Create referrals and bookings as a referrer

This page describes functionality to create a referral or booking in the NHS e-Referral Service (e-RS) via our API. Including the ability to defer an appointment booking to a service provider and create a triage referral.

It covers any scenario where a referral is sent to a secondary care provider:

• a GP refers a patient to a hospital service for specialist treatment 
• an optometrist refers a patient to a hospital eyecare service
• a dentist refers a patient to a hospital for specialist care or into a community setting

This use case guide covers:

1. Create a referral.

2. Arrange triage.

3. Arrange appointment.

The process diagram shows how the various endpoints can be used to create an integrated solution. Endpoints in red denote those which can be accessed via the application-restricted, unattended access route.

This referral process flow covers creating a referral with a shortlist of services.

A referral shortlist can contain one or more:

• directly bookable service (DBS) 
• indirectly bookable service (IBS) 
• referral assessment service (RAS)

A RAS is used to support a triage referral and is commonly called a triage service. Referrals can be sent directly to a triage service, without having to book an appointment.

Find out about the different channels available in e-RS via which a patient may be referred.

1.1 Carry out a patient service search

Endpoint: Patient service search (A010)

The first step in making a referral is for the referrer to identify an appropriate secondary care provider. This is done by querying the e-RS directory of services (DOS).

Referrers can use the most suitable search mechanism to locate services, such as:

• SNOMED clinical term
• speciality and clinic type
• named clinician

Find out more about what the DOS holds and how it enables referring clinicians to search for appropriate services.

Service search has to be carried out in context of a patient. Integrated software must have identified a patient prior to creating a referral. This is to ensure a PDS trace has taken place which verifies the patient and their demographic details, which could be used in later stages of the referral workflow. For example, the correct address has been used if a patient letter is subsequently sent out in the post.

1.2 Obtain reference data

Endpoint: Retrieve reference data (A004)

If users are required to perform a service search using specialty and clinic terms, the reference data endpoint will be required to obtain the latest set of codes.

1.3 Make a referral

Endpoint: Create referral (A011)

This step covers creating a referral with a shortlist of services.

A shortlist can include any combination of a DBS, IBS and RAS.

Pathway Start Date

The e-Referral Pathway Start Date is a derived value of when the Referral To Treatment (RTT) clock starts. Find out how e-RS derives the pathway start date here.

You can supply an optional, alternate pathway start date when creating a referral via Create referral (A011).

This may be because steps, such as reviews, take place early in your business process. Which means the clock started earlier than when the e-RS referral is created. Providing an alternate pathway start date ensures the correct date is recorded and used in other systems.

If you intend to use this function, you must seek approval from the NHS England National Elective Care team before developing your solution. They will ensure the RTT date is being calculated in line with National RTT rules.

You can contact the Elective Care team on [email protected].

Please note, the Elective Care team have an SLA of 20 days for these requests.

1.4 Upload a referral letter

Endpoints: Upload file to document store (A020), Maintain referral letter (A012)

Once a referral has been created, these endpoints allow for the upload of attachments, commonly known as the "referral letter" or "clinical referral information".

Clinical referral information must be added within the recommended timescales:

• two week wait - within one working day
• urgent referrals - within one working day
• routine referrals - within three working days

Adding clinical referral information via these endpoints is a two-step process involving:

1. Upload of a file attachment to the e-RS document store (Upload file to document store - A020).
2. Associating the file attachment to a referral (Maintain referral letter - A012).

1.5 Obtain the patient letter

Endpoint: Generate patient letter (A019)

This endpoint can generate a letter for the patient.

The letter summarises the current state of the referral and any steps the patient may need to follow. For example, appointment booking instructions.

In this scenario, the letter provides the patient with login credentials to allow them to make the booking at their convenience, either via the internet (using the Manage Your Referral patient portal or NHS App), or telephone.

