1. NHS e-Referral Service (e-RS)
Training environment – overview presentation

2. What is the NHS e-Referral Service training environment?
The NHS e-Referral Service (e-RS) training environment mirrors the live e-RS.  
This is a secure training environment which demonstrates all the functionality of the NHS e-RS.

3. Who can access the e-RS training environment?
Organisations who have an N3 connection can request access to the training environment.
If your location can access live e-RS you will be able to access the e-RS training environment.

4. Why use the environment?
Training teams are able to:
train on a life-like system, without the risk of altering live data
request data to suit organisational training requirements
connect with external systems to give an integrated training experience (such as GP systems and patient administration systems)

5. Considerations
The following should be considered when looking to gain access to the training environment:
Access to the environment can take several weeks
Support will be required from the organisation’s local:
IT team - discuss the requirements to access the environment with the IT team along with any possible ongoing support needs
Registration authority manager – to create smartcards to access the training environment
If planning to run end to end training using a GP Clinical System or Patient Administration System (PAS)/Provider Booking System, find out if there is already access to a test or training system that could be used. Depending on the system provider a cost could be associated to supply this.

6. What’s required to access the training environment?
To use the training environment, you will need:
an N3 connection
smartcard access specific for the training environment
installation of, and ability to change, registry settings (local ICT support required)
A data pack containing patient and organisation information
The following slides explains these requirements in more detail

7. 1. What is an N3 connection?
N3 is the national broadband network for the English NHS, connecting all NHS locations and 1.3 million employees across England. N3 provides the foundations to deliver NHS Digital Programmes securely, including e-RS.
*HSCN will replace N3

8. 2. Accessing different environments?
Insert live smartcard
Live registration files active
Live Spine
Live NHS e-Referral Service
Insert Spine Training smartcard
Training registration files active
Training Spine
NHS e-Referral Service Training environment
Logging into NHS e-Referral Service
Logging into e-RS Training environment
This diagram shows how accessing the training environment differs from accessing live e-RS.
To access both environments users will need:
separate smartcards
two registry files
ability to switch between the environments

9. 2. What is the Training Spine?
The Training Spine, which was previously known as ‘T Spine’ or ‘Training’, is a replica of the National Spine used for the live e-RS.
The Training Spine hosts synthetic data which is accessed from the training environment to enable users to replicate real processes in a safe manner. The type of data included are patients, organisations, services and appointment slots.
The e-RS training environment connects to the Training Spine. To access the Training Spine users require a Spine Training smartcard.

10. 2. Do I need to request a Training Spine smartcard?
If you or your organisation already has access to the Spine Training environment then:
You will only need to request roles to be added to existing Training Spine smartcards and to ensure that you have right registry settings (explained later in this presentation) set up on the required computers.
You can check this with your local IT team before you start, as this will save you a lot of time. Organisations often already have access to a path to live (sandpit) environment for testing, but this does not mean that the connection will be automatically configured in the Spine Training environment.

11. 2. Do I need to request a Training Spine smartcard?
If you or your organisation does not have access to the Spine Training environment then you should be aware of the following:
• Enough time should be allowed to request smartcards and data – this can take up to 10 working days for smartcards and up to three weeks for test data requests. Further information on these requests are detailed later in this presentation.
• Local IT need to install the registry setting (explained on the next slide) on each required PC needing to access the training environment.
• If you want to link to a GP Clinical System or Patient Administration System (PAS)/Provider Booking System, this will need to be configured locally and will likely require an End Point Registration (explained on the next slide).

12. What is an End Point Registration?
When the training environment is set up to connect to a test/training GP Clinical System or Patient Administration System (PAS)/Provider Booking System this is called the ‘end point’. This allows messages to be sent between the systems.
If organisations require this then the system provider will need to give the local IT information to allow the correct configuration between the test organisation/s in the training environment and the provider test system.
Once the connection has been set up it will allow the required Provider System end point to be selected (see embedded image) when
setting up the services in the
training environment.
More information on the end point information needed can be found in the Process for Connecting to a Path to Live Environment document (section 3.4) located on the e-RS website.
Return to:
Step 3. Complete and return forms

13. 3. What is a registry setting?
Registry settings, or certificates, are required to allow users access to the training environment. Separate registry settings are needed for each environment. The ‘training spine environment’ settings are required to be installed on all computers which will be accessing the e-RS training environment. In most cases this will need to be undertaken by local IT teams.
If the computer being used to access the training environment also need to use the live e-RS system then users will need the ability to install the specific settings each time they wish to access one of the environments.
Switching between registry certificates (Live and Training)
The person responsible for training needs to know where these files are located so that they can point the computers to the right registry certificates and switch them back, as necessary. These settings are retained until changed, therefore shutting down the PC will not revert the settings back to the default (Live).
Note: If you have a dedicated training room, computer or laptop you may not need to switch back. It could be that you set up the registry settings to point to the Training Spine, which can be left in place. However, if you need to use any live environment you will need to switch the registry settings back to the live one.

14. 4. What is a data pack?
A data pack contains synthetic patients and organisations which will be used within the training environment to support training scenarios.
Users are able to request data to suit their needs. It is recommended that different organisations are asked for eg CCG, referrer, providers. This allows referrals to be created and followed through to the providers.
This information is provided by NHS Digital Test Data Team
Note: Users will need to set up data (services/referrals) against these. For example, under an organisation services will need to be created. Once these services are published referrals can be made into them.

