Referrals and single points of access


The steps between receiving a query or referral and allocating it to the right team is shown below. In this resource, we have referred to this as the 'access process'. Getting this process right can improve waiting times, patient flow and quality of care.

The best access processes are:

  • easy to use for members of the public, staff and partner organisations
  • responsive so that people’s needs are met in a timely way
  • efficient so that they make the most of providers’ resources

These aims are best achieved through the use of a single point of access (SPA). You can use the below to assess the performance of your access processes and identify how you can improve.

Single points of access

A single point of access describes an access process where all services share a single set of contact information (telephone number, web address etc). All queries and referrals are therefore channelled through a single team for administrative triage.

The NHS Long Term Plan sets out a key ambition for implementing a single point of access through NHS 111 for urgent care in the community.

It is best for patients if all local health and care services are covered by the same single point of access. This provides a simple way of contacting all local services, regardless of provider organisation. It is also essential for providing integrated, person-centred care.

Despite this, most providers of services in the community do not have a single point of access covering their own services. 


We recommend that providers:

  • Implement a single point of access across all services they are accountable for, in preparation for a future where this is implemented across providers. We suggest that implementation is phased, e.g. starting with urgent response and reablement services
  • Implement and maintain an electronic directory of services (more information below).

Ensuring the access process is easy to use

An access process that is easy to use should meet each of the requirements below:

  • The access process can be described by one simple process map
  • Providers support different ways of making queries and referrals, including online referrals
  • Forms are easy to use and understand
  • Providers accept all reasonable referrals. Triage staff should work with referrers or patients when referrals are incomplete

Providers should have the following key enablers in place to support this:

1. An up to date electronic directory of services for triage staff and partner organisations. Our guidance on flow recommends this is part of the local 111 directory of services and available online. 

This should include the following information about local services (including non NHS services):

  • access criteria 
  • geographical areas covered
  • service response times
  • service operating hours
  • service contacts information

2. Measures to understand service user and staff experience, featured in performance reports, including:

  • customer service measures
  • staff engagement measures for triage staff
  • triage staff understanding of the process

3. Standardised referral forms for all services

4. Support materials for triage staff, including phone call handling policy.

Ensuring the process is responsive

An access process that is responsive should meet each of the requirements below:

  • Service users' needs are responded to within an appropriate time frame.
  • The access process supports services to meet national standards where applicable.
  • Clinicians working in front line services are confident that this process is responsive enough to meet patients' needs.

You should have the following key enablers in place to support this:

1. A system to prioritise queries according to urgency

2. Measures and targets for service responsiveness, featured in performance reports:

  • average time to process urgent and non urgent queries*
  • volume of queries not processed within the target time*
  • volume of queries not allocated to the right team first time

3. Measures to understand demand on their access process, featured in performance reports:

  • demand volumes
  • volumes of queries
  • volume of urgent queries
  • volume of queries and referrals from each source/type of source
  • volume of referrals allocated to each team
  • referral quality
  • volume of referrals with incomplete information
  • volume of referrals rejected by triage team and reasons

4. Measures to understand current work in progress:

  • volume of requests at each stage of the process
  • volume of queries waiting for administrative triage*
  • volume of queries waiting for clinical triage*
  • volume of referrals waiting for first contact*

Measures marked * should form part of a live performance dashboard.

Ensuring the access process is efficient

An access process that is efficient should meet each of the requirements below:

  • Triage staff work at the top of their license with access to senior clinical support as required.

You should have the following key enablers in place to support this:

1. Senior clinical support is available to triage staff at all times, including outside of core hours

2. Triage staff are supported by technology to make decisions in line with best practice, for instance through a decision support system
3. Measures to understand triage staff workload and productivity, featured in performance reports:

  • number of requests managed each day per member of staff

4. Clear definition of which responsibilities sit with each part of the team (administrative triage staff, clinical triage staff, front line team)

Other important enablers

  • Triage staff should have an easy way to manage appointments in the relevant clinical systems. If they are operating using multiple clinical systems, staff should use the same front end to access the different clinical systems, for instance through an Application Programming Interface (API)
  • Partner organisations should be set up to support online referrals
  • Defined career pathways and development opportunities for triage staff so that the workforce is retained

Case study

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