When is SPoA being introduced?

SPoA is being introduced in phases across England. In Humber and North Yorkshire, implementation will take place by provider and specialty rather than through a single system-wide go-live date, starting from around 10 October.

All elective specialties are expected to move towards an SPoA model by March 2027.

Is SPoA being introduced for all referrals?

No. The change currently applies only to NHS acute providers. Independent-sector and community providers of elective care may transition at a later date.

Urgent suspected cancer pathways are excluded.

Will all providers introduce SPoA at the same time?

No. Implementation is dependent on local readiness so go-live dates may vary between providers and specialties.

What if I refer to York and Scarborough?

York and Scarborough Teaching Hospitals NHS Foundation Trust already operate an REI model. Practices referring to York and Scarborough should continue to follow existing referral processes. Further details on REI expansion will be communicated out to General Practices in York and Scarborough via the ICB’s Referral Support Service team once confirmed. 

Should I use Gateway or e-RS?

This depends on the provider and specialty. For York and Scarborough services already using the REI model, Gateway processes will continue to operate. As additional specialties move into the REI model, Gateway will also become the route for those specialties. For providers implementing SPoA, referral and Advice and Guidance requests should be submitted through the published e-RS SPoA service once it becomes live.

What changes for referrers?

Practices may see a new "Single Point of Access" label against some services within e-RS as specialties move to the SPoA model.

For specialties using SPoA, referrals and Advice and Guidance (A&G) requests will be submitted through the designated SPoA route in e-RS, with specialist clinical review determining the most appropriate next step for the patient.

Will the referral process in e-RS look different?

As SPoA services are introduced, practices may see services labelled as "Single Point of Access" within e-RS.

What outcomes might I receive following specialist review?

Depending on the patient's needs, outcomes may include:

• Advice and Guidance
• a request for additional information
• straight-to-test diagnostics
• an outpatient appointment
• referral to a more appropriate service or specialty

Will anything change when submitting Advice and Guidance requests?

Yes. Referrers requesting Advice and Guidance will be asked to select the reason for seeking advice before being presented with available services. A new screen will be shown on eRS asking ‘Why are you requesting these services?’ and one of four options needs to be selected before the referrer can progress to make the request. The options are:

Advice to support management in primary care: For advice to help manage the patient without referring to secondary care

Advice to confirm whether a referral is needed: For advice before making a referral, to check suitability or next steps

Interim clinical advice while waiting for a referral appointment: For patients who have been referred but have not been seen

Advice for an existing hospital patient: For advice while the patient is waiting for their next planned hospital appointment

This information will not be visible to the clinician receiving the request. These new categories will be used nationally to support a clearer understanding of the different types of Advice and their impact on elective activity

Does SPoA replace my ability to refer?

No. GPs remain responsible for determining when specialist referral is clinically appropriate. SPoA does not override the clinical decision to refer.

Will patients still have a Right to Choose?

Yes. Patients continue to retain their Right to Choose provider where applicable.

When requesting Advice and Guidance, practices should discuss provider choice with the patient at the point of referral. If a patient wishes to receive treatment from a different provider, this should be clearly documented within the request so that specialist clinicians can take this into account if the request is converted into a referral.

Who is responsible for the patient at each part in the journey

The roles and responsibilities of primary and secondary care have not changed. As set out in the Primary and Secondary Care Interface responsibilities document, the point a specialist clinician receives a request for advice, a duty of care is engaged; the duty of care ends when a response with advice has been sent, unless there is a decision to convert to referral, in which case it continues.

Do urgent suspected cancer referrals go through SPoA?

No. Urgent suspected cancer referral pathways are excluded from the SPoA.

Are commissioning policies, pathways and services changing?

ICB clinical commissioning policies, pathways on the Pathways & Policies Repository and formulary still need to be adhered to. Where agreements already exist it is expected that these continue to be followed, including adherence to existing commissioning and contracting arrangements. Any changes that are identified as part of the introduction of the SPoA model need to be taken through the appropriate ICB governance routes e.g. by engaging with the ICB’s Clinical Effectiveness Unit.

