There are several methods by which a patient can be referred into the PCN hub by one of the constituent practices. Each referral method has different features associated with it which will determine whether it is suitable for specific services. When a new healthcare service is set up within the hub, a decision is made as to which referral method is most appropriate.

EMIS-to-EMIS Cross Organisational Appointment Booking

This method of referring a patient into the hub relies upon the setup and management of an appointment book within the EMIS Clinical Service that has been made bookable across multiple organisations via a technical data sharing agreement. When set up in association with a ‘service’ it allows a practice to search for a particular slot type to book the patient into. Slot types and services are set up with consistent naming conventions to make the slots easy for a practice to find.

The main drawback of this referral method is that, unless ‘Remote’ or ‘Enterprise’ consultations are to be used the PCN hub will need to register the patient into the EMIS Clinical Service. The PCN team put in place a manual workaround which required practices to copy the patient’s NHS number into the ‘Slot Notes’ when booking the appointment, which could then be copied and pasted into the ‘Patient Trace’ screen in the EMIS Clinical Service to trace the patient within the system.

GP Connect Appointment Booking

A second option is referral via the GP Connect Appointment Book. This carries the advantage that the patient is automatically registered within the PCN hub upon being booked rather than having to be manually registered, as is the case with the EMIS-to-EMIS cross organisational booking method. However, there are some trade-offs. Firstly, there are additional administrative steps to follow, including the setup of an organisational group within both the practice and PCN hub’s EMIS systems. The system also requires the user to be signed into the practice system using a smart card. And although there have been developments in the EMIS interface for GP Connect bookings, the functionality remains better within EMIS-to-EMIS appointment booking function.

EMIS-to-EMIS Document Send

There are also occasions where referrals into a PCN service are not best supported by cross-organisational appointment booking. There are two alternative methods of referral that can be used in these cases. The first is EMIS-to-EMIS document send. This allows a constituent practice to complete a referral form within EMIS Web and then send it directly into the EMIS Clinical Service for review. The document will arrive in the Workflow module of the EMIS Clinical Service for review. The service receiving the referral can then manage the patient through to the appointment book or – if the referral is rejected – send a message directly back to the referring practice’s EMIS Web system. This method of referral works well but when there are multiple services receiving referrals in this way an operating procedure to determine which referrals are allocated to specific services should be implemented. An administrator within the PCN hub currently completes this task manually.

Managed referrals

The other option is to support a managed referral via the EMIS Clinical Service ‘Patient Administration’ functionality. This allows direct referrals to be made from a practice clinical system into an inbound referral caseload for a specified service within the hub. A service-specific caseload management workflow assesses and then accepts or rejects referrals that have been received.

All communication regarding the progress of a referral is conducted directly between the EMIS clinical systems, reducing the need for alternative communication methods such as email. Updates are recorded directly into the patient’s record so that progress can be tracked by both practice and hub. The caseload model also allows enhanced reporting in particular relation to referral to treatment and episode of care metrics.

How these referral methods work in practice

Screenshot 1: The local practice view at the point of referral. The referral is made from within the practice clinical system and can target any of the PCN services that have been set up with a caseload model. In this example, a service is being offered to practices outside of the boundaries of the PCN – thereby opening services to a wider patient population.

Screenshot 2: The caseload management screen within the PCN hub. The hub user can view and assess inbound referrals, manage their caseload and communicate with the GP practice via direct system-to-system integration.

Screenshot 3: Managing referrals from the hub into Community Pharmacy Consultation Services. The project team has also worked with EMIS to develop a module integrated into the clinical system that enables hub-based teams to seamlessly refer suitable minor illness patients to a community pharmacy for a consultation, with the results being sent directly back to their GP practice. This screenshot shows the functionality in practice.

Next section: Detailed technical specification and workarounds