What is Referral Optimisation via Gateway? 
Referral Optimisation via Gateway is a new way of managing referrals and Advice & Guidance across Humber and North Yorkshire. It focuses on getting patients to the right place first time by using agreed clinical pathways, better-quality referral information and earlier specialist advice.  

What is changing? 
Referrals and Advice & Guidance requests from General Practice to secondary care will be made using Gateway, rather than directly through eRS. Gateway sits between the clinical system and eRS and supports higher quality referrals and Advice & Refer models.  

Why is this being introduced? 
The aim is to: 

• Improve the quality and consistency of referrals 
• Support Advice & Guidance and Advice & Refer models 
• Reduce unnecessary outpatient appointments 
• Help shift care to the most appropriate setting  

What is Gateway? 
Gateway is a digital referral platform produced by Accenda and purchased by the ICB for use across the whole ICS. There is no cost to practices for using it.  

How does Gateway work with our clinical system? 
Gateway integrates with EMIS and SystmOne. It automatically pulls relevant patient information from the clinical record into the referral, reducing the need for manual uploading of documents.  

Do practices need to download or install anything? 
Downloading and installation of Gateway is required. Depending on which clinical system is utilised by the Practice this may be deployed remotely without any significant steps for Practices to follow. 

How will referrals look in SystmOne or EMIS?
Referrals are built in Gateway rather than directly in the clinical system. Once completed, the referral and outcomes are automatically posted back into the patient record.

Are referral details and pathway criteria saved in the clinical system?
Yes. Completed referrals and Gateway outcomes, including completed pathway information, are automatically coded back to the clinical system.

Will Gateway code the referral correctly (e.g. 2WW, specialty-specific codes)?
Yes. Gateway codes referrals based on specialty using SNOMED coding (which has replaced Read codes).

How does Advice & Guidance work in Gateway?
Gateway enables two-way Advice & Guidance conversations between Primary Care referrers and secondary care clinicians. These conversations are viewable within Gateway saved directly into the GP patient record.

What happens if an Advice & Guidance response comes back when the GP is on annual leave?
Advice & Guidance responses completed in Gateway are returned as tasks, which are visible to all users within the practice, not just the original sender.

Will GPs be expected to complete all referrals?
This depends on each practice’s local processes. Gateway is designed so that both clinicians and administrative staff can create, save, task, process and book referrals.

What approach works best?
The model that has worked well elsewhere is:

• GPs create the referral and complete pathway questions if present on the referring pathways
• Referrals are either booked directly or saved and tasked to administrative staff for processing

What is the Referral Support Service (RSS)?
The RSS support referral quality, completeness and appropriateness in the ICB’s clinical policies, ICS clinical pathways and pathway referral criteria. The RSS supports a subset of complex referral pathways and for a number of pathways contact patients directly to offer Informed Patient Choice in line with NHS legislation.

What experience does the RSS team have?
The RSS has been operating since 2014/15 and has extensive experience supporting referrals across primary and secondary care, including SPOA models such as cataracts.

What skills does the RSS team bring?
These include:

• Strong patient communication skills
• Pathway and system knowledge
• Audit and data analysis
• Close working relationships with practices and providers
• Experience adapting to local referral models

What training will practices receive?
The ICB will offer:

• Virtual training sessions for clinicians and administrators
• Webinars and demonstration videos
• Practice‑level or PCN‑level training where beneficial.

Is Gateway difficult to use?
Gateway is designed to be intuitive, and experience elsewhere shows that limited training is needed. Demonstration videos and live support are available.

Where do we go for help?
Support is available from:

• The RSS team via phone and email
• Accenda’s technical support desk for Gateway‑specific issues.

Where will administrative teams see rejected referrals?
If a referral is rejected in e‑RS by a provider, it will appear in e‑RS. Work is underway with providers to display this information in Gateway in future, rather than relying on e‑RS worklists.

The NHS England Single Point of Access (SPOA) programme aims to make referrals simpler and more consistent, so patients are directed to the right care first time. 

Referral Optimisation via Gateway supports this approach by providing a single digital route for submitting referrals and Advice & Guidance, using agreed clinical pathways and high‑quality referral information. 

Gateway is not a SPOA service itself. Instead, it is the system that supports different referral models, including SPOA pathways where these have been agreed locally. Clinical triage, advice and onward referral decisions are still made by services or referral support teams. 

Not all pathways will operate as SPOA pathways. Where a SPOA model is in place, Gateway helps ensure referrals are managed consistently and in line with national and local best practice. 

For practices, this means: 

• One consistent way to send referrals and Advice & Guidance 

• Clear pathway questions built into the referral 

• Less variation in how referrals are submitted 

• Support for getting patients to the right service first time