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GPs told to ditch paper referrals as first trusts move to 100% digital system

GPs have been told their paper referrals will no longer be accepted, after two trusts became the first in England to implement the Government's requirements for all referrals to be made electronically in a bid to save GP time and NHS money.

Sherwood Forest Hospitals NHS Foundation Trust and Country Durham and Darlington NHS Foundation Trust announced this week that they would only accept referrals through the NHS e-Referral Service, with other trusts having to implement the requirement by October 2018.

NHS Digital said that GPs had agreed with their trusts to do away with paper referrals, with patients who can’t access the internet given the option of a telephone service instead.

But GP leaders warned practices had been an 'afterthought', as problems with e-Referrals continue to increase their administrative burden.

Health secretary Jeremy Hunt vowed in 2013 to make the NHS paperless 'at the point of patient care' by 2018, and these trusts are the first to implement 100% electronic referrals.

However, since the e-Referrals system was launched in 2015, there have been technical difficulties, including GPs being forced to use fax machines again and hospitals failing to make appointments available for online booking (see box).

This week’s announcement from NHS Digital says the trusts ‘are now processing all of their hospital referral appointments electronically via the NHS e-Referral Service'.

This means that patients and their GPs ‘now know in advance’ about services availability and waiting times, and NHS Digital said: ‘With around 60,000 referrals made across the NHS every day, electronic bookings not only relieve the burden on GPs by reducing their paperwork, but it is also much cheaper to run – saving millions of pounds for the NHS.’

NHS England said that the system also cuts down delays from lost or misplaced letters, and GPs can track patients’ referral progress from their practice IT system.

But Dr Andrew Green, clinical and prescribing lead for the BMA’s GP Committee, told Pulse there were continuing issues with the e-Referrals system. 

He said: 'GPs are reporting continuing problems with e-Referrals, the most significant of these being the administrative burden on practices, and the time taken up in consultations which would be better spent addressing the patients clinical needs.

'In many areas, a lack of capacity means that, far from being able to easily book the appointment they need, patients are left in limbo for long periods of time and inevitably then return to their GPs for assistance.'

He added that GPs were an 'afterthought' in introducing the requirement for hospitals and that practices have ‘no contractual obligation to use an eReferral system and in most areas no financial support for the significant cost implications'.

Morgan Thanigasalam, clinical lead for ICT at Sherwood Forest Hospitals, said: 'We are extremely proud to be the first trust to achieve 100% GP e-referrals. It is just one example of how we are looking at taking a digital ethos forward as a trust, and making our systems more efficient. We are committed to having patients and staff supported by IT to get the very best service, rather than the other way round.'

Sarah Perkins, director of performance at County Durham and Darlington, said: '[The system] enables them to see the availability and make an appointment for the date and time of their choosing, receiving instant confirmation. When patients prefer not to do this themselves, GP practices can make the booking for them.'

Problems with the e-Referral service

The e-Referral system launched in summer 2015 - although some early ‘technical difficulties’ force GPs back to fax machines shortly after,

CCGs were incentivised by up to £55m in funding to move away from paper referrals under last year's quality premium, and enabling patients to go online and book a time and hospital of their choosing is a key part of the Government’s 'patient choice' agenda.

e-Referrals replaced the old Choose and Book, which was also meant to be used for all referrals but in practice was never used for more than half of appointments.

Pulse reported the system left many practices frustrated by hospitals’ failure to make appointments available for online booking and issues using the system - which practices told Pulse have persisted in e-Referrals.

Readers' comments (17)

  • Traditionally, any hint of horizontal integration with patients has led to suspension by the GMC.

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  • When I am on a home visit and I send a patient in, the letter will be on paper, end of.

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  • 'When patients prefer not to do this themselves, GP practices can make the booking for them.'

    Well bully for you foundation trust exec. Congrats for subcontracting your work to the GP practices for free. Have a lollipop.

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  • should have incentives in place for GPs to use this. e-RS is not obligatory on us

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  • Biggest problem is that hospitals tell patients to go back to the GP for another referral as they cannot give them an appointment as they have none after an ereferral has been made !

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  • Dear All,
    F1 drivers told to go back to racing in horse and carts. Until eRS is fit for purpose it will not be used 100%. Even then 100% usage is ethnographically challenging.
    Paul C

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  • The usual IT will solve all problems. e referrals keep asking patients to see their GP again as the hospital is not giving them the appointment. Changing the name from choose and book has not helped and neither will this. Just something for managers to do to keep them in their jobs.

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  • Cobblers

    Who are the responsible head medical honchos in Sherwood & Durham? Inform said medical chappies that 100& compliance with such a system is not possible and that should harm come to a patient who had been referred by letter, and it had been refused, that it would be their arses served to them on a plate via the GMC.

    And see if we can get some backtracking to allow analogue referrals.

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  • Before hospitals start refusing paper referrals they need to make sure their end of the system works perfectly all of the time.

    I assume these also means they'll be sending all clinic letters back electronically as well.....

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  • There also needs to be a national conformity to one format for E referrals. GPs do not have the time to create different formats to keep different departments within different hospitals happy. By having one format it will be possible for GPs to automatically upload the relevant clinical information from their clinical database, frequently without having to add any further information.

    There also needs to be a common format for letters electronical reurned to GPs from hospitals after an outpatient visit or discharge. In that letter there needs to be one paragraph in bold type outlining any actions that are expected from the GP, like changes in medication, blood tests.. That will speed up the time taken for GPs to process this information

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