GovTech NHS Secondary Care Referral Platform — Integrated Care Board

NHS eRS FHIR R4 API

• create referral (POST ServiceRequest), retrieve referral status (GET ServiceRequest/{id}), search appointment slots (GET Slot), book appointment (POST Appointment), and retrieve consultant availability (GET Schedule).
• UBRN (Unique Booking Reference Number): assigned at referral creation — tracked throughout pathway. e

RS attachment

supporting clinical documents (investigation results, clinic letters) attached to referral as FHIR DocumentReference.

Referral quality improvement

GPwSI (GP with Specialist Interest) referral guidelines embedded as checklist — GP confirms required investigations completed before referral.

Red flag symptom check

structured red flag assessment (NICE guidelines) — red flag pathway automatically directed to 2-week wait (2WW) urgent referral stream.

Threshold adherence

specialty-specific referral criteria embedded (orthopedics: walking ≤ 200m, conservative treatment ≥ 3 months).

GP portal

real-time consultant availability (wait time by specialty, by consultant, by site), referral status tracking (referred, appointment booked, attended, rejected), and ICB-level wait time benchmarks.

Feedback loop

• consultant rejection reasons fed back to GP with clinical guidance — learning loop reduces rejection rate over time.
• RTT (Referral to Treatment): automatic RTT clock start at referral creation, RTT pathway tracking per patient.
• DCB0129 Clinical Safety —

Highest clinical safety hazard

decision support tool inappropriately blocking an urgent referral.

Mitigation

all decision support is advisory — GP can override any recommendation with documented reason.

Safety design principle

errors of omission (not referring when should) are more dangerous than errors of commission — decision support nudges towards referral, never blocks.

Clinical Safety Officer

GP clinical lead with eRS experience.