Source · HSSIB Patient Safety Investigation
Electronic patient record systems – electronic referrals for ongoing care
HSSIB’s introductionWe have launched an investigation that explores risks to patient safety where electronic patient record (EPR) systems, introduced to support referrals for patient care, have contributed to harm from missed or delayed care. We have published an interim report examining patient safety concerns linked to advice and guidance (A&G) services in the NHS in England.
Published 18 August 2026
Launched 13 January 2026
Published
Access to care
Follow-up care
Continuity of care
Indexed content
2 recommendations
2 observations
Safety Recommendations
HSSIB recommends that NHS England/Department of Health and Social Care undertakes a rapid evaluation of advice and guidance processes, including as part of single point of access. This is in order to address the varying risks to patient safety created by the: resource and capacity limitations of integrated care boards and providers, and their ability to support implementation and oversight of processes varying effectiveness of interface groups, and their ability to support collaboration between general practice and secondary care training needs of the multidisciplinary workforce to undertake safe and effective asynchronous consultations limitations in risk identification and mitigation associated with the deployment of the electronic referral service into local pathways, in line with standards gaps in reporting of patient safety incidents by general practice to inform understanding of patient harms and risks to patient safety. Completing this evaluation and addressing findings before further expansion of advice and guidance processes, including as part of single point of access, would ensure risks to patient safety have been identified, assessed and managed.
No response is indexed for this recommendation.
HSSIB recommends that NHS England/Department of Health and Social Care, in collaboration with relevant Royal Colleges: commissions the development of advice and guidance request and response templates for specialties where these do not exist, including general practice supports effective implementation of template use in practice. This is to support greater standardisation in the electronic clinical information provided when advice is sought from and provided by specialists.
No response is indexed for this recommendation.
Safety Observations
Organisations involved in the design and provision of healthcare education can improve patient safety by addressing gaps in knowledge and skill across the multidisciplinary workforce for the undertaking of asynchronous clinical consultation tasks, such as those undertaken through advice and guidance services.
Organisations can improve patient safety by ensuring the mandated requirements for digital clinical risk management (under DCB0160) for the deployment of the electronic referral service (e-RS) are achieved. For general practices and integrated care boards this includes agreeing responsibilities for the digital clinical risk management of e-RS. This is to enable identification and mitigation of risks to patient safety associated with e-RS when implemented into care pathways.
HSSIB suggests safety learning for integrated care boards
HSSIB investigations include safety learning for integrated care boards where this may help organisations think about how to respond to a patient safety issue that relates to integrated care across a geographical footprint. Informed by the findings in this report, the investigation proposes the following safety learning.
Safety learning for integrated care boards ICB/2026/021:
HSSIB suggests that integrated care boards (ICBs) – through co-design with general practice, secondary care and people with lived experience – ensure that the following are considered as part of advice and guidance (A&G) and single point of access (SPoA) processes:
alignment with national expectations, including ensuring that suspected cancer referrals are managed appropriately, and that formalised pathways are established for referral where general practice remains concerned that specialist assessment is clinically appropriate despite a referral being declined.
clarification of the concept of ‘clinically appropriate’ within local referral pathways, including the establishment of mechanisms by which clinicians can resolve differences in clinical opinion to support collaborative care planning.
clarification of the roles and responsibilities of different providers along patient care pathways where care is transferred, shared or informed by specialist advice.
ICB role in digital clinical risk management of deployed systems for A&G/SPoA, including support to general practice to understand local implementation risks.
clinical information sharing through interoperable health IT systems, alongside the use of standardised templates where appropriate.
oversight of the quality and safety of A&G/SPoA processes, including monitoring of patient safety incidents, the quality and timeliness of A&G responses, and redirection rates where referrals are responded to with advice.