Will patients notice any difference?

Patients may receive updates through the NHS App, email or text message as their referral progresses through the pathway.

What notifications might patients receive?

Patients may receive NHS App, text message or email notifications as their referral progresses through the pathway. Practices should be aware that patients may contact them with questions following these notifications.

What should I tell patients about SPoA?

Patients should be advised that their referral will be reviewed by a specialist clinician who will determine the most appropriate next step. This may include advice, investigations, an appointment or referral to another service.

Does redirection mean a referral has been rejected?

No. In some cases, specialist review may determine that a different service or specialty is better placed to manage the patient's care. Where this happens, the referral should be redirected appropriately and patients should be informed of the next steps.

Patients should understand that:

• Referrals may be reviewed by specialist clinicians before an appointment is booked.
• Some patients may move directly to secondary care ordered tests or treatment before, or instead of, an outpatient appointment where this is clinically appropriate. As described in the Primary and Secondary Care Interface Responsibilities document,  specialist service will ensure clear and timely communication to primary care including: any new diagnosis, recommended management plans, details and explanation of any medication changes, any planned follow up in secondary care, any actions advised for primary care, and any actions advised for the patient.
• Different services may work together more closely

Patients should be reassured:

• Their GP remains responsible for their ongoing general medical care. As described in the Primary and Secondary Care Interface Responsibilities document the point a specialist clinician receives a request for advice, a duty of care is engaged; the duty of care ends when a response with advice has been sent, unless there is a decision to convert to referral, in which case it continues. Urgent referrals remain urgent.
• Clinical decisions remain clinician led
• Patients still have rights and choices within NHS pathways.
• Nobody will be removed from a pathway without clinical review

Message for patients

The following is suggested wording to share with patients when accessing elective specialties via an SPoA:

“We are improving the way referrals are managed across the NHS. A Single Point of Access (SPoA) helps ensure referrals are reviewed and directed to the most appropriate service first time. Your referral will be clinically reviewed, and you will be told what happens next, who is responsible for the next action, and what to do if you have concerns or your symptoms change. If your referral is redirected, this should be explained clearly, including why another route is more appropriate and when you should expect an update.”

NHS App changes

Changes have also been introduced to the NHS App, whereby patients will be notified when their referral has been reviewed and accepted by the receiving specialty. Patients may receive notifications and have greater visibility of referrals managed through SPoA services via the NHS App, depending on the pathway and service configuration.

How quickly should requests be reviewed?

National guidance sets the following processing standards. Where providers are not currently achieving this, they should be working on plans to address this:

• Advice and Guidance responses within 5 working days
• Routine referrals actioned within 5 working days
• Urgent referrals actioned within 2 working days

What if I disagree with an outcome?

If you are concerned about the outcomes not being clinically appropriate or not fitting with the interface agreement please raise this with the relevant acute trust interface point of contact.

 Issues can be worked through in the Interface Groups that align to each of the acute trusts – these groups are made up of primary, acute and ICB representatives. If a satisfactory outcome is not achieved we recommend contacting your local LMC. If this does not resolve the situation then contact the ICB hnyicb-ery.clinicalandprofessional@nhs.net

What if my patient has not heard anything?

As set out in the Primary and Secondary care Interface Responsibilities document the referring clinician (who has made an outpatient referral or sought advice from a providing clinician in a Trust) retains a duty of care towards the patient. The specialist service will ensure clear and timely communication to primary care including: any new diagnosis, recommended management plans, details and explanation of any medication changes, any planned follow up in secondary care, any actions advised for primary care, and any actions advised for the patient. If there are concerns about how this arrangement is being implemented then referrers are advised to raise this directly with the acute trust via their interface contact (see Key Contacts section).

What information should I include?

Referrals should include sufficient relevant clinical information to support specialist review, including history, investigation results and treatments already undertaken, in line with local and national referral guidance.

Can I still request Advice and Guidance?

Yes. SPoA supports both Advice and Guidance requests and referrals through a consistent route into specialist services.