Expediting Referrals – how to communicate with Secondary Care

We are all aware that waiting times are increasing. We are also aware that patient’s develop new symptoms, or their symptoms can deteriorate during this time. This message is to help clarify the agreed systems and responsibilities across the ICS when attempting to expedite patient appointments.


  • Clarify responsibilities and minimise work-load shift
  • Avoid duplication of referrals on e-RS
  • Improve equitable access
  • Increase awareness of MyHealth-Devon patient resource

Expediting Appointment Scenarios

Expediting Appointment Scenarios

1. Patient is not currently under the care of Secondary Care (i.e., has been referred for Secondary Care input, but hasn’t received this yet):

  • If your patient’s symptoms have significantly deteriorated and you feel that your initial referral needs upgrading from routine to urgent – please send additional information directly to the provider:
    • The easiest way of achieving this is sending an e-RS A&G referral detailing the reasons for expedition, e.g., deteriorated symptoms, with a copy of the original referral so that the patient can be re-triaged. The provider will communicate their decision on e-RS.

For details on A&G availability within each Trust follow the links below:

The provider will communicate their decision by written response.

Please do not send a new referral on e-RS. This creates a duplicate referral, resulting in additional administration and paradoxical delays in patient care (e.g., multiple appointment dates, patient confusion and DNAs). If this is noticed during the triage process, the duplicate referral will be returned.

Please note that if a patient contacts a provider directly, asking to expedite their first outpatient appointment following referral, the booking clerk will only advise patients to contact their GP if the patient has noted a significant deterioration in their condition prior to first outpatient appointment.

If you feel that your patient has been advised to contact their GP inappropriately, please contact DRSS Helpdesk and we will escalate to the hospital teams.

2. Patient is under the care of Secondary Care (i.e., Secondary Care have had contact with the patient and the patient has a named responsible Trust clinician):

  • If your patient’s appointment is overdue, the patient should be advised to contact their named Trust clinician (contact details should be included on previous communication/clinic letters).
  • If you want to expedite your patient’s appointment because their symptoms have significantly deteriorated, then please send a letter directly to their named Trust clinician (contact details should be included on previous communication/clinic letters).
  • If urgent advice has been given, e.g., via telephone calls, please follow this up with a letter sent directly to their named Trust clinician, detailing the communication and request for expedition.

Please do not use send a new referral on e-RS.

3. If a patient is discharged in error or without having the original referral question answered then:

  • If urgent, their named Trust clinician should be contacted directly (followed by a supporting letter via A&G)
  • If non-urgent, then an A&G letter should be sent to their named Trust clinician.

As long as the A&G is within 3 months of discharge and the letter is regarding the original reason for referral, then this should not be ‘counted’ as a new referral.

MyHealth-Devon is here to help

MyHealth-Devon is a patient resource that has been created for the patients in Devon. Unlike other national resources, the content is specific to the resources and guidance in Devon.

We strongly encourage all clinicians to signpost patients to this resource at any point in their pathway. Specialists have been involved in writing the content.

Frequently used pages include:

Published: January 22


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