NHS e-Referral Service Advice and Guidance recommendations for cancer pathways

The NHS e-Referral Service (e-RS) provides an easy way for patients to choose their first hospital or clinic appointment directly in the GP surgery at the time of referral.

The Advice and Guidance (A&G) function allows a clinician to seek advice from another. It is a communication between two clinicians: the “requesting” clinician (referrer) and the provider of a service (the “responding” clinician).

The requester is able to attach documents to the advice request, which may include diagnostic results, scanned images (for example, ECGs) or previous correspondence related to the patient. They are also able to authorise the responder to convert the request to a referral.

The responder is then able to review the request (along with any attachments that may have been added) and, if required, add new attachments, such as a proposed treatment plan or links to external documents and websites, before sending a response back to the requestor or converting the request into a referral, where authorisation has been given

As part of the changes introduced in January 2021, a referrer may authorise a consultant to convert an A&G request into a referral where appropriate, or a provider clinician may recommend that a referral is required. In either case, the responsibility to refer remains with the referrer/GP and the provider clinician cannot reject a referral without discussion with the referrer.

The A&G function should not be used in place of a two week wait referral. for example where a patient clearly meets NG12 criteria this should usually result in an urgent suspected cancer referral.

A&G can be used locally where agreed at a system level. This may vary by pathway depending on what is clinically appropriate and must follow engagement with referrers and providers to develop any new processes.

Prior to any implementation systems/commissioners should undertake a local training needs analysis and carry out any training as necessary. There should also be ongoing support available to referrers and providers

A&G will be converted into 2ww appointments in line with the local referral and commissioning guidelines and must be classed as a suspected cancer/2ww referral, not a consultant upgrade.

The e-RS pathway start will capture the date on which the provider converts the referral. When making the decision on if to convert A&G directly into a referral and appointment, the clinician reviewing should take into consideration whether they have the required information, and whether the patient is likely to know there is a suspicion of cancer.

Systems or commissioners should regularly review A&G services and conduct quality assurance analysis to ensure they meet local requirements. Lessons learned should also be reviewed and findings shared across the system.