'Referrals black hole’ - new findings of people’s experiences of GP referrals (Healthwatch, 16 February 2023)

Summary

GP services are the first point of call for many health issues and the gateway to NHS specialist support. 

GP teams are highly skilled and may decide that treatment without specialist care is the best action. But when you need specialist support, such as hospital tests or treatment, you may need a referral from your GP team first.

New research from Healthwatch highlights that it can be very hard for some people to get a GP referral to another NHS service. And for 21% of people we spoke to, even when they get referrals, they can be lost, rejected or not followed up on.

When services don't process referrals properly, it can cause significant frustration, unnecessary anxiety, and even cause harm to patients. 

It can also lead to increased demand for either more GP appointments or help from healthcare teams in other parts of the NHS, putting more pressure on already overstretched services.

Content

Recommendations

Healthwatch have set out actions for the government, NHS England and Integrated Care Systems (ICS) to support GP practices and hospitals with referral processes.

1. Do more to understand the referral process:

There is currently no published national data collection on where patient referrals fail and bounce back to general practice for a new referral.

• NHS England should work with Healthwatch England to add questions to the annual GP Patient Survey to understand people's experiences of the referral process.

2. Improve communication with patients:

More support should be given to help GP and hospital teams to reduce the numbers of people returning to general practice due to communication failures following a referral. 

• Communications must be accessible. Failed referrals and missed appointments can sometimes be down to patients receiving information in the wrong format. For example, we've heard from blind patients receiving inaccessible referral letters. We recommend that adaptations are made to the e-referral system or other appropriate care record systems to ensure services record people's communication preferences at the point of referral. Services should support people to update them about their communication needs if they change.
• Communications must be transparent. All parties should have access to the same centralised information about which stage of the referral process the person has progressed to. This includes patients, along with teams in general practice, referral management centres, hospital admissions teams and other parts of the NHS. This could be through planned updates to the NHS App. However, information should also be available and shared with patients via other communication methods, as noted in their care records.
• Communications must be collaborative. As well as improving channels for the NHS to update patients about their referral, patients must also have access to care navigators in general practice and a single point of contact at their hospital (or another referral setting). This is so patients can give feedback about their condition while waiting for care, including whether they need to cancel or reschedule appointments or quickly chase up a referral if they have not received information about its progress.

3. Invest in NHS admin staff

• NHS England and the government should work to improve access to general practice by training and hiring more care navigators, staff who can ensure people's needs are met in the right setting the first time.
• With more care navigators, the future of general practice could become one with fewer long waits on the phone and 24/7 access to online triage systems. And when people do fall into the referrals black hole, they will be able to flag these issues more quickly and access required support as soon as possible.