STEP by STEP GUIDE on HOW to DO a 2WW REFERRAL USING DXS and NHS E-Referral Service (Ers)

STEP BY STEP GUIDE ON HOW TO DO a 2WW REFERRAL USING DXS AND NHS e-Referral Service (eRS)

Background
Hospital Trusts are required by NHSE to fully implement electronic referrals, using eRS web portal, by October 2018. Locally, Lambeth CCG is working closely with Southwark and Bromley CCGs, to oversee the implementation of this CQUIN requirement by Guys and St Thomas Foundation Trust (GSTT) and Kings College Hospital (KCH), both at Denmark Hill and the Princess Royal.

Agreed priorities – because they are high volume specialities or in the interests of patient safety - for moving to eRS are

• 2WW referrals
• Dermatology
• Gynaecology
• Ophthalmology
• Neurology
• Diabetes
• Antenatal/Maternity
• Musculoskeletal (physiotherapy, MCATTS, Orthopaedics, Rheumatology)

From 1 September 2017, GSTT will be switching off email referrals for two week wait (2WW) to their 2WW office, and it is mandatory therefore to make the 2WW referral to GSTT via eRS. KCH will follow suite in due course, in the next few months. Making a 2WW referral by email, or even worse by fax, where a 2WW referral should be made via eRS, will create a delay and a risk to patient safety.

DXS

Currently 2WW referral forms are held in DXS, a repository for standard referrals forms that is available for all clinicians and staff to use across all practices. The forms are the up to date latest agreed Pan London referral forms. Using an old form is not best practice and poses a risk to patient safety due to potential delays.

DXS should load automatically when you log onto Emis, it does not require a separate log in. If you cannot get access to DXS please raise internally in your practice and ask the relevant person to contact DXS support via E-Mail: or Telephone: 0800 028 0004 Option 1 working hours: Mon-Fri: 07:30-19:00 and Sat: 09:00-13:00

DXS currently does not interface directly with eRS (although this development is planned for future, we do not as yet have a firm date for implementation).

All 2WW forms are in the Lambeth CCG folder, in the folder marked 2WW.

ERS

eRS interfaces with Emis directly, but can also be accessed also from your desktop at

eRS can be accessed from Emis by

• Clicking on the EMIS menu, External Links and then click on NHS e-Referral Service;
• Adding an eRS short cut to the EMIS toolbar;
• Accessing from the patients consultation, under referral (in the left-hand pane).

Smartcards

You cannot access eRS unless you are logged onto Emis with a Smartcard. For smartcard issues please contact or 0300 303 2733.

How to make a 2WW referral

There are a few key essentials to ensure you are following before you start:

Emis must be open only ONCE in your PC – if you have Emis open in two windows, DXS does not know which Emis to look at and will crash/hang.

Make sure that Emis is showing the CORRECT patient – if you move between records in Emis whilst DXS is already open, DXS will be looking at the patient’s records of the patient you had open in Emis when you loaded DXS. There will be a red banner showing at the top of DXS when you move to DXS, saying the patients details in Emis have changed, and you can then press ‘populate’ to update the patient details with the current patient open in Emis. But it is better –and safer - to work doing one thing at a time in DXS and finishing before moving onto the next patient.

Be logged on with a SMARTCARD – you cannot access eRS without one!

CHECK THE PATIENT’S DEMOGRAPHICS AT THE BEGINNING – The PDS (personal demographics service) on the patient precis bar needs to be blue, which means that the demographics on your Emis system is synchronised with the national Spine. There is nothing worse than agreeing and starting a referral process to find at the end or half way through that the patient has moved and is now living out of borough/practice area. Start by confirming their address, home and mobile telephone numbers and if they have one, their email address! Trusts want patients’ email addresses; it really helps with their communications with patients.

‘Practice makes perfect’ – you cannot make a referral on eRS with a dummy patient, as you need a real and active NHS number, but the more you use eRS the more familiar you will become with the system and the faster you will get at it. However, we suggest that the first few times you want to make a 2WW referral you give yourself enough time and avoid being under pressure – clinicians make more mistakes when they are Hungry, Angry, Late and Tired – so HALT! Why not agree with the patient that you will do the eRS at the end of surgery and they either come back in person to pick up the information or you will phone them?

Step 1: From Emis, open DXS and create the 2WW form

You don’t need to have an open consultation, but you need to have the correct patient showing in Emis.

