Transformation Partners in Health and Care > Resources > Case study: NHS e-Referral Service rollout for London

Case study: NHS e-Referral Service rollout for London

Bringing together partners with transformation experts and Londoners is one of the key roles Healthy London Partnership plays in tackling London’s most complex health challenges. For example, through recent partnership working between local organisations, NHS England (London region) and NHS Digital, Healthy London Partnership has played an important part in helping London switch off paper referrals from general practice into acute trusts.

What was the challenge?

The NHS in England is committed to harnessing the power of digital to support transformation and innovation for the benefit of patient safety and experience. As part of this agenda, it has been a long held aspiration to manage a patient’s first referral from their GP to hospital through a paperless process.

Ensuring the full rollout of an NHS e-Referral Service (e-RS) would combine electronic booking with a choice of place, date and time for a patient’s first hospital or clinic appointment. The benefits of doing this include reducing waiting times, reducing administrative errors and improving patient experience.  Put simply, e-RS is about patients getting access to the professional they need, using digital channels much faster than the traditional route.

Additionally, e-RS is also financially critical for the NHS. In 2014, a report by the National Audit Office, NHS waiting times for elective care in England, estimated that the NHS could achieve additional savings of up to £50.5 million every year, if e-RS was used to book appointments for all GP to first outpatient referrals.

Earlier this year, the NHS constitution laid out instructions that from Monday, 1 October 2018 hospitals will only be paid for activity resulting from referrals made through an electronic system. In March 2018, NHS England London embarked on a challenging programme of work to implement e-RS across 23 providers to align with the NHS Standard Contract.  Healthy London Partnership were asked to provide specialised support to achieve this target.

What did we do?

The implementation of e-RS across 23 providers in London was reached one month earlier than the target date.  This was done through proactive and successful partnership working between London’s health and care organisations, including NHS England (London region), London’s sustainability and transformation partnerships (STPs), primary care organisations, London’s hospital trusts and NHS Digital.

To achieve this, we provided specialist technology focussed programme management support to focus e-RS deployment across London’s STPs and providers.  This saw us developing robust governance processes for the pan London e-RS programme, producing regular reporting and facilitating escalation management, where needed.

In addition to close working with NHS England London, our role involved working with all London STP systems and the NHS England national team for full e-RS rollout.  The effective partnership and programme management across STP systems, trusts and primary care helped ensure the success of the programme.

What were the results?

E-RS is a high profile, national programme being delivered through the various NHS regions.  For London, it’s an ambition which aligns with the shared ambitions set out in Better Health for London: Next Steps to put London at the centre of the global revolution in digital health.  The successful deployment of e-RS within 23 London trusts is a strong demonstration of how partnership working allows the NHS to transform at pace.

Key achievements included:

  1. Successful deployment of e-RS within 23 London trusts
  2. Paper switch off ahead of the national target date for all routine and ‘2 week wait’ referrals
  3. Increased utilisation ahead of the national target date, achieving 92% overall

Find out more

Contact Healthy London Partnership via  For more information about Healthy London Partnership’s digital work, visit:


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