NHS e-Referral Service (e-RS): Referring from the prison healthcare system

The Health and Justice Information Service is the national IT programme providing healthcare for patients within the justice system. Working in partnership with the North of England commissioning support (NECS), the programme aims to deliver a range of benefits including:

• transfer of patient records between health and justice organisations
• patients being able to register with a GP within justice healthcare
• access to NHS Spine services such as the Personal Demographics Service (PDS), Electronic Prescriptions (EPS) and the e-RS

In support of this programme, NHS England introduced a change to e-RS to ensure that whenever a patient has been referred from any detained estate, any referral or outpatient appointment booked via e-RS would not be visible to anyone online through the ‘Manage Your Referral’ portal via the NHS App. This change was required for security reasons to ensure no-one outside the prison or healthcare system would be aware of any upcoming outpatient appointment for a detained patient.

The Newcastle upon Tyne Hospitals NHS Foundation Trust is one of the busiest and largest NHS hospital trusts in the country, with around 15,000 staff and an annual budget of £1.6 billion. Staff oversee around 6,500 patients contacts every day. The trust is in the top five providers of specialised health services in the country, supporting people with a range of rare and complex medical, surgical and neurological conditions, cancers and genetic orders.

The trust is also the second largest provider of specialised health services in the country, supporting people with a range of rare and complex medical, surgical and neurological conditions, cancers and genetic orders.

The trust utilises many different aspects of the e-RS to receive and manage planned care activity. This includes e-RS Advice and Guidance, Referral Assessment (RAS) and directly bookable services published on the e-RS Directory of Services.

Newcastle Hospitals set out to implement several changes as part of this project with prison healthcare services to improve efficiency, minimise the administrative burden on staff and ensure data accuracy. This included:

• aligning referrals from detained estates with other e-RS referrals the trust receives
• ensuring detained estates are excluded from receiving telephone reminders and the Patient Engagement Portal (PEP)
• ensuring good communication between detained estates and trusts when there are changes to appointments

From the outset of this project, Newcastle Hospitals decided to align receiving e-RS referrals from the detained estate with the same process for receiving e-RS referrals from GPs and other referrers in the community.

This decision was taken to ensure consistency across their e-RS directory of service, minimise any duplication of effort, and ensure the trust teams manage all outpatient referrals using the same standard operating procedures.

Once the e-RS referral is received from the detained estate, the patient and their referral are registered on the trust’s patient administration system (PAS) and managed via the trusts’ outpatient waiting list. The trust verifies the ‘source’ who initiated the e-RS referral via the unique organisation (ODS) code for each detained estate, or youth offenders institute.

Due to the trusts’ PAS not being Spine compliant, any updates to the patient’s registered address (the detained estate from which the initial referral is received via e-RS) would not be automatically updated in the PAS. The trust team treating the patient previously relied on being informed of any change of address, which is then manually updated in the PAS.

The aim was to utilise appropriate data references, NHS organisation data (ODS) codes and the prison acronyms to further increase the accuracy of the data, minimise gaps and reduce the burden on trust teams who have to manually check and update the PAS.

The trust is therefore trialling a new weekly-check and update process to ensure the contact address for the detained estate is always accurate within PAS. This change ensures that any outpatient letter produced via PAS is automatically changed to include the relevant medical examiner as the letter addressee and remove the patient’s name before being posted. 

In addition, technical suppressions have been introduced across the trust’s systems and processes to ensure new e-RS referrals received from detained estates are excluded from their telephone reminder service and their PEPs. Aligned to the suppression introduced into patient-facing services for e-RS, the trust ensures digital letters, follow-ups and other clinic appointments are not visible online via their PEP portal or via the NHS App for any patient initially referred to them via e-RS from a detained estate.

All outpatient appointment changes or cancellations are managed within e-RS. Where this impacts an appointment booked for a detained patient, the trust contacts the medical officer at the detained estate to inform them of the change and discuss a suitable alternative date and time. Likewise, the detained estate also contacts the trust promptly if the patient is unable to attend their appointment for any reason, such has transport issues.

Maintaining good communication between the trust and the medical team at each detained estate is critical to ensure effective and safe processes are in place to support the transfer of care for each patient from their place of detention into NHS care.

Finally, the trust produces two reports each week; one of which identifies all patients who have an appointment in the next two weeks and the second report checks the patient address held on the NHS Spine against what is recorded in PAS. This includes where the address is confirmed as being a detained estate address. The trust team will then review to identify which address is correct and update PAS accordingly. This is defined in a new Standard Operation Procedure (SOP) which ensures both the nursing and outpatient reception teams are aware and can make the necessary preparations for when the patient arrives at the outpatient department.

Contact the NECS/Health and Justice team for further information by emailing [email protected].