• Trusts say GPs may not be ready for electronic referrals switch in October
  • Standard contract requires all first consultant led outpatient referrals to be made electronically
  • Providers agreeing local variations to the contract to ensure payment continues

Trusts are having to negotiate local deals to ensure they still get paid for outpatient referrals after the NHS switches from paper to electronic referrals later this year.

The 2018-19 standard national contract requires all first consultant led outpatient referrals to be made electronically from 1 October.

However, trusts have said they cannot control whether this happens and are dependent on GPs being able and willing to use electronic referrals.

Phillippa Hentsch, head of analysis at NHS Providers, said implementation is a challenge for many areas.

Commissioners and trusts are working together to find solutions and some trusts are seeking local variations to the national contract to ensure they continue to be paid. Where areas are not ready, there was a risk patchwork solutions would emerge with arrangements differing around the country, she said.

“The trusts we have spoken to are concerned as they have limited ability to influence GPs if they are not able to move to e-referrals. The risk sits with the trusts to resolve and with patients,” Ms Hentsch added.

Local solutions being discussed include continuing to pay for referrals that are not made using the electronic system and accepting paper referrals so patients are not delayed – but then asking GPs to complete the e-referral process so it complies with the national contract.

GPs have negotiated £10m of funding to improve their readiness for e-referrals. NHS England has said it will take a supportive rather than punitive approach if they struggle and there are no penalties if there are IT issues preventing referral. No such promises have been made to trusts.

Trusts have individual dates to switch off paper referrals. So far, 42 trusts have achieved this – more than half of them in the north – but six scheduled to switch off last month asked for extra time, including Moorfields Eye Hospital Foundation Trust, which has deferred until September. Its latest board papers show it has around 60 per cent of referrals made electronically and this is increasing slowly.

Moorfields said it was making good progress and was committed to implementing e-referrals. It said in a statement: “As we are a specialist trust and accept referrals from across the country, we have agreed with NHS England to extend our go live date for paper switch off until the 1 September.

“This reflects the challenges we are facing with varying paper switch off dates for clinical commissioning groups across the country. Delaying the paper switch off date for Moorfields will provide more time for CCGs to increase their readiness and will reduce the administrative task of returning referrals.”

In some areas, trusts have said they are ready to accept e-referrals but GPs are not using the system. Surrey and Sussex Healthcare Trust said 95 per cent of its services are available through the e-referral process and by the end of April all services will be. However, the latest figures from NHS Digital show some of their local CCGs have the lowest level of electronic referrals in the country – Horsham and Mid Sussex CCG was at 5 per cent at the end of March and Crawley CGG at 2 per cent. The trust is meant to switch off paper referrals in July.

At East Kent Hospitals University FT’s recent board meeting, medical director Paul Stevens said GPs were concerned about internet issues including slow speeds. Kent local medical committee chair Gaurav Gupta said GPs were concerned about whether referrals were going through correctly and about the extra time they took. “GPs will find it difficult to do an additional process during a 10 minute consultation,” he said.

Only three global digital exemplars have managed to switch off, according to the NHS Digital figures.