Thanks, i had this response from someone on the E-referral team
The letter which patients receive are in place following agreements with clinical councils and the DOH. They cannot be removed or switched off and are in place for every referral made through e-RS. The timeframe is calculated by e-RS from the date of referral and this is 40 working days for routine referrals. It does not mean that the patient has to have an appointment within 40 days, it means the referral needs to be acknowledged by the provider.