Why You Don't Need to Replace eRS to Fix Referrals

eRS does one thing well: it tracks where referrals go and keeps a national record. That's genuinely valuable. What it wasn't built for is the clinical conversation that should happen before a referral is made: fast, real-time, with enough context for a specialist to make a confident decision without asking for more information.

Advice & Refer is that conversation. And the friction most clinicians experience isn't eRS failing. It's eRS being used for a job it was never designed to do.

What eRS is actually for

eRS is the national backbone for NHS referrals. It standardises where referrals go, how they're tracked, and how activity is reported across England. For creating a consistent, nationally visible record of referral and Advice and Refer activity, it works well.

Where it runs into difficulty is when it's asked to be the primary working environment for clinical triage at pace. That's a different use case. It shows up as slow clinical triage, , additional manual steps and disconnected workflows. These are going to magnify significantly when significantly more cases are being triaged under the imminent Advice & Refer system.

Those difficulties have led some services to look at alternatives. But a clean switch away from eRS as the national record  isn't realistic. The compliance and reporting infrastructure built around it is too deeply embedded. The question will always be how to make eRS work better, not how to work without it.

What fixing clinical triage actually requires

GPs need a faster, more intuitive way to initiate Advice and Refer cases and share clinical information. Specialists need a cleaner way to review cases, access the full clinical picture, and respond quickly. The outcome of that exchange needs to be recorded in eRS without anyone having to do the admin twice.

Cinapsis SmartSync was built for this. It creates a bilateral API connection between Cinapsis and eRS. GPs can create cases in eRS or directly in Cinapsis. Specialists review and respond in Cinapsis, with access to NHS Spine data that gives them the full clinical context. eRS is updated automatically when a case is closed: no manual entry, no duplication and a complete national record.

The clinical workflow lives in Cinapsis, where it's faster and more intuitive. Compliance and reporting stay in eRS, where they need to be.

Why this matters now

National requirements around Advice and Refer are tightening. Organisations are expected to prioritise Advice & Guidance where clinically appropriate across at least ten specialties, and to move toward a Single Point of Access with specialist clinical review of A&G requests and referrals (other than urgent suspected cancer) by October 2026, in line with the wider Medium Term Planning Framework commitments. The expectation that this activity flows through eRS as the system of record is increasing alongside it.

For organisations using third-party tools for triage or A&R, the question is whether those tools are properly integrated with eRS, or whether they're running alongside it in a way that creates a gap in the national record.

SmartSync answers that question directly. All activity flows through eRS. There's no compliance risk from using a separate clinical workflow tool, because the two systems are connected rather than parallel.

The practical difference

Services that have moved to this model, Cinapsis handling the clinical workflow and Smart Sync keeping eRS up to date, report case management speeds more than four times faster than eRS alone. Specialists get richer information at the point of review, which means fewer requests for clarification, fewer patient accepted for appointment because of incomplete data and more cases resolved at first contact. Patients find out the outcome faster and less appointments are generated.

None of that required replacing eRS. It required building a workflow around it that clinicians actually want to use.

For ICBs and trusts looking at where their referral pathway is losing time and why the waiting list isn’t getting smaller, the distinction matters. Replacing the national system of record isn't a realistic option. Improving how clinical teams interact with it is, and the evidence from services that have done it is worth taking seriously.

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