For session two of HTN Now November, we were joined by Martin O’Neil, Programme Director for NHSX and Sue Allan, Programme Manager at NHS Digital, to find out more about the NHS e-Referral Service (e-RS), as well as how it is currently helping elective care recovery and what improvements will be made to the service in the future.
Starting off with introductions and outlining the project’s extensive user research, Martin championed the collaboration between the two organisations, stating: “You’ll note that we are a joint team today – NHSX and NHS Digital – and that’s very much the way we work in e-RS, it’s very much a joint piece of work and a joint transformation programme that we’re delivering.”
“An awful lot of what we’re going to be doing is focused on the here and now for elective care, but it’s starting to build the foundation for some fundamental structural changes to the e-RS, that will help elective recovery going forward as well,” he said.
Martin then handed over to Sue, who explained that her role involved “looking outwards” from the programme to patients and professional stakeholders, as well as with NHSX.
In a refresher about the fundamentals of the programme, Martin reminded the audience that e-RS platform covers 61,000 clinical services across 1,100 providers, and refers around 70,000 patients to secondary care every day. There are 5,000 requests for clinical advice made by GPs through the service daily, and nearly 30 million total interactions per year.
“On the face of it that looks great… but there’s also something about how the quality of the services are represented and how confident our clinicians are in referring patients along those pathways. For example, I’m talking here about the DOS – the Directory of Services – the quality of the information in there, about who can upload it, how often it’s updated, around the structured data versus unstructured data. So there’s a variety of things we can do to build confidence in these services,” he said.
Sue then stepped in to outline how the e-Referral System works, explaining that the service is a “digital system that allows GPs or other referrers to help their patients get to an appropriate secondary care or community level service,” noting that it can give patients choice and control – not only about where they receive care but also about when they go and who they see, including selections of times and days.
“Fundamentally,” she added, “it’s about what patients and our professional users of the system need from a digital referral system,” before going on to illustrate changes and improvements that have been made to the service recently.
For referrers, these include showing all the information about a referral and appointment on one screen, a “brand new, shiny, out of the box work list presentation that just went live this weekend”, and revamped advice summaries. The patient application, Manage Your Referral, meanwhile, has now been integrated with the NHS App.
Covering the three key referral channels that e-RS supports – Directly Bookable Service (DBS), Referral Assessment Service (RAS), Advice and Guidance (A&G) – Sue outlined the uses and purposes of each service and commented that there had been a significant increase in the use of A&G, particularly over the last 18 months.
Moving onto the key features of the service as a whole, Sue explained that, “one of the key things that we’ve done over the last few years is improve the way that e-RS can be integrated with other systems”, with a full suite of 29 APIs (Application Programming Interfaces) provided to enable an end-to-end e-RS journey in integrated systems, so that there is the potential for clinicians to be able to manage referrals and A&G in their own clinical system.
On the Advice and Guidance service, she added, “it’s one of the key elements of the system at the moment, which is continuously being developed”, while also noting that while data and reporting are key features of e-RS, the team are working on making it easier to understand and ultimately easier to use by authorised users.
Sue also commented on work that they are doing to enable access to e-RS over the internet, removing the need for users to come through the Health and Social Care Network and therefore opening up safe, secure access to other areas across the Health and Care network. Sue also talked about the training and support the team provide, including video tutorials and online guidance.
Moving on to the topic of elective care recovery, Sue raised the issue of long waiting lists and explained how e-RS is helping to support the NHS. “We’re working very closely with our colleagues at NHS England and Improvement, and NHSX, to look at how e-RS can support this recovery process,” she stated, highlighting that digital triage through Advice and Guidance, supporting a reduction in referrals can help relieve the demand on stretched provider organisations, as well as supporting the signposting of alternative options for patients.
The introduction of post-Covid assessment service types and telephone / video appointments, insight through data and dashboards, and a merging with the NHS App to give patients more control, are all ways the service can assist.
The selected use case, to illustrate innovative ways in which e-RS data can be used, was South Yorkshire and Bassetlaw Integrated Care System (ICS). Using e-RS data, they saw that cancer referrals were increasing – and knowing that around 80 per cent of those would require an endoscopy, the ICS harnessed e-RS data to plan for increased endoscopy capacity to try to avoid any treatment delays for patients.
On work around user experience and the wider roadmap, Sue also took us through the changes made in this area, which includes the alterations made to the system for referrers, the ability to attach more varied and larger files and images – work that will go live next year – as well as continued provision of the suite of APIs, looking at how to make e-RS data easier to use, as well as widening access to e-RS.
“The feedback we’re getting is that people want more timely access to the e-RS data but they also want it to be more accessible – they don’t necessarily want to have to be an information analyst to be able to understand and interpret it,” she concluded.
Martin then picked up the session to look even further forward into the system’s future, across the next two or three years – focusing on three areas: extending, enhancing and evolving.
“Essentially, we want to deliver an any-to-any booking, triage, referral and appointment management ecosystem, right across health and social care…we want to be the number one choice,” he said, adding that the team sees itself working “symbiotically” alongside industry providers.
“We are really keen to ensure that we have a rich ecosystem of referral software – as long as we can get access to the data nationally,” Martin added.
Describing e-RS as a “highway, this one lane motorway between GPs and specialists within secondary care”, Martin also acknowledged that sometimes the services that patients need can sit outside of secondary care, and shared that he wants to “get the digital plumbing in place” to provide “better coverage across the care continuum,” as well as take more of a patient-centric approach over the next year.
On his “three ways to improve” e-RS, he added the first way is to “enhance the e-RS programme” through new features and work on the underpinning architecture, as well as thinking about how to provide access to new technologies and allow for improved sharing of files.
He noted that the second way to improve the service was to “extend” e-RS to more services and help local areas to scale their use, while the third idea was to “evolve” the service through new ways of working and by linking it into other systems to “form the foundation of new clinical workflows”.
Other ideas and aims, such as using a biometric devices for secure and quick authentication, greater supplier interoperability, upgraded architecture, and improved user experience on mobiles and tablets, were highlighted.
Areas where e-RS can be extended into, Martin added, include enabling triage, booking and referrals in mental health, pharmacy, optometry, dentistry, ambulance services, and community services – with work already underway in some of these areas.
New capabilities in the works include a pathway timeline, which would allow “patients to see where they are on their journey” through the service. “Watch that space closely”, Martin said, before going on to detail plans about a universal service finder and single search engine to connect all directories, a universal booking platform with a single front door, AI referral triage with clinical decision support, and continuing work on a system-wide data flow.
To find out more about e-RS, contact firstname.lastname@example.org or visit NHS Digital’s website.
Catch up on this session in full by watching the video below: