Thousands of patients in England at risk as GP referrals vanish into NHS ‘black hole’ | GPs

The NHS’s own patient watchdog has found that one in seven people needing hospital care in England do not receive it because their doctor’s referral is lost, refused or delayed.

Three quarters (75%) of patients stuck in this “referral black hole” suffer harm to their physical or mental health because they are not placed on a waiting list for testing or treatment.

Communication with patients is so unreliable that seven in ten (70%) of those affected find out after inquiring on the NHS that they were not put on a waiting list because they were not told there was a blockage. In some cases, the referrals that the general practitioner agrees to make are not even sent from the surgery to the hospital. Healthwatch UK‘s findings were revealed.

Its research found that 14 per cent of all referrals were “stuck” between GPs and hospitals, leaving patients in the dark and anxious about when they would be seen and treated.

“Behind every delayed, lost or rejected referral is a human story filled with pain, stress and uncertainty,” said Chris McCann, vice president of Healthwatch.

“Even though improvements have been made, too many people remain stuck in this routing ‘black hole’ and tell us they are ‘existing rather than living’ because of the delays.”

Rachel Power, chief executive of the Patients’ Association, said the findings were “extremely worrying” and delays in referrals could leave some patients afraid to leave their homes.

“When seven out of 10 people find out that their referrals failed because they followed up, something is terribly wrong.

“These are people who are already worried about their health, already stressed out while they’re waiting for treatment, and then they discover they’re not even in line. Their situation can get worse as they wait,” Power added.

Healthwatch’s findings are based on YouGov polling, a nationally representative survey of 2,622 adults in England referred by a GP for testing or treatment in the past year.

They raise questions about how accurate the NHS waiting list is in terms of truly reflecting the number of people needing care (6.24 million people are waiting for 7.39 million tests or treatment) and how well the service is at keeping patients informed about the status of their referrals.

The survey found just over half (53%) of everyone referred had sought medical help or advice while they waited for the NHS to take action. 7 per cent go private, while a fifth (20%) seek help from other parts of the NHS, such as a different GP or urgent care services. “These results suggest that referral delays may increase pressure on other NHS services,” Healthwatch’s report said.

Patrick, 70, a former NHS worker from Milton Keynes, told the watchdog how he had been waiting since July to see a specialist for pain in his hip and back.

But after her doctor referred her, she heard nothing about when she would be seen. “When I called them on the phone, they were nice but couldn’t give me good news. It could take up to a year for me to get an appointment, the first step in a long process.”

Her pain has gotten so bad that she has trouble doing daily tasks like shopping, driving, and even putting on her shoes. He doesn’t know when he will be seen.

“I feel stuck in limbo,” he added.

The 14 percent of people whose referrals were lost, rejected, or rejected is an improvement compared to the 21 percent who suffered the same fate when the watchdog conducted a similar survey in 2023.

Ministers and health service chiefs have since tried to tackle the problem by making it easier for patients to track the progress of their referrals using the NHS app and using pharmacies to help people with suspected cancer.

“But despite progress, many patients still report that poor communication, delays and uncertainty caused by long waits are affecting their health, well-being and ability to work,” Healthwatch said.

According to the research, one in four people (23%) are dissatisfied with the referral process. Public satisfaction with the NHS overall has fallen to just 21% (the lowest level) in the latest British Social Attitudes survey.

A Department of Health and Social Care (DHSC) spokesman said the situation revealed by the findings was “unacceptable”. However, the spokesman added that improvements had been made since the survey was conducted in March.

These include the introduction of Jess’s rule in September that GPs must seek a second opinion if they cannot diagnose a patient’s illness after three appointments.

The spokesman added that the DHSC has allocated an extra £1.1bn to general practice, hiring extra GPs and cutting red tape so GPs can spend more time with patients. GPs are now also encouraged to seek “advice and guidance” from a hospital doctor who specializes in referrals. Patient satisfaction in primary health care increased from 60% to 75% in July 2024.

“We have made it clear that it will take time to turn the NHS around, but we are starting to see improvements. There is still a long way to go but we are starting to see the green shoots of recovery.”