The Countess of Chester Hospital NHS Foundation Trust is receiving over 2,600 electronic referrals a month using software that slots into Microsoft Word and replaces the print button, according to manufacturers Medisec.

The e-referral system links 33 surgeries in northwest England and Wales to the hospital. GPs send the referrals to the hospital using a ‘Send to Medisec’ button in the Word toolbar in the place of printing it out, and enter details in a pop-up form. When the form is delivered, around three seconds later an alert message is produced to confirm its arrival.

Dr David Morris, GP at St Mark’s Dee View Surgery, Flintshire, Wales, makes referrals across the border to the Cheshire hospital. The border issues are not a problem, he said. "Flintshire provides one quarter of Chester hospitals’ work – look at an atlas."

"The patients love seeing the flash, confirming that the hospital server has received the referral, before they get up from their chair my consulting room," he said. "It’s very reassuring both for them and us."

The pre-set forms that appear when the referral is made asks GPs to send across specific information about the particular discipline they are being referred to. Monique Duffy, assistant director of IM&T in planning and development from the Countess of Chester, explained: "In collaboration with the GPs, we have defined some mandatory fields for the referrals. This gives us much more control over the quality of the patient information we receive from GPs, helping our consultants to offer patients a better quality service."

Tom Rothwell, managing director of Medisec, said that one crucial aspect of the system was that it integrated into the workflow of the hospital: "That button effectively passes the electronic referral from out of Word to the website at the hospital," he told EHI.

For instance, a dermatology referral would immediately be sent to the dermatology department, with the correct information entered by the GP, and be available for monitoring on the Medisec website. In the GP’s surgery, the referral document is saved into the patient record and matched against the existing data.

Any Medisec user can log into the central site and track the progress of the patient. The password and username for GP monitoring will only work from within the practice.

Rothwell told EHI: "With Choose and Book and the NPfIT, there’s a lot of emphasis on the ‘choose’ and the ‘book’. But there seems to be less emphasis on the transfer on the electronic referral and processing within the hospital."

The Medisec site has been integrated into the workflow process of the hospital for a long time. Rothwell said that this is what gave birth to the e-referral system: "We’ve had in position in west Cheshire electronic communications between the hospital and the surgery for about five or six years. As part of the development of that process we looked at sending electronic referrals using the website as the vehicle for transfer."

GPs receive discharge summaries and bulletins for their patients, and all clinical correspondence is saved into the patient record. GPs can even access the hospital’s appointments calendar, although this is restricted to only their own patients.

Dr Morris intends to keep using the MediSec system in his practice. Wales is not receiving Choose and Book but he is yet to be convinced about the ability of what system he will receive to make referrals into England. "What I’ve seen makes me think that the excellent MediSec service will remain a better choice for as far forward as I can guess."