If there is a template referral form available in the EMIS global folder, you should use this. If not, your referral letter should include:

• a description of the reason for the referral; include the questions or concerns you and your patient are looking to have managed (clear and concise)
• significant medical history and relevant family history 
• relevant blood and imaging results (within the past six months)
• current medication and medication previously tried relevant to the referral
• any drug or other allergies.

Contact details should include:

• full patient contact details, including name, DOB, address, current mobile (and landline) phone number and email
• patient NHS number (do not refer a patient without a known NHS number as this will be returned)
• referring clinician's name, practice name, address, practice phone number and email
• date of referral (must be within three months).

The appropriate referral form listed in the EMIS global folder should be used where one exists.

NCL ICB is currently piloting a standardised referral letter template that can be used where there is no existing service referral form. This form is part of a levelling-up exercise across NCL, recognising that many practices have created their own version of a default referral letter.

The Demand and Capacity wider pilot is currently available to practices and provides an NCL standardised auto-populating referral form which includes a space that ensures the reason for the referral is identified. This should be used when there is no existing templated form in the EMIS global library for a particular service. This standardised format letter is preferred by secondary care and the RSS team as there is familiarity with how the information is laid out. This pilot also assists with providing a standardised specific SNOMED code for a particular referral, which will enable you to search and analyse the referral demand to a particular service.

Before the pilot started, 'referral to further provider' was the most common code attached to a referral letter. This pilot supports an Advice and Guidance templated letter, which is also coded.

You should always see if there is a clinical pathway (typically NCL or NICE CKS) relevant to your referral, as a number of referrals are sent back from the RSS for review because they do not appear to have followed these pathways. It is helpful to the RSS if you identify why a pathway is not being followed.

The NCL clinical pathways show essential criteria marked in pink boxes within the flow diagrams.

If a referral is rejected by the hospital, you may receive a standard letter and this will not necessarily provide a clear reason as to why the rejection has been issued. It is the responsibility of the referrer to review/discuss this with the patient and modify the referral if required.

1. With the increased use of one-stop outpatient appointments, it is becoming more important that patients are pre-investigated (where relevant) and that reasonable primary care management strategies have been tried before referral. Secondary care also regards this as important, as in some specialties it is further triaging the referrals. This should be openly discussed with patients.
2. Referrals must be sent from a secure NHS.net email address (for Barnet and Enfield RSS), or via e-RS (for Camden, Haringey and Islington RSS).
3. RSS will always give a choice of hospitals to the patient via e-RS, therefore you do not need to state hospital preference in the referral unless it is clinically necessary (in which case please state this at the top of the referral letter).
4. Referral urgency status for Barnet and Enfield RSS: Mark if the referral status is 'Routine' or 'Urgent' at the top of the referral letter.
5. Referral urgency status for Camden, Haringey and Islington RSS: Only 'Routine' referrals can be made to RSS, 'Urgent' referrals are made from the practice via e-RS.
6. For most routine cases it is important to wait until all the investigations and results are available to attach so that returns to practices are minimised.
7. If a patient has previously been seen for the same condition and you do not have access to the previous clinic letters, record this in the letter as it will prevent the referral being returned to you requesting these.
8. Advice and Guidance can help with any clinical queries; try to be specific with the question you are looking to answer to avoid a general reply.

1. RSS is unable to expedite appointments already in the system; please do not send these requests. Direct these queries to the provider instead.
2. If you make a mistake with a referral and then send an updated referral, add a note on the subsequent referral highlighting your error.
3. If a patient queries if a referral has been sent, contact the RSS query line first or send a note to the administrative GP email address to verify.
4. Use one of the accepted file formats when sending a referral to the RSS (applies to Barnet/ Enfield RSS). Accepted file formats are as follows: .doc, .docx, .msg, .rft and .txt, (accepted image file types include .bmp, .gif, .jpg, .png, .tif and .tiff). Enfield RSS prefers referral attachments saved in PDF format as uneditable.
5. Do not send in files over the size limit (15mb for all combined attachments; Enfield RSS requests a file size limit of 5mb).
6. Each patient referral must be made separately. For Barnet and Enfield RSS, a separate email is required per referral. For Camden, Haringey and Islington RSS, separate referrals must be made on a separate e-RS Unique Booking Reference Number (UBRN).