After finally staggering to its feet the woes surrounding the NHS's £131m gaffe-tastic e-Referrals system have continued, sources have told the Register, with more outages and a growing list of unresolved problems appearing in the past week.

In an email seen by The Reg, users have been told that "unexpected" issues have occurred impacting the performance of the NHS e-Referral Service database.

Last month, GPs across England had to resort to fax machines in order to refer patients due to the continued IT problems surrounding the new system, which was subsequently pulled offline.

The system is critical for GPs referring patients to hospitals and replaces the previous Choose and Book system. Its aim is to (eventually we assume) achieve a 100 per cent paperless referrals and booking across the NHS.

"Today, we have experienced further issues, which have required further fixes and a longer period of recovery," the email said, adding that it apologised for "the disruption these outages are causing".

It also advised people to switch to Chrome in order to reduce the current four-minute loading time to 50 seconds. Currently, the list of service issue stands at 28, in contrast to its list of just four fixed issues.

One NHS IT manager, who asked not to be named, said his local referral centre was deeply unhappy with the current situation. In fact, in order to make referrals the centre has been routing round the referral system by contacting hospitals directly via email and fax.

"But all that does is make a lot of manual processing work for the hospital concerned, and the patient loses the ability to choose their own appointment," he said.

A spokeswoman from the Health and Social Care Information Commission said the body will continue to work with trusts and "operate around the clock to monitor the system, to investigate, diagnose and fix issues that emerge".

She said: "Of the 28 known issues, 23 of them have a simple workaround that can be can used and these have been published on the website. A series of releases designed to further improve service are in the process of being tested and will be deployed following completion of this testing."

She added that the body will continue to update users about how the system is operating, and will alert them to planned maintenance as swiftly as possible. ®