Project Overview
An NHS Foundation Trust needed to replace a 2007 paper-based outpatient referral system. GPs referred patients...
Technology Stack
Compliance & Standards
The Challenge
An NHS Foundation Trust needed to replace a 2007 paper-based outpatient referral system. GPs referred patients via paper forms — manually processed by the Trust's admin team. Average referral processing time: 6.2 days. Referral Advice and Guidance (RAG) requests (GPs seeking specialist advice without a full referral) were handled by email. The Trust had a target of NHS e-Referral Service (eRS) integration and FHIR R4 patient matching. Budget: £85,000.
Our Approach
NHS eRS API integration for
- referral request creation, appointment slot retrieval, patient pathway tracking, and RAG (Referral Advice and Guidance) workflow.
- NHS Smartcard authentication for clinical staff.
- NHS RBAC (Role-Based Access Control) — only authorised clinical roles can access patient referral data.
FHIR R4 Patient Matching
NHS Spine PDS (Personal Demographics Service)
FHIR R4 API for patient matching
- NHS Number verification, patient demographic retrieval.
- GP Connect FHIR R4 for GP clinical data access.
UK Core FHIR R4 profiles
Patient, Appointment, ServiceRequest resources.
Domain 1
Clinical Safety Officer appointed, DCB0129 compliant, Hazard Log maintained.
Domain 2
DSP Toolkit Standards Met.
Domain 3
Cyber Essentials Plus, CREST pen test.
Domain 4
FHIR R4 UK Core compliant.
Domain 5
WCAG 2.1 AA, user research with 28 clinical staff.
Referral Advice and Guidance
structured question form (replacing free-text email), specialist assignment algorithm (specialty + geography + capacity), response SLA tracking (24-hour target), GP notification via NHS Notify, and clinical audit trail.
The Results
Live at 16 weeks, £78,000 — under budget.
DTAC approved all 5 domains (first submission).
Referral processing: 6.2 days → 1.4 days average.
RAG response rate within 24-hour SLA: 91% (previously unmeasured — email response time averaged 4.7 days).
GP satisfaction: 4.6/5 (vs 2.1/5 paper system).
NHS eRS integration: zero rejected referrals in first 3 months.
CQC inspection: referral system cited as good practice.
“Six point two days to one point four days — that is 4.8 days faster for every patient referred. At 14,000 referrals per year, that is 67,000 patient-days of waiting eliminated. The DTAC first-submission pass meant we went live 3 months ahead of the board's target." — Chief Clinical Information Officer, NHS Foundation Trust (name withheld)”
Project Details
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