eRS Primary Care Workflow Improvements: What's Possible in 2026

eRS is becoming more central to NHS referrals, not less. With national requirements expanding the expectation that Advice and Refer activity flows through eRS, and the GP contract now embedding A&R as a contractual requirement across at least ten specialties, primary care teams are being asked to do more through eRS, not step back from it.

The question worth asking is what "doing more through eRS" actually looks like in practice, and how far primary care workflow improvement can realistically go within what the system currently supports?

What eRS does well

eRS is the national system of record for NHS referrals in England. It standardises how referrals are made, tracked and managed across organisations. For a health system the size of the NHS, that standardisation matters: it provides visibility of referral activity, underpins national reporting, and gives commissioners and providers a framework to work within.

Its Advice and Guidance functionality added something important: a route for GPs to seek specialist input before making a referral, rather than defaulting to an outpatient appointment every time a clinical question arises.

Those foundations are solid. The limitations tend to show up at volume and pace.

Where the workflow breakdown

The day-to-day experience of GPs using eRS for Advice and Refer is often one of difficulty. Cases are created in one system and reviewed in another. Responses come back asynchronously, sometimes days later. Clinical images have to be handled separately. When the specialist's advice results in a referral anyway, the process starts again from scratch.

None of this is unique to eRS. It reflects the complexity of joining up systems that weren't originally designed to work together. But in a busy primary care environment, that friction has real consequences. It takes longer than it should to initiate a case, longer than it should to get a response, and longer than it should to close the loop with the patient.

For GPs already managing full lists and heavy administrative loads, a workflow that adds rather than removes steps tends to get used less. And when A&R is used less, the intended benefits, fewer unnecessary referrals, shorter waits, better use of specialist time, don't materialise.

Read more: Is There An eRS Alternative?

What meaningful improvement looks like in 2026

The most useful improvement to eRS workflows currently available to primary care teams is a genuine two-way integration between eRS and a purpose-built clinical triage platform.

eRS Smart Sync, developed in partnership with NHS England, does exactly that. It creates a bilateral connection between Cinapsis and eRS. GPs can create A&R cases in eRS or directly in Cinapsis, specialists review and respond in Cinapsis, and eRS is automatically updated to reflect the outcome. No double entry. No cases falling between systems.

The practical effect is that cases move faster. Organisations using eRS Smart Sync report managing cases more than four times faster than through eRS alone, while maintaining complete visibility of all activity within eRS itself. That speed matters for GPs because it changes the decision: if a specialist response comes back quickly, seeking advice becomes the natural first step rather than an additional delay.

What e RS Smart Sync adds that eRS alone can't

A few workflow improvements are worth spelling out:

Richer clinical context

eRS Smart Sync connects to the NHS Spine, pulling patient demographics and clinical history directly into the case view. A specialist reviewing a case sees the full picture, not just what the GP entered into the referral form. That means fewer requests for more information, and more cases resolved at first review.

Patient communication

Subject to local agreement, Cinapsis can notify patients directly of the outcome of their A&R request, reducing the volume of follow-up calls to GP practices and keeping patients informed without adding clinical workload.

EPR integration

Unlike eRS A&G, all clinical triage activity through SmartSync can be integrated into a trust's electronic patient record, so oversight isn't limited to a single system.

Compliance with national requirements

As expectations around Advice and Refer continue to develop, eRS SmartSync is designed to keep organisations aligned, not by requiring a change of workflow, but by making the compliant workflow the faster one.

The workflow question primary care should be asking

The question for primary care teams in 2026 isn't whether to use eRS. That question is largely settled. It's whether the way eRS is currently being used is working as well as it could, and what would need to change for Advice and Refer to become a genuine improvement to clinical workflow rather than an additional administrative step.

For services that have answered that question and invested in better tooling, the evidence is clear: faster case management, fewer unnecessary referrals, and a process that GPs use because it helps them, not because they have to.

Across NHS trusts and ICBs, Cinapsis has processed over 162,000 cases through a single point of access at Royal United Hospitals Bath, with 75,500 of those managed in the community rather than acute care. In Gloucestershire, 10,800 out of 12,465 urgent care requests avoided an ED attendance entirely. 

Find out more about how eRS Smart Sync works alongside eRS.