NHS e-Referral Service or find it is running too slowly then report this via your IM&T Lead. Compare speeds in main surgery and branch. Your CCG/ CSU NHS e-Referral Service Lead should be able to support you.

• Is it referrals generated during evening surgery? Users logged on to the spine via their smartcard will be “timed out” after 10 hours. Check that referrers are not logging on for morning surgery and staying logged on all day.

• Is it referrals made by duty doctor? No access to system or limited access?

Does the practice provide services on behalf of the local commissioners? If so, then those services should be published and available for local commissioning on NHS e-Referral Service. If YOUR services are available you may be in a good position to help colleagues within your group to publish and manage their services, thereby making them available for you to refer to.

GP Practice

• Less resources required to support patients who are waiting to hear from providers.

• Where all referrals are via NHS e-Referral Service then all referrals can be tracked and expedited as part of the same process

• “double” appointments where the patient has booked to “see the doctor” to chase up referral


• Faster access to services for your patients against those patients who are referred electronically and get sooner appointments

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Benefits



Level 3 90% of eligible referrals are made via NHS e-Referral Service

3. PERFORMANCE

Steps to improve maturity rating• Ensure that the practice can support GPs where they cannot access the system or are running late

during surgery. Where this happens there should be a defined process where GPs can hand some pre-printed information to patients and a member of practice staff takes on the responsibility to ensure the patient is contacted and involved in their referral.

• Does the practice have a process for Locum clinicians? Many practices have systems in place where a locum referrer will refer on behalf of a partner and that the partner in question will check the referral before it is made. The above process can be adapted to suit this referral model. Where your practice has a regular locum, arrange for them to have a smartcard issued.

• Work with your local CCB/ CSU NHS e-Referral Service Lead, Commissioners and Clinical Commissioning Group to put pressure on providers who have not published some services.

• Where those services are local Primary Care services point out to the community provider that they are losing revenue where GPs are not seeing their services and are referring elsewhere.

• Ensure that your Clinical Commissioning group publish ALL of their services. If YOUR services are available you may be in a good position to help colleagues within your group to publish and manage their services, thereby making them available for you to refer to.

GP Practice


• Confidential exchange of information between referrer and receiving clinician both for referrals and requests for advice and guidance

• Access to national Directory of Services

• Greater clinical confidence – Confidence that the patient will be seen in a service and within a timescale which meets the clinical need

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Benefits



Level 4 100% of eligible referrals via NHS e-Referral Service. Ongoing engagement to encourage providers to publish missing services

4. PERFORMANCE

• Convenience

• Convenience• Supports cross site working. The ability to use NHS e-Referral Service from any site where there is N3 access.• Use of integrated clinical system provides seamless referral process connecting GP system to national Directory of Services and

ultimately, Provider PAS

• Confidence • Greater Clinical Confidence – Confidence that the patient will be seen in a service and within a timescale which meets the clinical need• Certainty improved with use of advice and guidance from specialists prior to referral.

• Time saving • Certainty of appointment is increased for patients when they book their appointment leading to a reduction in calls and follow up

appointments where they are concerned about their referral.• Electronic process means that information from the clinical system can be included automatically with the referral and that referral letters

do not need to be printed and sent to the provider

• Better Patient Care and Increased Patient Satisfaction• Service specific booking guidance helps referrer to ensure that patient is referred to the right service, first time, every time. This will lead

to a reduction in rejections and redirections.• NHS e-Referral Service enables patients to be involved in their referral. They can select the provider and date & time of their choice and

can manage their booking 24 hours a day either via the internet or The Appointments Line.

• Overall - NO LOST REFERRAL LETTERS will improve patient care, reduce the workload within the practice where admin staff are dealing with confused patients, GPs are seeing those patients during repeat visits and then letters have to be re-sent to the provider.

GP Practice

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Benefits



Place Your organisation on the Model

HSCIC NHS e-Referral Service Maturity Model

Service ProviderCommissioning

OrganisationGP Practice

Back to Maturity Model

Select any of the scorecards below to print and identify where you are on the model

Level 3Mainstream

Established NHS e-Referral Service leadership

working in partnership with primary care colleagues

Complete view and understanding of NHS e-

Referral Service utilisation across all

specialties

Local IT service fully supports NHS e-Referral

Service. High spec desktops.

