eReferrals Paper Switch off for Hampshire

The Challenge

In 2017 NHS England announced that, as of October 2018, all referrals for first outpatient, consultant-led services would have to be sent via eRS, the NHS Electronic Referrals Service. In Hampshire, GP practices were still heavily reliant on using traditional methods (e.g. paper) to refer into Frimley Health Trust.

This was due to a combination of factors: lack of engagement by both sides, services not available on eRS, the Directory of Services (DoS) not being maintained properly by the Trust, etc. In effect, there was nothing to drive the use of electronic referrals and practices felt that, so long as the existing system of referring ‘by post’ was working, they didn’t need to change. The upshot of all this was that eRS utilisation rates in Hampshire were amongst the lowest in the country, at between 1 to 8%.

 

What we delivered

An eRS working group, consisting of local GPs, admin and primary care representatives from CCGs, the SCW Project Manager and the SCW IT training team, was set up with the express purpose of facilitating a smooth transition from paper to electronic referrals.

Members of this group met with the Trust on a monthly basis, and a project plan was developed, agreed and signed off for Surrey Heath and North East Hampshire & Farnham CCGs.

All 42 practices across the two CCGs were visited by the training team, and eRS training materials were developed for local processes. The Primary Care, GP Clinical Leads & IT leads at the CCGs were involved at all stages and supported both the training team and practices, acting as liaison and feeding back any concerns and queries raised.

Primary Care and SCW CSU representatives continued to meet monthly with the Trusts to look at process and agree next steps. Where required, representation from the NHS National Team was called on for further advice and guidance.

Rather than a ‘Hard Paper Switch-off’ (insisting practices use electronic referrals and rejecting paper referrals) which was thought unlikely to work well, a phased approach was employed. A few specialities at a time went fully live with eRS, and practices would be expected to use eRS for all referrals to those services from that time.

As soon as each speciality went live with eRS, reports could then be sent out detailing numbers of all paper referrals still being made into them and trying to identify the reasons for this.

Throughout this process the SCW IT training team were involved in training (face-to-face), supporting and advising practices in the effective utilisation of eRS.

To complement this, the CCGs hosted quarterly meetings for Medical Secretaries, arranging for both Trust representatives and the SCW IT training team to give presentations in support of the transition to eRS.

 

The Outcome

Results were seen immediately, with eRS rates increasing to 25% within 2-3 months. As each new service was made available practices were informed and utilisation increased further.

Finally, in July 218, Frimley Health Trust were able to start a ‘Soft Paper Switch-off’, returning any ‘stray’ paper referrals to practices with a polite request that they resubmit them on eRS. At this point Surrey Heath and North East Hampshire & Farnham practices were already making 86% of referrals via eRS; and by September 2018 this had increased to a staggering 99.5%.

With continued support from the SCW IT training team, including live webinars and the full implementation of our IT Training Support Desk for one-off telephone queries, eRS utilisation has remained consistent in Hampshire and is now seen as ‘the norm’ by local practices for making first outpatient referrals.

This is a positive example of where collaborative working across partners in CCG, CSU, Trust and NHS national teams has resulted in a better healthcare experience for patients in three counties.