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Clinical Referrals

Liz Barfield, Clinical Lead, NHS e-Referral Service Programme, Health Digital Services, NHS Digital

RCN member, Liz Barfield, is a clinical lead on the NHS e-Referral Service programme, part of NHS Digital

After qualifying in 1989, she worked in acute and emergency nursing before moving into IT, joining Connecting for Health – the forerunner to NHS Digital - in 2009. Since then, Liz has worked with the NHS e-Referral Service - formerly Choose and Book - which is the national electronic referral and booking system that also enables clinicians to offer choice to patients and to support effective referral management.

I took part in a workshop run by the Professional Record Standards Body (PRSB) in January 2018, looking at clinical referrals. The aim was to improve the quality of information sent in referral letters, so that hospital consultants can review clinical referrals easily, knowing they have all the information to quickly confirm the referral is appropriate.

I went along wearing two hats: the first was as a nurse who understands how we refer patients, and what is needed to do that well, and the second was representing my current role within the NHS e-Referral Service.

The workshop brought together around 40 professionals and patients to discuss what information should be recorded when someone is referred for further treatment. Participants came from different UK trusts and organisations and included nurses, GPs, hospital consultants, speech and language therapists, pharmacists and allied health professionals. It's always good to have a variety of clinicians bouncing ideas off each other and the discussions that happen at these events are always productive.

For me, nurses always bring a slightly different dynamic to these conversations, as we tend to consider the patient in a more holistic way - we're looking at the whole person and not just a set of symptoms. It's also important to remember that GPs aren't the only professionals who make referrals - for example, nurse practitioners working in GP surgeries are also likely to refer. The system has to work for everyone, so it's vital to involve a variety of groups, with nurses understanding and contributing to these discussions.

During the workshop we looked at the use of headings and considered the right level of information to make an effective referral - long gone are the days when someone might simply say, "please see my patient who has a sore knee". Structured formatting allows us to see a patient's current medications and any allergies, alongside a whole range of other information to help ensure they are seen by the most appropriate clinician. Having that knowledge to start with also saves time and avoids duplication. Sometimes what someone thinks is relevant information, others may not, with differences between what is essential and what is just nice to know. I don't think anyone really wants to read a 20-page referral letter.

After the workshop, there were online surveys and a consultation process to check what a wider group of clinicians considered to be best practice. The standards have now been published. My hope is that they will be easy to use, but it's the way that they are implemented that will be key to realising benefits. I hope they will lead to faster diagnoses and give clinicians all the relevant information they need to make quick decisions, speeding up any further tests.


Overall, I found it a very interesting and worthwhile experience and I recommend taking part in future PRSB projects to other nursing colleagues, particularly as we bring a different viewpoint. The involvement of clinicians is crucial to make sure standards work in the real world - and not just on paper.

Liz Barfield
Clinical Lead, NHS e-Referral Service Programme, Health Digital Services, NHS Digital

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