A new report has condemned ‘serious issues’ with NHS referral processes, amid findings that one in five patient referrals made by GPs went into a ‘black hole’.
Healthwatch England said that 21% of people they spoke to with a GP referral to another NHS service were rejected, not followed up on or sent back to general practice.
The watchdog said that more support should be given to help GP and hospital teams to reduce the numbers of people returning to general practice due to ‘communication failures’ following a referral.
The report said: ‘We heard from 1,777 adults in England between September and October last year who had an experience of getting a GP referral within the previous 12 months. Of these, 368 (21%) fell into what we have called the “referrals black hole”.
‘NHS England and the Government should work to improve access to general practice by training and hiring more care navigators, staff who can ensure people’s needs are met in the right setting the first time.’
According to the findings, the failures were due to GP teams not sending referrals, referrals going missing between services, or being either booked or rejected by hospitals without any communication.
As a result, the patents affected went back to their GP to chase up the referral, the watchdog said.
The report added: ‘One in five people we spoke to with a GP referral for specialist care had bounced back to general practice. This suggests potentially serious issues with referral processes. We are calling for more to be done to understand people’s experience of getting a referral.’
Louise Ansari, Healthwatch England’s national director, said that thousands of people told the watchdog that the process is ‘far from straightforward.’
She said: ‘Falling into this “referrals black hole” is not just frustrating for patients but ultimately means people end up going back to their GP or visiting crowded A&E departments to get the help they need.
‘This adds more burden to already stretched services, making things even harder for the doctors and nurses trying to provide care.
‘Extra admin support must be put in place to improve referral processes and ensure that everyone who needs treatment can access it as quickly as possible, in the right setting and in a way that meets their needs.’
Dr Kieran Sharrock, BMA England GP committee acting chair, called for a ‘common-sense approach’ that removes bureaucratic barriers and the need to jump through restrictive hoops.
He said: ‘GPs and their colleagues are often frustrated by the merry-go-round of new referral forms and pathways that get introduced without warning, meaning staff can be left not knowing who to send referrals to, which form to use, and how to follow it up.
‘The whole NHS is under unprecedented pressure and patients are already experiencing exceptionally long waits for care. If these are then extended further by delayed or lost referrals, it can mean conditions becoming more serious, pain getting worse, and an increased need for ongoing care from GPs and other parts of the system.
‘Patients’ uncertainty of not knowing what has happened to their referral, or when they can expect to be seen, only adds unnecessary anxiety.
‘For the good of both patients and staff, the NHS needs to develop a much more transparent system so that patients know when they have been referred, who and to which department they have been referred, and how they can track the referral.’
RCGP chair Professor Kamila Hawthorne said that GPs take their responsibility to refer appropriately and in a timely way ‘very seriously.’
She said: ‘When doing so they will take into account the various factors impacting on a patient’s health, their family and medical history and clinical guidelines, as well as pressures on local onward services. It is a professional letter that is written carefully and thoughtfully.
‘With this in mind, it’s essential that GP referrals made to specialist care are taken seriously and not rejected without a very good reason.
‘If a patient has been told a referral will be made, but for whatever reason it is not or it gets lost or the patient doesn’t hear about it, then this needs to be addressed as it could have a negative impact on the health of the patient and in the longer term, the wider health service.’
She said that most GP practices have measures in place to make sure referrals are not missed, adding: ‘It is in everybody’s best interests, particularly patients’, that referral processes are working efficiently. We would agree with Healthwatch that the government needs to further invest in expanding the number of GPs as well as more administrative staff in general practice, such as care navigators.’
Last month, a Pulse survey revealed that two thirds of GPs feel ‘advice and guidance’ is preventing patients who really need a referral to secondary care from getting one.
So 48 hrs on after this was put on the website, no-one has posted a single comment.64,000 members of the college,27,000 headcount, 16,000 WTE, 9,000 trainees, and not a single one has any comment whatsoever.
Pulse reports thousands of stories every year, but I suspect over the last 20-30 years there has never been an article with no views whatsoever after 48 hours.
May I therefore respectfully make one. Thank you ,many many thanks to the authors, and to Pulse for reporting this.Quite simply extraordinarily useful, significant and helpful.I think we all knew this, but to see it studied measured and published is incredibly helpful. Data is priceless.
The NNH for secondary care referral is 5 .Having given many talks, I can testify, very few GP’s can point to any therapy with an NNT less than that, and almost none to one they actually deliver themselves .Put another way, as a GP you cannot do anything as effective as tackling your local referral management centre.
One can only hope the authors will expand on this theme, looking at the hospital letters that never arrive, arrive ridiculously late, do not address the original question, or bury the crucial next step at the bottom of page three in incomprehensible jargon.
The best of luck in your endeavours, and once again thank you