All clinicians have smartcards

Secretary, proxy clinician led.

Some Clinicians review online A&G on >50% of

services. Process


Information

Technology

Level 1Basic

No defined NHS e-Referral Service leadership

and limited awareness

Low levels of information reacting to demand &

capacity issues

Minimum specification for NHS e-Referral Service on

selected desktops. Smartcards available to

admin staff only. Minimum support from Local IT

High proportion of paperonly referrals (no NHS e-

Referral Service)

Level 2 Limited



Understanding of available performance information

Reliable high spec machines in defined business areas.

Some clinicians have smartcards. Lack of

ownership from Local IT

Centralised, proxy clinician led, paper process. Minimal

A&G Services.

Proactive leadership – regular updates and events to promote the service and benefits throughout LHC.

Continuous Planning / Mgmt routinely matches demand &

capacity

Local IT gives high priority to NHS e-Referral Service, it available in all work areas.

System access (smartcards) managed proactively

Majority of clinicians review online – paperless process.

A&G on all appropriate services. Majority Named

clinician services

Performance

Utilisation = national averageMajority DBS Services


Utilisation > national average>90% DBS Services


Utilisation 90%.or above100% DBS Services

100% services publishedSlot issues <4%

Utilisation < national averageMajority IBS Services

<50% services publishedSlot issues >15%

SERVICE PROVIDER SCORECARD

Level 4Optimised

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Level 3Mainstream

Established NHS e-Referral Service leadership working together with providers and

commissioners

NHS e-Referral Service fully supports the commissioners

business objectives by providing timely reports of

activity across their referrers

Local IT service fully supports NHS e-Referral Service business process

Consistent, GP Practice initiated referral

Process


Information

Technology

Level 1Basic


limited awareness

Only partial data available due to low utilisation. Does

not support future commissioning

Technology only meets minimum specification for NHS e-Referral Service . Smartcards available for

appropriate staff

Low uptake - less than 30% of practices utilising NHS e-Referral Service for majority

of referrals

Level 2 Limited



NHS e-Referral Service data gives indicative referral trends but not complete

picture


business process

NHS e-Referral Service used by or on behalf of the majority of practices

Proactive leadership – regular updates and events to promote NHS e-Referral

Service and benefits throughout LHC

Information from NHS e-Referral Service supports

demand planning and informs future service needs




PerformanceUtilisation = national average>50% eligible Primary Care

services published

Utilisation > national average>90% eligible Primary Care

services published

Utilisation 90%.or above100% eligible Primary Care

services published

Utilisation < national average<50% eligible Primary Care

services published

COMMISSIONING ORGANISATION SCORECARD

Level 4Optimised

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Level 3Mainstream

NHS e-Referral Service leadership both management

and clinical, working in partnership with

commissioning colleagues.

Complete view of practice information used to identify

referral patterns within practice

Practice IM&T Lead supports NHS e-Referral Service.

Local IT recognise importance of service and respond promptly to issues

Referrals generated on NHS e-Referral Service, by admin

or GP, with patient involvement

Advice & Guidance used for some servicesProcess


Information

Technology

Level 1Basic


limited awareness

Low levels of NHS e-Referral Service referral information


IT issues disengage referrers. Limited or no

support from Local IT Service. Not all clinicians

registered on spine

Very limited use of NHS e-Referral Service within

practice – High proportion of paper referrals

Level 2 Limited



NHS e-Referral Service referral information available

Reliable high spec machines in some areas but ongoing adhoc IT issues disengage referrers. All clinicians have

smartcards.

Referrals generated on NHS e-Referral Service, by admin staff, either within practice or by local referral management

centre - no patient involvement

Proactive clinical and management leadership both

at both practice and CCG level to promote NHS e-

Referral Service and benefits within the CCG.

Information used in conjunction with other practices to identify

commissioning opportunities



All appropriate referrals generated on NHS e-Referral Service, by GP, with patient

involvement Advice and Guidance used

wherever appropriate

Performance50-70% of referrals via NHS

e-Referral Service


Service

100% of eligible referrals via NHS e-Referral Service. Ongoing engagement to encourage providers to

publish missing services

Less than 50% of referrals via NHS e-Referral Service

GP PRACTICE SCORECARD

Level 4Optimised

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