Understanding Referral Forms
Referrals were traditionally made to secondary care in the form of a handwritten letter. With the arrival of computerised IT Systems, we now have ability to create referral forms that can help speed up the referral process and provided consistent information to those receiving them.
However, we have seen a rise in the number and complexity of forms over time which has lessened their usefulness to General Practice. We therefore often get asked about this by clinicians at the practices we support.
Wessex LMCs view is that there is no contractual requirement to use a referral form.
The exception to this is the form that the coroner’s office request is completed to refer to them, given the legal nature of the request and the status of the Coroner. However, Wessex LMCs can engage with the local Coroner to suggest changes to the forms should this be required.
The BMA additionally advise that Urgent Suspected Cancer referral forms are used for patient safety reasons. Both practices and Wessex LMCs can influence these forms by contacting the local acute hospital and cancer alliance, should changes to these forms be needed.
BMA Guidance
- The BMA have detailed guidance: focus-on-proformas-and-referral-forms.pdf (bma.org.uk)
“The use of referral forms is not a contractual requirement.”
“16. There are no national regulatory or contractual requirements regarding the form that a referral must take, provided it is made via the e-RS. As long as the necessary information has been properly provided by the GP Practice in relation to the e-RS referral then a Trust will be obliged to accept it in accordance with SC 6.13.1 of the NHS Standard Contract.”
- Joint Guidance on the NHS e-referral service: Joint guidance on the NHS e-Referral Service – NHS England Digital
- Use of templates and pro-forma
– If constructed with due diligence, templates and pro-forma can play an important role in ensuring concise and appropriate clinical information is exchanged between GPs and specialists. Using an integrated GP system, it is possible for e-RS to easily ‘pull’ data from GP records and quickly construct a referral ‘letter’, which saves time for GPs and/or their admin staff. These templated documents, which should be agreed locally between GPs, providers and commissioning organisation, can be attached to the e-RS referral.
Since patients have the right to choose to be referred to any provider in the country for elective (as opposed to emergency) care and, therefore, may have several providers listed on their e-RS shortlist, referral templates and pro-forma should be as generic as possible and should be ‘owned’ by the referring or commissioning organisation, with the content having been agreed with local providers and endorsed by Local Medical Committees.
Any provider of NHS services receiving a referral via e-RS, should accept clinical referral information in whatever format has been approved for use by the referring/commissioning organisation and endorsed by the responsible LMC. So long as adequate and appropriate clinical information has been added to the e-RS referral, providers should not refuse to accept a referral simply because it is not on their locally branded template.
Online Portals and Online Referral Forms
The use of self-referral online portals and forms has increased. These can be helpful for patients, but they create significant challenges for General Practice.
- Not mandatory: There is no contractual requirement to use an online portal or online referral form (the only exception being referrals to the Coroner, as outlined above).
- Practicality: GP systems already generate referral letters that are auto-populated, securely transmitted, and stored in the patient record. Practices cannot realistically support multiple external IT platforms across the wide range of referral pathways.
- Patient safety: Standalone forms require manual data entry, increase the risk of errors, and often lack confirmation of receipt or an audit trail in the patient record. This can delay care and increase medico-legal risk.
- Information governance: Any significant change to referral processes, particularly when third-party platforms are involved, should be subject to a Data Protection Impact Assessment (DPIA). Without this, both practices and providers are exposed to unnecessary risk.
- System fragmentation: Allowing individual providers to introduce separate platforms undermines consistency across the ICS, increases workload, and creates confusion for patients and clinicians alike.
Wessex LMCs does not encourage the use of online portals or online forms for referrals due to the concerns outlined above. If a provider chooses to offer a portal or online form as one method of referral, they should also accept referrals via alternative methods, such as email, for practices that prefer not to use the portal or online form.
Generic referral forms
Should you wish to use a generic form, these can be found on both EMIS and System one.
- EMIS – The’ General referral letter (v14.9) (Ardens)’ is available on the national document launcher, filed under “Miscellaneous GP letters+reports”.
- System One – First access the “MED3 and patient letters template. Then select “Medical Notes summary done” from the “summary” section.