Every seventh person in England those who need hospital care are not receiving it because their GP referrals are lost, rejected or delayed, an NHS patient watchdog has found.
Three quarters (75%) of those caught in this “referral black hole” suffer harm to their physical or mental health because they are not added to the waiting list for testing or treatment.
Communication with patients is so unreliable that seven in 10 (70%) only discovered they were not put on a waiting list after contacting the NHS because they were not told there was a delay. In some cases, referrals that GPs have agreed to make are not even sent from the surgery to the hospital. Healthwatch EnglandThe results show.
The study showed that 14% of all referrals are “stuck” between GPS and hospitals, leaving patients in the dark and worried about when they will be admitted and treated.
Chris McCann, deputy chief executive of Healthwatch, said: “Behind every delayed, lost or rejected referral is a human story of pain, stress and uncertainty.
“Even though improvements have been made, too many people are still stuck in this referral black hole, telling us they are ‘existing rather than living’ because of delays.”
Rachel Power, chief executive of the Patients' Association, said the results were “deeply worrying” and that delays in referrals could leave some patients afraid to leave home.
“When seven out of 10 people find out that their direction failed because they were looking for it, something is wrong.
“These are people who are already worried about their health, already stressed out waiting for treatment – and then find out they weren't even in the queue. While they wait, their condition may worsen,” Power said.
Healthwatch's findings are based on a YouGov survey of a nationally representative sample of 2,622 adults in England referred by a GP for tests or treatment in the past year.
They raise questions about how accurate National Health Service The waiting list is a true reflection of the number of people needing help (6.24 million people are waiting for 7.39 million tests or procedures) and how well the service keeps patients informed about the progress of their referrals.
The research found that just over half (53%) of people referred are seeking medical help or advice while they wait for NHS action. While 7% use private care, one in five (20%) seek help from other parts of the NHS, such as another GP or emergency services. “These findings suggest that delays in patient referrals may increase pressure on other NHS services,” the report said.
after promoting the newsletter
One patient – Patrick, 70, a former NHS worker from Milton Keynes – told the Observer how he had been waiting to see a specialist since July for hip and back pain.
After being referred by his GP, he had heard nothing about when he could be seen. He said: “When I called they were kind enough to talk on the phone but couldn't give me any good news. It could be a year before I get an appointment and this is just the first step in a long process.”
His pain has become so severe that he has difficulty performing everyday tasks such as going to the store, driving, or even putting on shoes. He doesn't know when he will be seen.
“I feel like I’m stuck in limbo,” he added.
The 14% of people whose referrals were lost, rejected or declined is an improvement on the 21% who suffered the same fate when the watchdog conducted a similar study in 2023.
Since then, ministers and health service chiefs have tried to tackle the problem by making it easier for patients to track the progress of their case through the NHS app and using pharmacies to help people with suspected cancer.
“However, despite progress, many patients still report that poor communication, delays and uncertainty caused by long waits are affecting their health, wellbeing and ability to work,” Healthwatch said.
It found that one in four (23%) people are dissatisfied with the referral process. Public satisfaction with the NHS as a whole has fallen to just 21% – its lowest level, the latest British Social Attitudes survey has found.
A Department of Health and Social Care (DHSC) spokesman said the situation revealed by the investigation was “unacceptable”. But there have been improvements since the study was conducted in March, the spokesman added.
They include introduction of Jess's reign in Septemberwhich requires GPs to seek a second opinion if they cannot diagnose a patient's condition after three visits.
The DHSC is investing an extra £1.1 billion in general practice, hiring more GPs and cutting red tape so GPs can spend more time with patients, the spokesman added.
Family doctors are now also encouraged to seek “advice and guidance” from specialist doctors in hospitals regarding referrals. Patient satisfaction with primary care has increased from 60% in July 2024 to 75%.
A DHSC spokesman said: “We have been clear that it will take time to turn things around in the NHS, but we are starting to see improvements. We still have a long way to go, but we are starting to see the green shoots of recovery.”
