Paper switch-off programme frequently asked questions

These frequently asked questions are to support NHS organisations implementing changes to deliver electronic referrals (e-referrals) to first out-patient appointments across the NHS.

NHS Digital will provide e-RS subject matter expertise through their implementation and business change team and this resource will be discussed and agreed with providers during the establishment of their paper switch-off projects. NHS England will provide programme support through named leads in each of the regions and ensure that there is read-across within the local sustainability and transformation partnership (STP) or across health economies. NHS Improvement will also provide support as necessary.

Providers will be expected to support paper switch-off by appointing a named project manager and engaging senior executive sponsorship in the Trust by appointing a senior responsible owner (SRO). It is recommended that this is the Trust chief executive officer or the chief operating officer, but other models of project management may be agreed locally.

Yes. CCGs will be expected to work alongside providers at the outset to develop the project approach and controls including preparation, planning and implementation activities. They should be active participants in paper switch-off, engaging GP practices early on in the project life cycle so that they can be involved in the development of local referral return processes.

NHS Digital has published a comprehensive suite of case studies which describe the e-RS benefits for primary and secondary care providers and patients.

As the Paper Switch-off Programme progresses, a range of documents will be made available including project artefacts, lessons learnt documents and case studies, all of which will be included in the published implementation guide.

In the first instance you can contact your NHS Digital e-RS implementation and business change manager. If you do not have contact details for your nominated subject matter expert please contact

Providers must ensure that their ASI worklist is actively managed so that appointments are booked for patients in a timely way. Best Practice Guidelines to manage patients on an appointment slot issue worklist are available on the NHS Improvement website.

Where ASIs do occur and cannot be avoided, patients should be removed from the ASI list as soon as possible, ideally by booking an appointment through e-RS as appropriate, ensuring the RTT clock start rules are adhered to. If this is not possible, the referral should be manually entered onto PAS so that the patient can be tracked via the PTL.  For any clarifications on RTT rules please refer to RRT guidance on our website.

Trusts are advised to monitor their ASIs on a monthly basis through the report available on the NHS Digital website.