One in seven people in England who need hospital care are not receiving it because a referral by their GP is missed, refused or delayed, the NHS patient watchdog has found.
Three quarters (75%) of those patients trapped in this “referral black hole” suffer harm to their physical or mental health as a result of not being added to the waiting list for tests or treatment.
Communication with patients is so unreliable that seven in ten (70%) of those affected discover they were not put on a waiting list after an NHS prosecution because they were not told there had been a delay. In some cases, GP-approved referrals from surgery to hospital are not even sent; Health Watch EnglandResults revealed.
Its research has shown that 14% of all referrals are ‘stuck’ between GPs and hospitals, leaving patients in the dark and anxious about when they will be seen and treated.
“Behind every late, lost or declined referral is a human story filled with pain, stress and uncertainty,” said Chris McCann, Executive Vice President of Healthwatch.
“Despite the improvements that have been made, too many people are still stuck in a referral ‘black hole’, telling us they are ‘there and not surviving’ because of delays.”
Rachel Power, chief executive of the Patients’ Association, said the findings were “deeply worrying” and that delays in referrals could leave some patients afraid to leave their homes.
“When seven out of 10 people find out their referral has failed because they pursued it themselves, then something has gone terribly wrong.
“These people are already worried about their health, already stressed out waiting for treatment — and then they find out they weren’t even on the waiting list,” Power added. “And while they wait, their conditions can get worse.”
The Healthwatch findings are based on a YouGov poll of a nationally representative survey of 2,622 adults in England who were referred by a GP for tests or treatment in the past year.
It raises questions about how accurate the NHS waiting list is as a true reflection of the number of people needing care – 6.24 million people waiting for 7.39 million tests or treatments – and how well the service is keeping patients informed of the progress of their referral.
The survey found that just over half (53%) of all people referred are seeking medical help or advice while waiting to act on it. While 7% go private, one in five (20%) seek help from other parts of the NHS, such as a different GP or urgent care services. The Healthwatch report noted: “These findings suggest that delaying referral may increase pressure on other NHS services.”
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One patient – Patrick, 70, a former NHS worker from Milton Keynes – told the watchdog how he had been waiting since July to see a specialist about pain in his hip and back.
After being referred by his GP, he heard nothing about when he would be examined. “When I called them they were nice over the phone, but they couldn’t give me any good news. It could be up to a year before I get an appointment, and this is just taking the first step in a long process.”
His pain has become so bad that he struggles to do daily tasks such as shopping, driving, or even putting on his shoes. He does not know when he will be seen.
“I feel like I’m stuck in limbo,” he added.
The 14% of people whose referral was lost, declined or declined represents an improvement on the 21% who suffered the same fate when the watchdog conducted similar research in 2023.
Since then, ministers and health service chiefs have tackled the problem by making it easier for patients to track the progress of their referral using the NHS app and using pharmacies to help people with suspected cancer.
“However, despite progress, many patients still report poor communication, delays and uncertainty caused by long waits, impacting on their health, wellbeing and ability to work,” Healthwatch said.
It found that one in four (23%) people were dissatisfied with the referral process. Public satisfaction with the NHS overall has fallen to just 21% – the lowest level – according to the latest British Social Attitudes Survey.
A Department of Health and Social Care (DHSC) spokesman said the situation revealed by the findings was “unacceptable”. The spokesman added that improvements have been made since the research was conducted in March.
They include the introduction of the Jess Rule in September, under which GPs must seek a second opinion if they cannot diagnose a patient’s illness after three appointments.
In addition, the Department of Health and Human Services is putting an extra £1.1 billion into general practice, hiring more family doctors and cutting red tape so GPs can spend more time with patients, the spokesperson added. Family doctors are also now encouraged to seek “advice and guidance” from a specialist doctor in hospital about referrals. Patient satisfaction with primary care increased from 60% in July 2024 to 75%.
“We have made it clear that it will take time to transform the NHS but we are starting to see improvements. There is still a long way to go but we are starting to see the green shoots of recovery.”