For Camden, Haringey and Islington practices, urgent RSS referrals are sent by the practice via e-RS. For Barnet and Enfield practices, urgent RSS referrals are sent to the RSS via email.

University College London Hospitals (UCLH) and Royal Free London (RFL) have confirmed that they will be clinically triaging urgent (non-2WW) referrals on e-RS. GPs should still phone the on-call registrar for very soon referrals.

The process is as follows:

• when writing the referral, mark your letter as ‘Urgent’
• select ‘Urgent’ as priority in e-RS
• click ‘Search all’ to find and select the hospital service you are looking for
• select ‘Appointment search’ to bring up appointments to book.

There will be two scenarios you could encounter:

1. You are able to book an appointment

The referral will then be reviewed by a clinician at the hospital and the appointment will either be:

• brought forward if it is felt the patient needs to be seen sooner than the appointment you have booked (you may need to check ‘View history’ for the date and time as it could be booked outside of e-RS)
• downgraded if the referral is triaged but considered non-urgent and the appointment left as it is; the URBN will be 'Accepted' in e-RS as this is the hospital’s way of indicating that it is taking responsibility for downgrading the referral to routine (check ‘View history’)
• deemed suitable if the appointments on the system are within appropriate timescales for an urgent (non-2WW) referral and therefore may not be triaged.

2. There are no appointments available

You should ‘Defer to provider' and after consultant clinical triage either:

• an appointment will be booked in e-RSs (either routine if downgraded or booked as urgent)
• no appointment is booked but a note is left in e-RS explaining that an appointment will be booked when available.

Both RFL and UCLH state in their access policies that they will triage referrals within five working days.

It is advised that urgent (non-2WW) referrals sent via e-RS are monitored and safety-netted in the same way that urgent (non-2WW) referrals are currently safety-netted.