NHS hospitals reject one in four GP referrals in push to cut waiting lists

Thank you for subscribing!

Blocked referrals included patients presenting with red-flag symptoms suggestive of cancer

Hospitals across England are turning away roughly one in four GP referrals to specialist care in a bid to bring down NHS waiting lists, a survey of family doctors has revealed.

The findings, published by GP trade publication Pulse, drew on responses from 712 general practitioners who reported that an estimated 26 per cent of their referral requests were being rejected by hospital trusts.

Most troublingly, the blocked referrals included patients presenting with red-flag symptoms suggestive of cancer, raising serious questions about patient safety.

Rather than being seen by a specialist, these patients had their cases sent back to GPs with guidance on how to manage them in primary care — despite the referring doctor having already judged that hospital assessment was clinically necessary.

The revelations come as the NHS waiting list remains stubbornly high at 7.27 million cases.

The system at the heart of these rejections is known as "advice and guidance," or A&G. Earlier this year, it emerged that health officials had instructed GPs to seek consultant input on a quarter of cases before making referrals, ostensibly to filter out unnecessary ones.

NHS England, however, denied imposing any fixed national target for diverting referrals away from hospital settings.

According to the Pulse survey, more than a quarter of GP referrals were being sent back as "unsolicited advice and guidance" — effectively returning cases to family doctors without their consent.

GPs warned that the expanding A&G programme was delaying specialist assessments and fuelling patient frustration.

One family doctor practising in the North East raised particular alarm about cancer pathways, noting that the system was creating additional obstacles to urgent two-week-wait gastrointestinal referrals for patients displaying suspected cancer symptoms.

Response times were also a concern, with GPs reporting an average ten-day wait for hospital replies to A&G requests — double the contractual five-day requirement.

The personal toll on doctors was laid bare by a London GP who said mounting difficulties in securing referral approvals had directly contributed to her decision to leave the profession. "It was getting more risky and unsafe, and I didn't want to take that on at a time in my life where I didn't have to take it on, so it was a factor in my decision to quit," she said.

Her experience was far from isolated. Numerous GPs reported being forced into additional consultations with patients simply to explain why their expected hospital appointments had been refused.

The burden extended beyond awkward conversations. Over a third of the advice and guidance responses that GPs received from consultants asked them to carry out clinical tasks that fell outside their professional remit, effectively shifting secondary care responsibilities onto already overstretched family practices.

Dr Clare Bannon, who chairs the British Medical Association's GP committee, insisted that hospital trusts had a contractual duty to accept referrals from general practice, with only very narrow exceptions permitted.

"Referrals should not simply be rejected with requests for additional GP actions unless part of a locally agreed pathway," she said.

Dr Bannon stressed that her committee had been campaigning since April to safeguard GPs' fundamental right to refer patients when clinical judgement demanded it.

"More needs to be done to avoid inappropriate rejections and absolute clarity is needed for GPs on where the medico-legal risk lies," she added.

The question of legal liability looms particularly large given forthcoming structural changes. From October, all referral requests will be routed through consultant-led "single points of access," granting hospitals the power to determine whether a GP's referral merits acceptance — a shift that could further concentrate gatekeeping authority away from family doctors.

The NHS waiting list, still standing at 7.27 million, has been shrinking at a glacial pace — averaging just 8,000 fewer cases per month over the past year.

The statistics watchdog has separately ordered the health service to improve transparency around "unreported removals," a category encompassing patients struck from lists after seeking private treatment or dying.

The Department of Health defended the A&G model, stating it had "supported millions of patients to receive care in the right place" and citing the recruitment of 2,000 additional GPs since July 2024. Officials maintained that clinical thresholds for referrals remained unchanged.

An NHS spokesman, meanwhile, sought to downplay the survey's significance, noting that Pulse itself acknowledged the poll — which offered participants a £500 prize — was "not scientifically representative of GPs."

The spokesman described advice and guidance as "a well-established and successful way of giving patients earlier input from an expert consultant".