GP Referrals Briefing 2 (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 different demographics.

The figures quoted in this briefing are based on the 1,518 patients who fall into the second group - those who were referred for tests, diagnosis, or treatment. Fieldwork was completed in October 2022. We also shared our survey via the Healthwatch network (1,825 respondents overall of which 1,458 respondents were in the “referred group”) and comments from both surveys are used to support the analysis and provide quotes for this briefing.

Using the NHS Monthly Referral Return we know that GP referrals to hospitals are almost back to pre‑pandemic levels, with around 1 million GP referrals made every month. However, hospital teams are rejecting more referrals, and waiting lists have grown in the last three years leading to an increase in wait times. 

Considering how long it can take for a patient to be told they are being referred, combined with the time it takes to get onto a waiting list, the total time the patient has been suffering from their symptoms or condition can be much longer than official waiting time statistics would suggest. There are gaps in measurement for some parts of the referrals process – creating a dangerous blind spot.

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

• Two in five (39%) patients are referred during their first GP appointment, and nearly four in 5 (79%) are referred within their first three visits, but nearly one in five (18%) require four or more GP appointments.
• Over one in ten (11%) waited over four months from their first GP appointment to being told they were to be referred and over one in ten (11%) waited over four months between receiving their GP referral and having that referral confirmed by a specialist team. So, patients can wait weeks, months or even years before joining NHS waiting lists for specialist appointments. These waiting times are not captured in NHS statistics.
• Two in five (42%) sought medical care from other parts of the NHS while trying to get a referral from their GP practice.
  • Those experiencing three month or longer waits at each stage were twice as likely to seek medical care from other parts of the NHS, compared to those who experienced waits of less than a month.
  • Some go private out of desperation – whether they can afford it or not.
• As well as negative impacts for the patients themselves such as worsening physical and mental health, reduced ability to work and damage to relationships, delays in the referrals process can also impact those around them. Some patients needed additional care from friends and family and some needed social care support.
• Patients can be referred in different ways. Just under two in three (63%) were referred by their GP practice via a referral letter sent to the hospital/community clinic, while 16% were told to call or go online to book their own appointment directly with the hospital/ community clinic and 12% had their referral appointment booked while at the GP practice.
  • The use of a referral letter may make the process take longer, but those who were referred in this way were more likely to progress to the waiting list or referral appointment itself. The mode of referral used varied depending on the profile of the patient.
• At the point of referral, advice, choices, and information were rarely given to patients, and in fact around one in seven (15%) were not given any advice, choices, or information at all.
  • The most common support offered was advice on how to manage symptoms while waiting (39%) and information on why people were being referred (31%).
  • Fewer were given information on how the referral process works (16%), estimates of when to hear back about the referral (15%), a copy of their referral letter (12%), or a choice of appointment times (8%).
  • Those highly educated and better off financially were given more advice, information and choices at the point of referral.
• Chances of a referral progressing smoothly vary greatly. Around 7 in 10 (71%) patients progress directly to an appointment or to join a waiting list, while others experienced problems along the way, such as not hearing anything further about their appointment (10%), finding out from the GP practice that the appointment hadn't been made (5%), discovering the hospital/clinic had no record of the referral (2%) or the GP had no record of it (2%), the referral was rejected (2%) or they were referred to the wrong clinic (1%).
  • Mental health referrals were less likely to lead directly to an appointment or waiting list (only 60%) than other conditions like cancer (90%).
  • People aged 18-24 (66%), those really struggling financially (63%), LGBTQ+ people (59%) and neurodivergent people (58%) were less likely than the total for all respondents (71%) to experience their referral progressing directly to an appointment or joining a waiting list.
• We asked patients whether they agreed with a range of statements about their referrals experience to understand the quality of those experiences. While there is room for improvement in all aspects of the referrals process, those who reported having a poorer experience were more likely to be younger, of ethnicity other than white British, neurodivergent, less well off or lower educated.  
• For some patients, getting through the referrals process is arduous and it erodes their faith in the NHS. When the NHS gets it right, however, patients really appreciate it, and it can positively affect their health outcomes. This should be everyone’s experience.

Comprehensive recommendations are given within the body of the report.