This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

CAMHS won't see you now

GPs told to ‘hold urgent referrals’ after IT issue prevents electronic referrals

Exclusive GP leaders in Kent have warned local hospital trusts that they will not support the switch-off of paper referrals for fear that it will compromise patient care.

This comes after an IT failure at a local hospital trust meant GPs were asked to 'hold urgent referrals' for 24 hours earlier this month.

Maidstone and Tunbridge Wells Hospital NHS Trust said the IT issue was resolved within four hours and did not adversely affect patient care.

But Kent LMC argued that this shows a ‘lack of preparedness’ and that GPs should continue to use paper referrals until all concerns have been addressed.

GPs in Kent were alerted to an issue with the trust's patient administration system (PAS) on 10 May, which meant they could not book appointments, and so should hold urgent referrals.

The alert from the trust, seen by Pulse, said: ‘Unfortunately there has been an IT issue this morning at MTW meaning their PAS system has gone down, so although you may still be able to access eRS you may not be able to book any appointments.'

GPs were then told that they should ‘hold urgent referrals for 24 hours and routine referrals for 48 hours’ before emailing them to the clinical assessment unit teams.

But the email added that ‘in no circumstance should you hold 2WW referrals; these should be emailed immediately to the CAU teams’. 

This comes after Kent LMC sent a letter to the local hospital trusts last month stating that it was ‘concerned that patient care will be compromised’ by e-referrals. 

The letter included a motion that was passed by the LMC with five conditions to be met before they would support eRS, including the implementation of a backup system in case of an IT failure.

Kent LMC chair Dr Gaurav Gupta, who also sits on the BMA’s GP committee, told Pulse: ‘This shows a lack of preparedness and why the system is not yet fit for purpose.'

He said: ‘Kent LMC wants to ensure that the eRS roll out does not compromise patient safety. It is not acceptable that patient referrals should be delayed due to problems with eRS.

‘We are working with NHS England to ensure that the system is safe for patients and does not add unnecessary burden on practices already under pressure.’

But Maidstone and Tunbridge Wells NHS Trust spokesperson told Pulse: ‘The trust has robust business continuity measures in place.

‘These were recently used when a power test resulted in our PAS being unavailable for four hours and maintained real-time referrals for urgent cancer appointments.’

The trust said that while the system was down for four hours, it did not adversely affect patient experience.

Neighbouring trust Medway NHS Foundation Trust said it is in talks with local GPs to ‘address the issues that they have raised’ before implementing a ‘hard switch-off’. 

Liz Capp-Gray, acting director of IT, said: ‘Since our “soft switch-off” of hard copy referrals a few weeks ago, where we continued to accept both electronic and non-electronic referrals, we have seen the majority of referrals from GPs come through the e-referral system.’

Problems with the e-Referral service

Earlier this year GP practices were told that paper referrals would be switched off from October, in accordance with the new GP contract.

This comes after health secretary Jeremy Hunt vowed in 2013 to make the NHS paperless 'at the point of patient care' by 2018.

Sherwood Forest Hospitals NHS Foundation Trust and Country Durham and Darlington NHS Foundation Trust were the first trusts to ditch paper referrals in 2017.

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

CCGs were then incentivised, with 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.

Readers' comments (7)

  • we are spending hours of extra admin time every day on e-referrals. Much of the time there are no appointments available to book! Another clunky IT system unfit for purpose, and another work-dump

    Unsuitable or offensive? Report this comment

  • The term "working with NHS England" never inspires confidence!

    Unsuitable or offensive? Report this comment

  • Whatever significant benefits IT has given the world it’s left us ever more vulnerable when systems don’t work and in the real world no system is ever perfect.
    This begs the question when rather than whether we should become reacquainted with hand writing again or using a typewriter!
    Just a thought as it may yet be safer or more efficient than crossing our fingers and hoping that the e-referral has gone to where it was meant to go!

    Unsuitable or offensive? Report this comment

  • Why oh why, colleagues, are GPs so negative about digital ways of communicating. Your 'paper' referrals are digitally generated and, if faxed, transferred digitally. Faxes break, so do phones and so do typewriters. Ok, eRS is clunky and not as fit for purpose as it should be.... but suggest ways to improve it or replace it, not just abandon it.

    Unsuitable or offensive? Report this comment

  • Cobblers

    Vortexman @ 10:46am

    I suspect you are not a GP. You will, in the main, find GPs up there at the cutting edge of communication but Booze & Chook and eRS are clunky and badly designed as you say.

    We have all had the experience of good software that just seems to work, and work well, without referring to the manual too often. C&B and eRS are not that kind of software seemingly designed by non GPs without the end users in mind. So using it is a pain, it crashes often and seldom gives you what you want in the end.

    So should GPs get involved? Most of us are too busy keeping our heads above the water in the day job. Those who could have looked at it and decided that it probably needs a bottom to top rethink and redesign. A full time job.

    Don't all rush at once.

    Unsuitable or offensive? Report this comment

  • David Banner

    Re Vortexman

    The issue here is not GP reluctance to use new technology, but having a back up when it (inevitably) crashes.
    There should always be a “paper” referral pathway left open for such crashes, but it many areas (mine included) it has been shut down, so when eRef goes nipples up, there is no Plan B, and chaos will ensue, when it was totally avoidable.

    Unsuitable or offensive? Report this comment

  • Thanks @Cobblers. I am most certainly a GP and just as heads down as anyone with the current challenges. I am however trying to improve and mitigate the limitations of eRS locally.

    Thanks @David Banner. I would be surprised if this Trust in Kent has no capacity at all to receive referrals if there was a prolonged failure and indeed say as much wrt 2ww. This is probably more about that locality wanting to discourage GP colleagues who more routinely send paper referrals, perhaps because they do not want to use eRS. Happy to be wrong.

    Unsuitable or offensive? Report this comment

Have your say