15. How to access and set up the environment?
The following 6 steps are required to access and set up the training environment ready for use:    
Raise a request by contacting
Download the access request pack
Complete and return forms
Liaise with your local IT team
Receive RA smartcard and data packs
Set up services and referrals 1 2 3 4 5 6

16. How to access and set up the environment?1 2 3 4 5 6
Raise a request by contacting asking for access to the e-Referral Service training environment
This request will be received by the NHS Digital (Solution Assurance) Environment Management Team (EMT). Their helpdesk is the initial gateway to your training environment request
EMT will ask you some questions to help identify your needs
For example, do you have access to Training Spine already?
This will help prevent unnecessary form filling and/or delays
EMT will return the appropriate forms (detailed in step 3) for completion 1

17. How to access and set up the environment?1 2 3 4 5 6
Download access request pack 
The information in the pack has been provided by the e-RS programme to inform end users of the following:
• The benefits of using training environment
• Step by step information on what you need to do
• Specifies how much you need to do, which is dependent on your/your organisation’s current position
• Details on how the process works, including estimated timeframes
• Information about who you need to contact both locally and at NHS Digital 2

18. How to access and set up the environment?
Complete and return forms
The following forms will be provided from NHS Digital on completion of step 1. Examples of the forms are available in the access request pack
NHS Digital SA EMT Spine Training Environment Requirements Pro Forma: this form is to formally request access to the training environment. If possible, include contact details for your IT department or system administrator in the returning your completed pro-forma, so that NHS Digital can contact them for further information.
Test Data Request Form: this document asks you to give a high level description of your requirements
Spine Training Environment Requirements: this document asks you to set out your requirements, such as the environment you want access to, end point connection date, data load requirement
NHS e-RS Training – User Requirements Form: this document asks you to set out what smartcards and roles you require
Specific Test Patient Data Request Form: this document enables you to request and personalise the patients you will receive and use during training 3 1 2 3 4 5 6

19. How to access and set up the environment?1 2 3 4 5 6 4
Liaise with your local IT team
If you require connection to a GP Clinical System or Patient Administration System (PAS)/Provider Booking System. They will need to provide information for the systems to connect to the environment.
Installation of registry settings. The registration file will be provided by NHS Digital solution assurance team. IT have the required access to install this file on the machines needing to access the environment.

20. How to access and set up the environment?1 2 3 4 5 6 5
Receive RA smartcard and data packs
NHS Digital will provide:
An RA smartcard to access the Training Spine. The person responsible for your local smartcards will be required to copy the RA card for any user needing access to the training environment
the data you have requested into the training environment. Only users with access to the organisations (using the training smartcards) will be able to see and use the data

21. How to access and set up the environment?1 2 3 4 5 6 6
Set up services and referrals
Once access to the environment has been established data set up is required. Services will need to be created from the organisations you have been provided with in your data pack. Once services are published you are able to make referrals into them.
Note: if you wish to use the environment to train provider processes referrals will need to created in the various required states to enable training to be carried out. Be aware that this set up can take a large chunk of time.

22. Environment maintenance
The following slides provide answers to frequently asked questions:
Does the environment data get refreshed?
No. All the data in the environment will continue to be available. No data is removed. Please be aware that the Training Spine patient PDS data will be reset every night. This means that any changes to patient’s personal information (eg address, DOB, etc) will revert back to its original state overnight.

23. Environment maintenance
When does the environment get updated?
Maintenance and new releases will be put into training environment when available, on a weekly basis. This is to ensure that the environment mirrors the live NHS e-Referral Service and any issues are resolved regularly. The environment has a maintenance slot each Friday from 20:00 through to Saturday 06:00. This is only used when updates are required.
The live e-RS is more up to date that the training environment. Why is this?
The training environment is usually updated one week after a release into the live e-RS (during the slot noted above). On occasions, where issues are found deployment into other environments may be delayed.

24. Environment maintenance
Can users from other organisations access my services?
Yes. Any users of the training environment are able to refer into services you have created (unless you have set them up with restricted access).
However, only users with smartcards who have access to the organisations where the referral has been made to, will be able to action the request.
If you wish other organisations, who have access to the training environment, to have access to your services this can be arranged by asking your Registration Authority manager to apply the required roles to their smartcards.

25. Support information available
Further information can be found on our website under the referrer and provider training sections. This includes:
the access request pack and all the supporting documentation to gaining environment access
a user guide which is a tool for you, as a user of the training environment, and provides the following supporting information:
An explanation about the training environment and how it works
Technical details on how to access the system
Practical information on how to use the training environment
Descriptions of “how to” set up data within the training environment
Sample Lesson Plans
training environment tips on getting the best out of using the training environment.

26. Helping to improve the process
There have been many updates to the supporting documentation detailed in this presentation. To help improve the information provided, and to support other organisations wishing to access the environment, please to provide feedback on the process.
Thank you for viewing this information and we hope it has provided a good insight into how the e-RS training environment works and is accessed.
Any queries on this subject can be addressed to