1.6 Determine the healthcare service type

Endpoints: Retrieve healthcare service (A033), Search for healthcare services (A035), Retrieve healthcare service version (A037)

These healthcare service endpoints will allow you to determine:

• the type of service on a shortlist and which request flow it supports
• which options to present to your user in order to book, defer or send for triage

Click the play button to watch a short video which explains the terms used within e-RS and demonstrates how specialty and clinic types are used to locate a suitable service for patient referral.

This short video lasts around 5 minutes.

Following the creation of a referral and a shortlist of services, a referral can be sent to a RAS for triage.

This is an optional step – it is possible to make a referral without sending for triage.

2.1 Check the service supports triage

Endpoints: Retrieve healthcare service (A033), Search for healthcare services (A035), Retrieve healthcare service version (A037)

Prior to progressing a referral via Book or defer appointment (A016), the healthcare service endpoints should be checked to ensure it supports a triage referral.

2.2 Send for triage

Endpoint: Book or defer appointment (A016)

This endpoint can be used to send the patient to a triage service.

2.3 Upload a referral letter

Endpoints: Upload file to document store (A020), Maintain referral letter (A012)

Once a referral has been created, these endpoints allow for the upload of attachments, commonly known as the "referral letter" or "clinical referral information".

Clinical referral information must be added within the recommended timescales:

• two week wait - within one working day
• urgent referrals - within one working day
• routine referrals - within three working days

Adding clinical referral information via these endpoints is a two-step process involving:

1. Upload of a file attachment to the e-RS document store (Upload file to document store - A020).
2. Associating the file attachment to a referral (Maintain referral letter - A012).

2.4 Obtain the patient letter

Endpoint: Generate patient letter (A019)

This endpoint can generate a letter for the patient.

The letter summarises the current state of the referral and any steps the patient may need to follow. For example, appointment booking instructions.

In this scenario, the letter provides the patient with login credentials enabling them to select their clinic at their convenience, either via the internet (using the Manage Your Referral patient portal or NHS App), or telephone.

Following the creation of a referral, an appointment booking can be made for the patient if the service is directly bookable. For example, in scenarios where the referral is for an urgent or two week wait priority.

With an indirectly bookable service, the patient must contact the provider directly to make an appointment.

This is an optional step – it is possible to make a referral without a booking.

3.1 Check the service supports bookings

Endpoints: Retrieve healthcare service (A033), Search for healthcare services (A035), Retrieve healthcare service version (A037)

Prior to progressing a referral via Book or defer appointment (A016), the healthcare service endpoints should be checked to ensure it supports a booking.

3.2 Check appointment availability

Endpoint: Retrieve appointment slots (A015)

To create an appointment booking, a search must be performed for available appointment slots. This endpoint allows the retrieval of appointment slots for a single service.

This endpoint is only applicable for directly bookable services.

3.3 Create booking or defer appointment

Endpoint: Book or defer appointment (A016)

Book an appointment

If an appointment slot is available, this endpoint can be used to book an appointment for the patient. When a booking attempt is made, e-RS will communicate directly with the Patient Administration System (PAS) to create the booking.

Defer an appointment

In cases where there are no available slots, or the booking results in failure, then the responsibility for booking the patient’s appointment can be deferred to the service provider using the same endpoint.

This action places the referral on the service providers Appointment Slot Issues (ASI) worklist. The defer action is sometimes referred to as an ASI.

3.4 Upload a referral letter

Endpoints: Upload file to document store (A020), Maintain referral letter (A012)

Once a referral has been created, these endpoints allow for the upload of attachments, commonly known as the "referral letter" or "clinical referral information".

Clinical referral information must be added within the recommended timescales:

• two week wait - within one working day
• urgent referrals - within one working day
• routine referrals - within three working days

Adding clinical referral information via these endpoints is a two-step process involving:

1. Upload of a file attachment to the e-RS document store.
2. Associating the file attachment to a referral.

3.5 Obtain the patient letter

Endpoint: Generate patient letter (A019)

This endpoint can generate a letter for the patient.

The letter summarises the current state of the referral and any steps the patient may need to follow.

In this scenario, the letter confirms the appointment booking, any information from the clinic and details on how to cancel or change their appointment.