GP paper referrals will be switched off from October, according to the new GP contract, which calls for practices to use an electronic referral system.
However NHS England has said that contractual action will be a last resort and practices will not be penalised if it is not fully implemented in their locality due to IT issues.
The contract, which was announced last month, and came into force this weekend, stated that it aimed to have ‘switched off paper referrals’ from October 2018, but announced a non-recurrent £10m investment to recognise the ‘additional workload’ associated with the implementation.
When addressing the execution, NHS England has said it’s approach ‘will be a supportive one with any contractual action being a last resort.
‘Where a practice is struggling to use e-RS, there would be a contractual requirement to agree a plan between the practice and CCG to resolve issues in a supportive way as soon as possible.
It added that practices will not be penalised if e-referrals are not fully implemented in their locality, and gave the example of IT infrastructure not being capable of effectively delivering the service.
Where there are system-wide issues, NHS England will listen to and work with ‘practices and GPs in the area who will be kept involved in agreeing any revised paper switch off date’.
BMA GPC executive team member Dr Farah Jameel said: ‘We recognise that there are a number of concerns among GPs over how the scheme will affect workload, which is why, during this year’s contract negotiations GPC secured £10m extra funding to assist practices in ensuring they have the resources they need.
‘We also gained assurances in contract negotiations that NHS England would take a supportive, rather than punitive, approach in cases where practices are unable to meet the October deadline.
‘Going forward we will be closely monitoring the roll-out, and will work with NHS England on a post-implementation review to identify any challenges in the process, including those associated with workload.’
But NHS Digital argued that patients being able to choose when their appointments are, will halve the rate of those missed from 10% to 5%.
National medical director for the e-RS programme, Dr Stephen Miller, said: ‘The NHS e-Referral Service helps to relieve the burden on GPs by cutting down on their paperwork and reducing the number of patients who go back to them to find out what is happening with their hospital appointment.
‘The system also reduces the risk of letters going missing and allows doctors to more easily track their patients’ referrals.’
NHS England has said that while they are aware that some GPs are still concerned about the implications for practices, they are committed to work with the GPC to ‘improve the referral process and to deliver an ever more efficient and effective system that minimises workload for the practice’.
There have been issues with the e-RS in the past, starting from its launch day in summer 2015, when GPs were forced to delay patient referrals when they couldn’t access the system.
Last year, CCGs were offered up to £55m in funding to move towards electronic referrals as part of the quality premium, and that September two NHS trusts announced that they would no longer accept paper referrals, opting for the e-RS.
Sherwood Forest Hospitals NHS Foundation Trust and Country Durham and Darlington NHS Foundation Trust were the first in the country to make such a move.
At the time, NHS Digital stated that GPs in the area had agreed with their trusts to go paperless, with a telephone option given to those patients without internet access.