One in seven patients stuck in a GP referrals ‘black hole’

One in seven patients who have been referred by their GP are stuck waiting for specialist care due to paperwork being delayed, lost, or rejected.

New research by Healthwatch England reveals that 14% of patients have been stuck between their GP and hospital teams, often due to a delay in the referral being sent, or the referral being lost, rejected, or never sent.  

And 71% only found out they hadn’t joined a waiting list for specialist care after chasing NHS teams up themselves. 

GP referrals are the gateway to specialist care and that’s why healthcare leaders need to take action to ensure they work for everyone

The poll of 2,622 adults in England referred by their GP for specialist tests or treatment in the last year suggests that quicker referral confirmations, clearer communication, and greater patient choice significantly improve people’s satisfaction with the referral process.  

The survey found

• Almost one in four (23%) were dissatisfied with the referral process
• Satisfaction rose to 67% when people were referred between their first and third GP appointment
• Satisfaction rose to 88% when hospital teams accepted referrals in a week or less
• Satisfaction rose to 83% when people were given all the information they need along with a referral
• Satisfaction rose to 77% when people were given a choice of hospital location, consultant, or appointment time
• Satisfaction rose to 98% when people had all four of the above

The poll also found that 14% of people bounced back to their GP following a delayed or failed referral. 

Three quarters (75%) of this group reported at least one negative impact on their health and wellbeing, compared to just over one in three (36%), who experienced no referral issues. 

Seven in 10 (70%) delays and just under one in 10 (8%) rejections were only uncovered after patients chased updates, which suggests the total figure of people who experienced issues could be higher.  

Since 2023, the Government and the NHS have taken steps to improve the referral process, including:  

• Using the NHS App to give patients greater visibility of their referral
• Piloting the use of pharmacies to refer people with suspected cancer
• Enabling GPs to get expert advice before making a formal referral to help direct patients to the right care they need more quickly

The research was commissioned to assess whether recent changes to the referral process had made a difference following reports of poor patient experience in 2023. 

And it concluded that some improvements were made, including how quickly people are referred by GPs. 

Overall, fewer people fell into the referrals ‘black hole’ (14%) compared to the last time the patient champion ran similar research (21%) in 2023.  

Yet, despite this progress, many patients still report that poor communication, delays, and uncertainty caused by long waits are affecting their health, wellbeing, and ability to work.  

Chris McCann, deputy chief executive at Healthwatch England, said: “GP referrals are the gateway to specialist care and that’s why healthcare leaders need to take action to ensure they work for everyone. 

We call for a referrals checklist with clear responsibilities across NHS teams, accurate waiting time estimates, and rapid implementation of Jess’ Rule to ensure patients are referred when health issues remain unresolved

“Behind every delayed, lost, or rejected referral is a human story of pain, stress, and uncertainty.

“And, while improvements have been made, too many people remain stuck in the referral ‘black hole’, telling us they’re ‘existing, not living’ due to delays.  

“Simple steps, such as quicker GP referrals, faster hospital confirmations, and better communication, would ensure people don’t bounce back to busy GP teams and improve their safety and experience.  

“We call for a referrals checklist with clear responsibilities across NHS teams, accurate waiting time estimates, and rapid implementation of Jess’ Rule to ensure patients are referred when health issues remain unresolved.”