New Advice and Guidance in the NHS e-Referral Service

NHS England is updating the Advice and Guidance (A&G) functionality in the NHS e-Referral Service (e-RS) to support the outcomes outlined in ‘Reforming Elective Care for Patients’ in relation to ‘Care in the right place’ and supporting the Policy direction of elective care referrals being managed through Single Points of Access (SPOA).

A national rollout of the new A&G will allow the NHS to:

• standardise how A&G is accessed and delivered
• support elective recovery by reducing unnecessary referrals
• improve clinical collaboration between primary and secondary care
• provide a scalable, nationally supported solution rather than multiple local workarounds
• enable third-party systems to integrate with the NHS e-RS
• respond to feedback from users about current usability and workflow issues
• establish A&G as the clinical front door to elective care

 
Without intervention, the current A&G service will be unable to meet future requirements, leading to: 

• the existing A&G service being unable to support elective recovery or adapt to future models
• A&G not being able to scale effectively to meet demand and will continue to cause workflow challenges
• restrictions around advice-first strategies and limits reform in elective care
• greater fragmentation for local solutions
• outdated technology hinder progress and change
• missed opportunities to enhance patient flow and safety

Primary care: the new A&G service in e-RS makes it clearer, easier to use, and better supports quick, safe clinical advice. GPs can ask follow-up questions, for a patient already under the care of a hospital.

Secondary care: the new A&G improves visibility of queries, responses, and request status, enabling clinicians to prioritise effectively and make safer, more informed decisions. Clinical colleagues can also add themselves to a conversation to ensure the right expertise is involved.

Effective July 2026, A&G will become a core, nationally consistent function within e-RS. This requirement will extend to organisations using third-party services from October 2026.

Key characteristics include:

• a single national system
• nationally aligned clear expectations of the use of A&G
• reduced variation
• improved user experience
• better use of data
• faster access to the right care for patients

Primary care, secondary care, ICBs, and system teams.

Clinicians and operational teams will need to attend webinars, receive end user training on how to use the new A&G and navigate between A&G and e-RS, update standard operating procedures, and support staff through the transition.

1. Faster access to specialist advice.
2. Consistent advice at scale.
3. Fewer unnecessary referrals.
4. Alignment with elective care reform.
5. A service that can continue to improve.

Benefits of the Primary Care include:

• greater confidence managing patients
• clearer outcomes
• reduced administrative burden
• quicker access to specialist advice when needed
• fewer unnecessary referrals and follow up appointments

Benefits for Secondary Care include:

• clearer worklists
• consistent advice
• better visibility of outcomes
• reduced inappropriate referrals
• support for future elective models of care, including Single Point of Access (SPoA) (login required)

What’s new 

• new Advice and Guidance service
• redesigned workflows
• new worklists
• improved conversation views
• continuation of conversations after advice request converted to a referral
• creation and management of templates
• opt in email notifications
• opening and closing requests will ask for a reason for the action
• unable to select a named clinician when creating a request – this function is planned for a future release

What unchanged:

• still part of e-RS
• existing roles remain
• supporting clinician and admin processes 

Controlled pilots 

The initial pilot sites will start using the new advice guidance supported by the e-RS team. Once the success criteria has been met, more sites will be gradually introduced to the new system.

Dual running Advice and Guidance

During rollout, some organisations will use the new A&G system while others use the current one. This is not expected to affect processing of requests and referrals. 

National rollout

All users will utilise the new A&G when it is launched, which includes all necessary components aligned with current A&G, along with some extra features. Future updates are intended to further refine and modify the system.

The e-RS team has scheduled virtual workshops and will provide materials to support local training teams. Integrated Care Boards (ICBs), Ministry of Defence (MoD) and Health and Justice (H&J) will be responsible for cascading information and training to their practices. ICBs will also be responsible for working with local providers to develop and implement changes to Advice and Guidance pathways as well as communicating those changes to their practices. 

Provider organisations will be responsible for preparing their services for the change, working within ICBs and cascading of information and training to their users. These organisations will also be responsible for developing and communicating any changes to standard operating procedures to reflect how they will be adopting new A&G features.

Support

Virtual awareness workshops

The e-RS team are holding online workshops with the expectation that nominated individuals from primary care and providers will attend. More detail about the workshops and how to register can be found on the e-RS events page.

These workshops will cover in detail the A&G changes specific to each care setting and offer the opportunity to ask questions.

Tutorial videos which delegates will use to support local training will be played during each workshop. Delegates will have the opportunity to also ask questions during the workshops. Process guides will be circulated to all delegates after each session. These can be adapted as needed to support local knowledge sharing.

Access to support materials

In addition to sharing with workshop attendees, tutorial videos for each care setting will be published on the e-RS website to help support colleagues with the planned changes.

Post release virtual drop in sessions

Online drop-in sessions will be held over a two week period post go live for users to ask queries and resolve issues. 
Details on when these will take place will be published on this page nearer the release dates.

On-site subject matter expert 

Representatives from the Digital Partnering team will be present at selected locations as long as necessary to support teams with the initial transition. 

Online Help

A Help link will be available from the new Advice and Guidance screens. This will lead to information covering the processes when using the new A&G.