GP Referrals Briefing 1 (of 2)

We commissioned Panelbase to carry out an online survey covering two distinct groups who had an appointment with their GP practice in the past 12 months. Firstly, those who either expected or requested a referral for tests, diagnosis, or treatment, but didn't get one, and secondly, those who were referred for tests, diagnosis or treatment. We heard from 2,144 people overall. We set quotas for ethnicity and financial status to ensure that we could make meaningful comparisons across these groups.

The figures quoted in this briefing are based on the 626 patients who fall into the first group - those who either expected or requested a referral for tests, diagnosis, or treatment, but didn't get one. Fieldwork was completed October 2022. We also shared our survey via the Healthwatch network (1,825 respondents overall, of which 357 respondents were in the “not referred group”) and comments from both surveys are used to support the analysis and provide quotes for this briefing.

From national data, we know that GP referrals to hospitals are back to around pre‑pandemic levels. However, as outlined below, more referrals are being rejected by hospital teams and waiting lists have grown in the last three years leading to an increase in waiting times.

This briefing shares people’s experiences and the impact behind these figures.

• For those who thought they needed a referral, expected to be referred, asked for a referral, or were told to ask by another clinician, barriers to getting that referral included referrals getting lost, feelings that symptoms were not taken seriously, and issues in the first instance with access to GP teams.
• Those expecting a referral to mental health services from their GP practice are less likely to receive it compared with those expecting to be seen by other health service.
• Nearly three in five (57%) of those that failed to get a referral had asked their GP for the referral. Around a third (34%) had been told to ask their GP for the referral by a medical professional at another medical setting.
• Nearly three quarters (73%) of those that failed to get a referral were repeat visitors (had seen their GP about symptoms or condition before).  
• One in five (21%) who of those who expected to get a referral but failed to get one had previously been referred and fallen into the “referrals black hole” meaning they didn’t hear anything further about the referral, the referral appointment was cancelled, they got taken off the waiting list or they were referred to the wrong medical setting.
• Respondents could choose from a list of multiple reasons why they believe they weren’t referred and combining all the reasons selected, just under half (47%) of reasons were clinical, while just over half (53%) of reasons could be described as non-clinical. For example, the top non-clinical reason, selected by just over one in four (26%), was that they only had a phone appointment with their GP, which they felt meant their GP didn’t fully understand their symptoms or condition.
• Nine in ten (91%) patients experienced consequences as a result of failing to get a referral, some relating to their condition, but many others relating to their life in general such as ability to work or mental health.
• Over four in five (82%) patients failing to get a referral, tried alternative ways to get help. Attempts to get help elsewhere can place an additional burden on other areas of the NHS such as A&E or out of hours GPs. In some cases, patients have no choice but to visit these services when their condition reaches crisis point.

Comprehensive recommendations are given within the body of the report.