Do private practitioners have access to the electronic referral service (ERS)?
Why the NHS e-Referral Service is closed to purely private GPs, what that means for your referrals, and how to get a referral accepted without it.
- England
The short answer
No. A purely private GP cannot refer through the NHS e-Referral Service (e-RS), because access depends on an NHS organisation code, NHS smartcard authentication sponsored through a commissioner, and NHS-commissioned services. You can still refer NHS-eligible patients to NHS services, but by letter through each trust’s non-e-RS route, and LMC guidance says the NHS GP should not be asked to re-refer simply because a hospital prefers e-RS.
Key points
- e-RS is the NHS platform for referring, booking and advice and guidance between NHS referrers and commissioned services.
- Access needs an organisation code, NHS smartcard or equivalent login through a registration authority sponsor, and commissioned services.
- Private providers can refer to NHS services without e-RS, but by letter or secure email to each trust.
- Advice and guidance through e-RS is also unavailable, so arrange specialist advice privately or through the NHS GP.
- Urgent suspected cancer referrals from the independent sector now have their own route in England.
What e-RS is
The NHS e-Referral Service is the digital platform NHS GPs use to refer patients to hospital and community services. It lets the referrer create a referral, book an appointment or send the referral for triage, and hold advice and guidance conversations with specialists. Users log in through NHS Care Identity Service 2 (CIS2), with a smartcard, security key or Windows Hello for Business.
NHS England’s national elective access policy says all GP referrals to consultant-led services should be made through e-RS. That is why many hospital departments now prefer, or insist on, e-RS referrals.
Why private GPs are locked out
Access to e-RS runs through NHS organisations and commissioning. NHS England’s guidance for independent sector providers shows what is involved even for a private company that does hold an NHS contract. It needs an organisation (ODS) code for each site, its services commissioned on the e-RS directory, and a smartcard for each user issued through a registration authority sponsor identified with its commissioner.
A purely private GP service has no commissioner and no NHS services to list, so there is no route to referrer access. LMC guidance summarises it: private providers lack access to e-RS because it requires an NHS contract and smartcard access. At the time of review we found no announcement that this will change.
Referring to the NHS without e-RS
Lack of e-RS access does not stop you referring. The BMA says private GPs are free to refer their patients to the NHS in the same way as NHS GPs can refer to the private sector. Its guidance for NHS practices adds that private providers can refer to NHS services without going back to the GP, provided the patient would be eligible for NHS referral.
In practice:
- Find the trust’s route for referrals that do not come through e-RS. Many have a referral management centre or a published email address for paper referrals. The elective access policy expects trusts to have procedures for processing paper and email referrals.
- Write a full referral letter with the NHS number, the NHS GP practice, the clinical question and the urgency.
- Send it securely, for example by encrypted email to the trust’s official address.
- Tell the patient how long it may take and to contact you if they hear nothing.
- With consent, copy the NHS GP so their record is complete.
If a department rejects your referral solely because it did not come through e-RS, raise it with the trust. Surrey and Sussex LMCs’ guidance says GP practices should not routinely be asked to recreate or facilitate referrals solely because local processes require e-RS, and that private providers and trusts should agree a method between them.
See making NHS referrals as a private GP for the wider picture, including emergencies and waiting times.
Advice and guidance
NHS GPs increasingly use e-RS advice and guidance to ask a specialist a question before, or instead of, referring. Private GPs cannot. Your alternatives are a private specialist opinion, which the patient pays for, or suggesting the patient asks their NHS GP. If you do the second, send the NHS GP what you found and why you think advice would help, and make clear it is their decision.
Urgent suspected cancer
This is the one area where things have changed. Since July 2025, NHS England’s cancer waiting times guidance has said systems should have processes to take direct referrals from the independent sector, including patients seen by a private GP, where the patient meets the usual urgent suspected cancer criteria and is eligible for NHS care. These still do not go through e-RS in most areas, so you need the local route. See urgent suspected cancer referrals from private GPs.
Options at a glance
| Need | NHS GP route | Private GP route |
|---|---|---|
| Routine NHS outpatient referral | e-RS | Letter to the trust’s non-e-RS route, or the patient asks their NHS GP |
| Specialist advice without referral | e-RS advice and guidance | Private specialist opinion, or via the NHS GP |
| Urgent suspected cancer | e-RS or local urgent pathway | Local independent sector route for urgent suspected cancer referrals |
| Emergency | Direct to on-call team or ED | The same: phone the on-call team or send to ED |
Outside England
e-RS is an NHS England service. Scotland, Wales and Northern Ireland use their own electronic referral systems, which are also built around NHS referrers. Check with the local health board or trust how they accept referrals from private practitioners.
Frequently asked questions
Can I get an NHS smartcard as a private GP?
You may hold one through your NHS work, but it only gives access for that NHS role. You must not use NHS systems or credentials for private patients.
Will a hospital accept a paper referral from a private GP?
Many will, through their route for non-e-RS referrals. Policies vary, so check with the trust’s referral management centre before sending.
Is it quicker for the NHS GP to re-refer?
Sometimes, but the NHS GP has no obligation to do so. Only suggest it where the NHS GP will be managing the patient’s ongoing care anyway.
Does the patient lose their place if I refer privately first?
For planned NHS care, the waiting time clock starts when the NHS provider receives the referral, so time spent in private care does not count towards NHS waiting time.
