Healthwatch finds that one in seven patients who have been referred by their GP are stuck waiting for specialist care due to GP referrals being delayed, lost or rejected.

One in seven patients (14%) have been stuck between their GP and hospital teams, often due to a delay in the referral being sent, or the referral being lost, rejected, or never sent.

Seven in ten of this group (71%) only found out that they hadn’t joined a waiting list for specialist care after chasing NHS teams up themselves.

The figures come from a Healthwatch report which polled 2,622 adults in England referred by their GP for specialist tests or treatment last year. It suggests that quicker referral confirmations, clearer communication, and greater patient choice significantly improve people’s satisfaction with the referral process.

Since 2023, both the government and the NHS have taken steps to improve the referral process, including using the NHS App to give patients greater visibility of their referral, piloting the use of pharmacies to refer people with suspected cancer, and enabling GPs to get expert advice before making a formal referral to help direct patients to the right care they need more quickly. 

The independent statutory body commissioned the research to assess whether recent changes to the referral process had made a difference following reports of poor patient experience in 2023.

Falling into the black hole

Overall, fewer people fell into the referrals black hole compared to the last time, which saw more than a fifth (21%) of patients vanish in 2023. Yet despite progress, many patients still report that poor communication, delays and uncertainty caused by long waits are affecting their health, well-being, and ability to work. 

“GP referrals are the gateway to specialist care, and that’s why healthcare leaders need to take action to ensure they work for everyone,” said Chris McCann, deputy chief executive at Healthwatch England. 

“Behind every delayed, lost, or rejected referral is a human story of pain, stress, and uncertainty. And while improvements have been made, too many people remain stuck in the referral ‘black hole’, telling us they’re ‘existing, not living’ due to delays,” he added. He called a referrals checklist with clear responsibilities across NHS teams, accurate waiting time estimates, and rapid implementation of Jess’ Rule to ensure patients are referred when health issues remain unresolved. 

Responding to the report, Kat James, managing director of Consultant Connect, said: “Not only are these findings a sign of hospital services being overwhelmed, but they also show the extent of the disconnect between primary and secondary care.”

“The government’s announcement in the budget to invest in neighbourhood health centres will shift even more care away from hospital. This makes it even more important that we make sure the different entities in the system are strongly connected. Some of the solutions are already here and need to be ramped up faster, otherwise even more patients will fall into the referrals black hole,” she added.