Early GP referrals up by half since 2023, patient watchdog finds
More than 50% more patients are being referred by a GP at their first appointment, new survey data suggests.
A survey of 2,622 people ‘with an experience of a referral’ in the last year by patient watchdog Healthwatch England found 59% were referred by their GP at their first appointment – up from 39% in its 2023 survey.
The increase in earlier referrals has been accompanied by a fall in the proportion of patients needing more than three appointments before a referral – from 18% in 2023 to 9% in 2025.
As the report notes, slower referrals are often explained by ‘valid clinical reasons’ such as a GP waiting on an advice and guidance (A&G) response from a hospital specialist.
The survey also found around one in seven (14%) of patient referrals by a GP to hospital fall into a ‘black hole’ before being ‘bounced back’ to the GP. Of these, the most common issue was delayed referrals (60%), followed by unsent (14%), rejected (13%) and lost (12%) referrals.
However, the 14% figure still represented a decrease since 2023, when more than one in five (21%) of referrals were not actioned.
People frequently said that their GPs ordered ‘in-house’ tests (i.e., further tests carried out at the GP practice) (42%), suggested using medication (34%), and monitoring their condition or symptoms (30%) before referring them.
The report recommended the Department of Health and Social Care and NHS England should provide support to NHS teams to implement Jess’ Rule – an initiative rolled out this year asking GPs to ‘think again’ if after three appointments they have been unable to offer a ‘substantial diagnosis’ or if a patient’s symptoms have escalated.
It also said the anticipated updated 10-Year Workforce Plan should include a commitment to invest in ‘trained admin staff to support people’s referrals journeys’.
A&G requests have risen since the Government introduced a payment for practices in April. The 2025/26 GP contract offered practices access to an £80m A&G funding pot, which enables access to a £20 Item of Service (IoS) fee for ‘pre-referral requests’ as part of a new enhanced service specification.
Healthwatch England is set to play a key role in negotiating the next GP contract after the Government expanded the group of stakeholders to consult on the contract.
The watchdog has said it would ‘welcome the opportunity’ to make the contract ‘more patient‑centred’.
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READERS' COMMENTS [5]
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If they would like to set a target of referring 100% of patients at their first appointment, I am sure we can handle that. They might not like the consequences…..
I suspect a major factor here is how overwhelmed general practice is. If you have a 6 week wait for routine appointments, patients don’t want to try something and come back because they already feel like they’ve waited ages. Referring them now also saves you that extra appointment in 2 months time when you’ll probably be referring them anyway.
I think patients would be much more happy to try something or wait and see if they felt like it would be easy to see you again.
I didn’t see the figure for the number of patient who are not referred at all because they a reassured and/or treated by their own doctor. I would guess that is around 97%.
Not sure how Jess’ rule will work re referrals when referral rejection is ubiquitous for presentations that don’t fit into a neat common shaped box, or complex patients are managed via asychronous arms length means via advice back and forth to the GP who then has to review and discuss with the patient and then go back and forth with the specialist. It’s like the slow back and forth with a French pen pal in the 90s, expect on the nuances of diagnosis, investigations and management, and the pen pal is a psychiatrist, neurologist or gastroenterologist.
Seriously… updated 10-Year Workforce Plan should include a commitment to invest in ‘trained admin staff to support people’s referrals journeys’.
would it not be better to actually make a system that works… given gps can only register refrals via an 9bline portal how on earth are they getting lost ?