Engaging Stakeholders to determine the future needs for electronic referrals and bookings

e-RS is a national platform used to refer patients from primary care to secondary care services, allowing patients to choose their first outpatient hospital or clinic appointment and book it in the GP surgery, online or on the phone.

The NHS Transformation Unit (TU) partnered with the electronic Referral Service (e-RS) Futures Team, part of NHS England, to conduct extensive stakeholder engagement focused on identifying future business needs, service gaps, and user requirements to support the creation of a future programme business case. Covering e-RS and related digital products, including Wayfinder, BaRs (Booking and Referral Standard), and the NHS App, the engagement sought to understand how to develop the digital referral and booking service to meet future needs and demands.

Between October 2023 and March 2024, TU produced a comprehensive “Digital Referral and Bookings Futures Business Needs Assessment” report, outlining the case for change, detailing our engagement approach, analysis of the key findings to aid strategic decision-making.

The Challenge

With the evolving needs of patients and NHS staff, coupled with advances in technology, it is essential for the NHS to “future-proof” itself by advancing its digital capabilities. The e-RS Futures Team commissioned the NHS Transformation Unit to collect the future digital requirements for referral and booking services across various pathways. Whilst e-RS is predominantly used to get referrals from primary care to secondary care, there is an ambition for ‘any to any’ referrals – meaning the ability to make electronic referrals from any point in the health and care system, to any point in the health and care system. A good example of this is in eyecare – where there is an ambition for Ophthalmologists to be able to make referrals directly to a specialist, rather than going via a patient’s GP.

So, the critical question we asked was:

“In three to five years’ time, what digital capability should the referral and bookings pathways have to meet the anticipated needs of both services and patients?”

The client wanted the TU to engage a broad and diverse range of stakeholders, encouraging forward-thinking to identify future priorities and requirements. Stakeholder groups in scope were:

• Core business areas (including Elective Care and Outpatients, Urgent and Emergency Care, Primary Care, Optometry, Dental and Pharmacy)
• National digital programmes, such as Wayfinder, NHS App, Mobile First and Digital Citizen
• Services and stakeholders that represent users of digital referrals and booking solutions.

Our Approach

We used a phased approach to the engagement.:

• initial communications from the senior programme team to key stakeholders highlighted from a stakeholder mapping exercise;
• information gathering conversations based on specific key lines of enquiry (KLOE) with recommended stakeholders following the initial communications; and
• sense-checking meetings to ensure we understood what we had heard and to play back our findings, ensuring buy-in from the stakeholders.

The KLOEs developed aligned to six phases of the referrals and booking journey. These underpinned the semi-structured interviews with stakeholders.

Overall, the KLOEs shaped the conversation to draw out:

• The vision for referrals and bookings over the next 5 years.
• The changes they expect to see to how referrals and bookings will work over the next 5 years.
• The key challenges faced, and the support required by patients and carers while experiencing the referral and booking process.
• The key challenges faced by healthcare professionals when making referrals and bookings.
• The digital enablers required to best support referrals and bookings.

To meet the goals set by the e-RS Futures Team, TU implemented a structured, multi-phase engagement approach, prioritising broad and inclusive input from stakeholders across England.

Methods of Engagement We employed various methods to reach stakeholders:

• Interviews and Workshops: These were tailored to each stakeholder group and allowed us to gather deep, qualitative insights.
• Documentation and Thematic Analysis: We recorded and analysed feedback from engagement activities through multiple lenses, including:
  • Different phases of the referral and booking journey,
  • Types of stakeholders and beneficiaries,
  • Impacted business areas.

Logic Model Construction To guide thematic analysis, we developed a logic model, enabling a structured understanding of issues by mapping the perceived problem, identified needs, potential solutions, alignment with existing strategies, and potential costs and benefits. This structured approach allowed for a more comprehensive and actionable analysis of user requirements.

The Outcome

As a result of the engagement activity and analysis, we delivered:

• National engagement activity with 183 stakeholders across ten key business areas, seven national digital programmes and seven regions of England
• Comprehensive process maps showing current and desired future state, across key business areas.
• A long list of user requirements constructed against a clear logic model – it set out the ‘problem’ that we had heard, the ‘need’ that this created, the potential solution, how this aligned with existing strategies, the potential cost / benefits and feasibility to implement. Effectively these are the building blocks needed to go on to construct a strategic case of a programme business case.
• A business needs report describing our activities, engagement outputs and suggested approaches to prioritising the long list of requirements.