Decommissioning of CHEC Gateway Referral Process
– e-Referral Questions & Answers
Following the communications on the new referrals processes and training sessions, the CCG have summarised the key questions and points raised and discussed. Amendments have also been made to the MSK pathways update. Please see below for important changes to MSK admin rights information previously circulated.
- How does record sharing work with an MSK SystmOne e-Referral?
Concerns have been raisedaround access to patient records as part of the MSK referral process.The process does not breach Information Governance as only the referred patient’s record will be shared and consent recorded by the practice (implied or explicit) and the MSK hub (explicit) as per the EDSM model.
The referral to the MSK hub is a SystmOneReferral. Implied in the use of a SystmOneReferral is use of the EDSM sharing system. This is the system in use when an MSK e-Referral is made. It is the same system already currently used by other community services. Practices will be familiar with EDSM and can find more information from TPP including patient information. The EDSM sharing model is developing and improving; TPP, the BMA and ICO all share regular updates with SystmOne users about the progress of this work.
This system allows the clinicians assessing a patients referral to access that patients records in SystmOne including x-rays and other relevant information. This means further information such as x-rays do not needto be attached to the initial referral.
The access rights that Practices have been asked to give to MSK Hub staff relates to Choose & Book e-Referral only. SystmOne Referral (often referred to as e-Referral) is separate to e-Referral (previously known as Choose & Book).
MSK staff will be able to create a new Choose & Book e-Referral using Choose & Book e-Referral only, unlike the process Practices use who create a Choose & Book e-Referral by first creating the referral through SystmOne.
This is the same process and sharing model as is used when an EPaCCs template is used.
The MSK Hub consists of SFHT and Nottinghamshire Healthcare staffdirectly employed by the NHS.
If a practice has switched off sharing and so are unable to send SystmOne e-referrals please contact the MSK hub directly to find a solution.
If a patient does not consent to sharing their record with the MSK hub please explain the reason for data sharing with the patient to obtain consent to the referral and contact the MSK hub directly to discuss.
- Which Choose and Book access rights do MSK admin staff need?
To enable MSK admin staff to make Choose and Book e-Referrals on the GP Practice’s behalf, ’Choose and Book Referring Clinician Admin’ access rights need to be added to the MSK admin staff smartcards.
Choose and Book Referring Clinician Admin rights allow admin staff the activities ‘Proxy Manage Outbound Referrals’ and ‘Manage Outbound Appointments’. See description of these activities below.
A screenshot of the role on CIS is below:
The following users are the current MSK admin staff who will need to be added (more names and smartcard numbers to be added):
Name / Smartcard Numbers can be found on the CCG intranet:Documents/Current MSK Hub admin staff are.docx
Dawn Shipman
George Garbett
Following this, practices will need to wait until NHIS have approved these (try the following day) and find each MSK hub member on your SystmOne staff and organisation setup page, and untick “logon” next to their name. This will completely block these staff members from your SystmOne. See screenshot below.
- How do I contact the MSK hub?
Contact details are currently for use by practice staff only. The hub can be contacted by email: or phone: 01623 784774. Patient contact details will follow.
- What should I tell patients about their MSK Hub referral?
There is an information leaflet attached which explains what the MSK Hub is and how their referral will be managed, along with information regarding EDSM and consent.
- How does eReferral support patient choice?
NHS Choice Framework - The government is committed to giving patients greater choice and control over how they receive their health care, and to empowering patients to shape and manage their own health and care. The NHS Choice framework sets out some of the choices available to NHS patients.
In complying with the choice framework, practices must offer patients a choice of provider at the point of referral. The e-referral system provides the information on available providers to support patient decision making.
Further information, including easy read leaflets is available on the following webpage: https://www.gov.uk/government/publications/the-nhs-choice-framework
- Do I have to use the Ardens referral letter?
Practices are encouraged to use the Ardens referral letters. An Arden routine referral letter must be saved to the record as “final” before referral to the MSK Hub. Please see the attached “How To” guide for instructions on creating and sending an MSK SystmOne referral using Ardens.
- How do I book Ardens training if my practice hasn’t had it yet?
All practices get two hours of training provided by Ardens – one hour for admin staff and one hour for clinical staff. If you haven’t already had this, training can be booked via the Ardens website – click ‘Support Desk’ then ‘Book Training’.
- What is the future for Ardens within the CCG’s?
Ardens provide a suite of templates which work within System One and aim to reduce the administrative burden of Primary Care. The CCGs previously made a funding decision to trial the software. There will be a formal review of the benefits and value for money outcomes. The uptake, use and feedback of Ardens by practices will impact the CCG evaluation of the service.
- What do I need to do with Prior Approvals?
The Prior Approval policy applies to primary and secondary care. Prior Approval forms completed in primary care should be sent to the IFR team by email to for approval before being attached to the relevant referral(unless stated below.)
The prior approval forms are available as auto-populating letter templates on the orange communications arrow (next to the MSK tab) and contain the email address of the IFR team as well as instructions. These are also available to view on the Mid Notts Pathways website.
There are several categories of prior approvals depending on speciality:
MSK: MSK prior approval forms need only to be saved to the patient record once validated and before the SystmOne referral is sent.
Ophthalmology: Health Harmonie will authorise ophthalmology prior approvals. Practices shouldattach the prior approval to the e-Referral and send it to Health Harmonie.
Cosmetics: Book into the ‘cosmetics’ worklist using e-referral. This will be accessed by the IFR team to review prior approval forms. If prior approval is granted, the practice will receive notification through the e-referral ‘referral action required’ worklist. Practiceswill then need to send the referral with completed prior approval attached and manage the appointment booking.
Varicose veins: Book into the ‘varicose veins’ worklist using e-referral. Clinical triage will be managed through CCG. Practices will be notified of the outcome via the e-Referral ‘referral action required’ worklist. . Practices will then need to send the referral with completed prior approval attached and manage the appointment booking.
Other prior approvals: all other prior approvals should be sent by email to the IFR team for review. Notification will be returned via email, so that the practice can send the referral with completed prior approval attached and manage the appointment booking.
A review of the prior approval process is on-going and further information will be circulated detailing any change to current processes.
- What do I do if a referral is rejected by secondary care due to the lack of a Prior Approval form?
If the Prior Approval form was appropriate to be completed in Primary Care then this should be done and the referral re-sent following approval. If the Prior Approval form was not appropriate to be completed in Primary Care, please let the CCG know – this can be done through the GP Feedback form which can be accessed onlinethrough the Mid Notts Pathways website or downloaded as a button link to SystmOne (see attached guide). Please do not include any patient identifiable information in your feedback.
- Helpful tip for safeguarding against missed referrals
For practices who are planning to book appointments over the phone, some practices already using this system have shared a tip to safeguard against missed referrals. They ask their GPs to hand out a slip to patients who are being referred, asking them to phone the practice if they have not been contacted to book an appointment within 48hours. An example slip is attached.
- How do I access support?
The CCG helpline number will be available from 11th-31st August between 9am and 5pm - Please call on 01623 673636 and your call will be directed to a relevant member of staff. Following this time period, help will still be available if needed but there will not be a dedicated line.
Shadowing opportunities are available with admin staff within practices that have an experience of running a full e-Referral process for patients. If you would like to access this please contact Steph Hart, Primary Care Project Support Officer on: .
You can access the Mid Notts Secretarial Forum through ‘Forums’ on SystmOne. This is a useful tool for sharing skills and asking questions.
- Where can I get more information?
The CCG circulated information to support the transition in services. These documents will be made available on the Mid Notts Pathways website.
Last Updated 11 August 2017