My first job in the NHS in 2003 was working on the procurement of the first national electronic referral service for GP to first outpatient appointments (known then as Choose and Book).
I can still remember the jubilation when we got our first ten bookings completed and now, its successor the NHS e-Referral Service (e-RS) handles 50,000 patient referrals a day.
But despite the proven benefits to patients and clinicians, we’ve collectively missed the opportunity to maximise the technology investment with utilisation rates hovering around 52% for several years – until now.
Thanks to partnership working between local organisations, NHS Digital, NHS England, we are working hard to finish the job and switch off paper referrals from general practice into acute trusts.
Partnership in the sense that NHS England has put in place the levers and incentives that make it a no-brainer to adopt this technology, whilst at NHS Digital we have worked closely with users to shape and deliver a technology roadmap which responds to the feedback we’ve had from users to help them maximise the product.
We’ve also put in place a strong support structure on the ground, through our Implementation and Business Change team working hand in hand with NHS England regional teams and trusts.
Now, for the first time, NHS England’s Standard Contract for 2017/19 requires the full use of e-RS for all consultant-led first outpatient appointments.
From 1 October 2018, providers will only be paid for activity resulting from referrals made through e-RS.
So far, 16 trusts have switched from paper referrals to full use of e-RS for all GP referrals to consultant led first outpatient appointments, with a further 16 planning to switch before the end of March.
To support trusts as they prepare to meet the October 2018 target, we have developed and shared resources, including an implementation pack, video case studies and a communications toolkit.
We are also supporting health communities by providing advice, guidance and support through our Implementation and Business Change Team.
We are also working hard to make e-RS easier, quicker and more convenient to use.
Recent developments include the improved Advice and Guidance function, which provides GPs with access to consultant advice prior to referring patients into secondary care. Whilst the new Referral Assessment Service (RAS) allows providers to set services up on e-RS without booking appointments.
This supports complex care pathways, such as gastroenterology and cardiology, where it’s not always clear whether a patient needs a consultant appointment or a diagnostic test. This often means that patients can be treated quicker and closer to home, without the need for a hospital appointment.
Other developments include a new online patient booking service.
The ‘Manage Your Referral’ website is mobile-friendly and makes it much easier for patients to take control and make meaningful choices.
Not only are patients getting a better service, but it’s cheaper for the NHS when patients book online. ‘Manage Your Referral’ is a great example of how our services empower patients and make taxpayers’ money go further.
Realising the many benefits of e-RS is critical for the NHS. In 2014, a report by the National Audit Office, estimated that the NHS could achieve additional savings of up to £50.5 million every year, if e-RS was used to book appointments for all GP to first outpatient referrals.
e-RS results in a better patient experience, allowing patients to book an appointment at a location, date and time that is convenient to them. The booking is immediate, speeding up the time it takes to be treated and reducing the number of appointments where the patient fails to attend (DNAs).
For professional users, e-RS improves the efficiency of the referral management process by reducing the time taken to create and manage referrals, improving the accuracy of recorded clock starts by automatically populating a date in trusts’ computer systems and facilitating improved communication between primary and secondary care. The quality of referrals improves, and the number of inappropriate referrals is reduced, ensuring patients are seen by the right person, in the right place, first time.
Achieving paper switch off will be a significant milestone for e-RS and we are absolutely committed to supporting trusts to make the switch to only using e-referrals as smooth and successful as possible.
We are also adopting a similar approach to supporting the development of other products and services, including Child Protection – Information Sharing (CP-IS) and the introduction of the Electronic Prescription Service (EPS) into integrated urgent care settings.
Through a combination of partnership working, collaborating with users, ongoing product development, introducing levers and incentives and deploying a strong support structure on the ground, we are determined to achieve a step change in the adoption and use of our digital technology solutions for the benefit of patients.