Press home in the DXS icon (the house), go to professional in tool bar, select ‘Lambeth CCG’ folder and then ‘2WW’ folder.

Open the 2WW folder

and select the right 2WW form

Alternatively you can enter ‘2WW’ in the DXS icon and press search and then select the right 2WW from the picking list.

Enter the clinical details in the form.

Click the link in each form if you want some clinical guidance

Click the link within the form and print the patient leaflet.

See below for one example. These are useful as they explain a lot about what the patient should expect to happen at the 2WW appointment, so it saves time and ensures the patient has all the relevant information, it is really helpful to give them to the patient.

SAVE the referral form – but remember once SAVED it cannot be edited – so make sure you have entered everything you want to enter before pressing SAVE!

Saving will automatically close DXS and return you to Emis. You will see this banner in the patient’s notes – this means the form has been saved into Emis. Click on the banner to re-upload the patient’ Emis record and the banner will disappear.

The form will now be saved as a separate consultation

and also saved in documents within Emis.

Step 2:Creatingthe eRS referral from Emis

Open eRS, either directly from Emis – in which case the patient’s details will be added automatically – or from the icon on your desktop.

From within a Consultation, select Referral on the left-hand pane,

point to NHS e-Referral and then select an appropriate Priority
(Routine, Urgent or 2 Week Rule)

If you open from your desktop you will have to enter the patient’s nhs number and find them and check you have the right patient.

Press ‘refer’ – bottom right hand corner of the screen.

Under clinic type – chose 2WW from the TOP OF THE PICKING LIST. Do not go to the relevant speciality. Some 2WW referral forms cover more than one speciality so they are a speciality/clinic type of their own e.g. Head and Neck covers ENT, oral surgery, ophthalmology, etc.

Select a distance from the patient’s home address (to avoid trying to load every hospital across the country) – a good idea is ’10 miles’ as gets most of London.

Choose the right clinic type and the right Trust from the options showing.

Once you have selected a speciality and clinic, click on ‘Search all’.

Select the appropriate 2WW service

Press for appointments to be shown.

Confirm the section by clicking on ‘Continue with selected services’

• Click an appropriate appointment in the list
• Click Book
• Select Submit

Select the right appointment for the patient. Appointments are ‘live’ and being booked by others, so they might show as available but when you select them they disappear – because someone else has already booked them. It is sometimes easier to select an appointment a few down to avoid disappointment and having to choose multiple appointments, only to find they have already been booked by someone else.

Note: When you book an appointment, you will be prompted by the Check Patient Details pop-up box to confirm that the patient’s details are correct. Click OK (patient details should have been checked in Emis).

Print the appointment letter for the patient

The referral will be sent through eRS, but you will need to complete the process in Emis by sending the referral letter/form and any results that need to go with the appointment. In the bottom set of buttons,

• Click on ‘I have Selected a Service’
• Click OK

Note: If you no longer require the referral, select

‘I have abandoned the process’. If you select this option, you also need to access eRS again and cancel the UBRN.

eRS closes, and the NHS e-Referral screen is displayed in EMIS Web, with some fields already completed, but the referrer will need to enter some details to complete the process.

Step 3: Adding the referral form from Emis

In the NHS e-Referral Complete Referral Details screen in EMIS, there are a number of mandatory fields

(marked with a red asterisk *) .

Depending on local processes the only mandatory field that needs to be completed is the clinical term to describe referral.

• Select Create Now and Click OK.

The next screen has three main sections.

1.NHS e-referral letter

2.Referral letter

3.Clinical content

4.Preview

• NHS e-referral letter – DO NOT check the Add referral box but DO add some text e.g. ‘See attached referral letter’
• Referral letter – Only use if you don’t use the DXS referral form, and have your own referral template. Make sure the check box on the NHS e-referral letter is checked and then select your template.
• Clinical content – this can be used to add your DXS referral letter/form prepared earlier and/or to add more attachments or information (e.g. allergies, test results).
  

Select Clinical Content and then click Attachments.

• Select the document/s required; and/or
• Additional supporting information required.

Note: Depending on local processes for checking the referral before it is sent, you can save as Draft or select Authorise and Send.

SelectAuthorise and Send will send the referral letter to e-RS, and once the consultation is saved the UBRN details will be saved in the patients’ record in EMIS.

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