NHS e-Referral system goes live, despite 33 issues and GDS warning

The replacement NHS England system for booking hospital appointments has gone live, despite having 33 unresolved issues with the online software and after a warning that the service is being launched without following correct government digital guidelines.

The e-Referral service replaces the £356m Choose and Book system that was first introduced in 2004. It allows patients referred by their GP for an outpatient appointment to choose the date and time, and potentially the venue if there are several providers available.

E-Referral was due to go live last year, but was delayed to allow further time for testing – yet according to the Health and Social Care Information Centre (HSCIC) which runs the system, there are still 33 known issues with the now-live service.

“It is not anticipated that any of these issues will pose a clinical safety risk, cause any detriment to patient care or prevent users from carrying out essential tasks,” said the HSCIC on its website. “Even though we have done a huge amount of testing, it is impossible to test every possible key stroke and action, and new issues may well surface now the system is in use.”

Several of the issues relate to screen handling errors – or what the HSCIC calls “cosmetic defects”. Reports and data extracts that were available in Choose and Book are not yet available and many may not be in e-Referral until August. Other problems relate to potential delays in processing transactions.

Officially, the e-Referral service is in its beta testing phase, according to Government Digital Service (GDS) standards. The system passed its latest assessment in May, but the GDS assessors were critical of the fact e-Referral was effectively going live without a formal beta stage, and said this increased the risk of problems.

“Moving straight from alpha to live in this way without a period of beta testing is not recommended by the [assessment] panel. The panel note that in this particular circumstance it would be very difficult (though not impossible) to do a phased beta launch given the complexity and scale of the system, and they recognise that the team has done a lot of work in advance to minimise the risk of things going wrong – this work is recognised as being valuable,” said the GDS service assessment report.

“However, the risk and impact of failure given the complexity and scale of the system are the precise reasons why a beta phase is recommended for new digital services, rather than a big bang launch. To approve the move into ‘live’, the service needs to undergo a live service standard assessment. At this stage, the panel think it is unlikely the service would pass such an assessment, because there is work still to be done during the beta phase to fully meet the criteria for a live service.”

The e-Referral system was developed using agile methods and open technologies, in contrast to its predecessor, which was run by Atos Healthcare. The decision to scrap Choose and Book was made last year, despite it being regarded as one of the few successes of the failed £12.7bn National Programme for IT (NPfIT).

About 40,000 individual patient referrals were completed on Choose and Book each working day, with around 45,000 available services published.

But according to a report last year by the Public Accounts Committee, not all hospital appointment slots were available to be booked on Choose and Book and only half of all possible GP-to-first-outpatient referrals were being booked on the system. MPs said the system was under-utilised because many patients found it complicated and time-consuming, and it consequently failed to deliver promised annual savings of up to £51m.

Back in 2006/7, the Department of Health set a target of 90% of hospital referrals to be made through the electronic Choose and Book system, but two years later the NHS was still falling well below, with an uptake of around 40%.