Going 'e-referrals only' in a mental health trust

South West London and St George’s Mental Health NHS Trust provides mental health services across the London boroughs of Kingston, Merton, Richmond, Sutton and Wandsworth. It serves 1.1 million people and employs more than 2,000 staff. 

Last year, the trust mandated the use of the NHS e-Referral Service (e-RS) for all referrals from local GPs. Compliance is now almost 100%. GPs and trust staff are reporting efficiency gains, and patients have better access to mental health specialists. 

The NHS e-Referral Service (e-RS) is a digital platform that allows GPs and other referrers to easily find appropriate clinical services for their patients and refer them for more specialised care. The service also allows referrers to request advice from specialist clinicians. 

The trust managed their e-RS rollout in phases, starting with an analysis of their 2,000 monthly referrals in early 2021. Although they were receiving a few referrals electronically via email, the vast majority were paper based. 

The trust then decided to mandate the use of e-RS for GP referrals and set a date, 1 April 2022. 

e-RS Deployment Lead Tamara Emetu oversaw the implementation and worked closely with GPs and other primary care colleagues, inviting them to join the project’s steering group. 

The group played an important role in reviewing and signing off each of the 30 services that would be created and added to e-RS’s Directory of Services (DOS). 

Our Product Implementation and Relationship Management Team also provided support. Sandra Lees, Implementation and Business Change Manager, and other members of the team were on hand to give advice on specific issues, including process mapping, DOS configuration, data analysis and testing.  

From November 2021, the trust began to contact local GPs and their staff through regular bulletins to highlight the planned move to e-referrals. Tamara also attended GP meetings across the 5 boroughs served by the trust to increase awareness.   

The trust’s local GP practice teams were already familiar with e-RS (it’s already used for all GP referrals into physical health services) but the team still had to work hard to encourage GPs to change long-standing habits. 

Ahead of their upcoming paper referral switch-off, the trust also wanted to make sure that their move to e-RS made the most of its functionality, and so the option for electronic Advice and Guidance was added for all of their services. This lets GPs and other referrers seek advice about patient care from specialists without having to refer them, helping to avoid unnecessary referrals and speeding up access to the right treatment for many patients. 

They also utilised e-RS’s referral management functionality by introducing electronic triage through Referral Assessment Services (RAS). This helps the GP or referrer to better navigate and ensure they are referring their patient to the correct service and allows trust clinicians to review whether a referral is in the right place. 

The trust’s paper referral switch-off date arrived, and teams across the trust began returning all paper referrals to GPs, asking them to resubmit via e-RS. Some trust staff had initial reservations about this, but referrals were usually quickly resubmitted through the electronic system. 

South West London and St George’s move to electronic referrals was extremely successful. Through close working with primary care colleagues and regular reminders to GPs to use e-RS, the trust has seen a large increase in referrals received via e-RS, rising from less than half of GP referrals in January 2022 (48.3%) to almost full compliance by the end of the year (92.9% in December 2022). 

Requests for Advice and Guidance are also on the up, with requests from local referrers for specialist guidance more than doubling over the same period (225% increase). 

Feedback from both GP practices and trust staff has been very positive.

Richard Morton, Deputy Director of Operations at the trust, said: "The NHS e-Referral Service (e-RS) has made it easier for our frontline healthcare workers to meet the needs of the many patients we serve.

“By adopting e-RS, we have freed up valuable NHS staff time, providing a service where GPs can easily see when patient referrals are received, accepted, or declined with signposting information. It also provides a quick response to GPs' queries via the advice and guidance system.  

"Most importantly, our approach to e-referrals means we are able to direct patients even more rapidly to the many specialist mental health services we provide across Kingston, Merton, Richmond, Sutton and Wandsworth.” 

The e-RS implementation journey isn’t over for South West London and St George’s, next the trust plans to work with their IT system supplier so that e-RS can be integrated with their electronic patient records system RiO using our APIs. This will mean that staff can manage referrals and subsequent appointments from within their existing systems, improving efficiency and maximising e-RS’s benefits. 

They also plan to utilise more of e-RS’s functionality, by adding some directly bookable services which will allow some patients to book their first appointments over the phone, online or through the NHS App. 

Contact the trust’s e-RS Deployment Team at [email protected]