Doctors tell Sajid Javid to urgently remove barriers preventing GPs’ patient referrals to hospital

“The lack of GP access to secondary care referral pathways is not acceptable”,

say doctors from The Doctors’ Association UK, Doctors for the NHS, GP Survival and campaign group 999 Call for the NHS in an open letter to Health Secretary Sajid Javid.

Among all their other normal tasks, GPs are currently under huge pressure to care for patients who may be waiting for planned hospital care. For example, patients enduring long waits for joint replacements often need medication for pain or antidepressants. GPs are also picking up the fall-out for patients who are having to wait months for physiotherapy and years for assessments for autism and ADHD.

In addition a large number of GPs’ patient referrals are being rejected, which leaves patients who can afford to, to pay for private care, and those who can’t, to suffer.

It is no coincidence that GPs are seeing a huge increase in demand for private referrals

100% of Doctors’ Association UK members who completed a recent poll believed that requests for private referrals are rising. 

Dr Lizzie Toberty, GP Lead for The Doctors’ Association UK, believes Advice and Guidance is becoming another hurdle to climb, as it appears to be so heavily mandated that GPs are being prevented from referring onwards when required.

Advice and Guidance is a “service” introduced by NHS England to cut up to 30 million hospital outpatient visits a year, by providing the means for GPs to seek advice from hospital consultants GPs about investigations, interventions and potential referrals. NHS England’s public-facing guidance doesn’t say anything about use of Advice and Guidance being mandatory for GPs – the spin is all about it being a helpful option for them.

Dr Lizzie Toberty says,

“If a GP has decided a referral is necessary, and the situation is outside their competency then they must refer onwards, in line with GMC advice. 

Allowing specialists who have not assessed the patient themselves to make the decision whether a referral is justified, is not in keeping with the current emphasis on face-to-face consultations, and risks patient safety.”

Healthcare in England is becoming a two-tier system

Barriers to GPs’ referral of patients combined with long waiting lists for planned hospital care are driving unequal access to medical care.

Spokesperson for Doctors for the NHS, Alan Taman, said:

“The growing trend in private referrals demonstrates the critical need to invest in the NHS and redress staffing problems which have been building for years, and will take years to resolve.

“People should not have to face paying for their own treatment in order to escape painful waits of months to years – or because they can no longer get treatment from the NHS because it has been cut.

“Privatisation is happening one worried person at a time, those who can afford to pay or increasingly those who can put themselves into debt.”

Health Secretary must act swiftly to support GPs and their patients

The Doctors’ Association UK, Doctors for the NHS, GP Survival and 999 Call for the NHS are calling for the Rt Hon Sajid Javid, former banker and non-doc, to urgently review and act on the following points:

  • To recognise the impact of these waits on primary care, the need for greater resources and a review into primary care access
  • To recognise that when GPs decide to refer patients to other services, rejection of referrals must be the exception. A clear explanation and alternative plan must be given. All rejection letters should be personalised and written directly to the patient, with the GP copied in.
  • To halt all moves to mandate Advice & Guidance
  • To continue discussions to reduce waiting times
  • And finally, to visit our practices. Please come and understand first-hand the pressures we are under and listen to the solutions. Some things need decades to remedy, but there are quick wins too.

Steve Carne, Chair of campaign group 999 Call for the NHS said:

“GPs play such an important role in our NHS that the Government should be supporting and celebrating their contribution to the nation’s health. Instead, GPs are being expected to do more and more with fewer and fewer resources. We fully support doctors’ call for the Health Secretary to listen and understand the dangers faced by GPs and the NHS workforce”

Update 30.4.22 – The Health Secretary, Sajid Javid, has not responded to requests from Doctors and the Public to improve GP referrals to secondary care appointments. In the absence of any such guidance, Pulse recently reported that Hospital Trusts in various parts of England are making ‘conscious decisions’ to send more neurology referrals back to GPs to manage:  

“Pulse understands that a national shortage of consultant neurologists is leading to several areas having to restrict or ‘vet’ referrals from GPs, with the cases being sent back to primary care.

“One trust put out a statement saying that this was being done because of ‘patient care and safety’, as referrals were taking over six months to be seen. 

“GPs have said that this amounts to introducing advice and guidance ‘by stealth’ …”

Under the A&G schemes currently being pushed, this responsibility stays with general practice – which is already facing unsustainable workloads – and brings in medicolegal issues around GPs retaining clinical responsibility for a patient even if they had judged referral to be the best option. 

Pulse had previously reported that October 2021 saw the introduction of a target on A&G referrals for the first time. In its planning guidance for the second half of 2021/22, NHS England mandated a minimum of 12 A&G requests per 100 outpatient attendances by March 2022. 

“The guidance says all systems will have to ‘demonstrate monthly increases in referral optimisation, with assessment to monitor the impact on avoiding referrals and on improving patient experience and outcomes’. However, NHS England provided no further detail on how the target could be mandated.”

Under the NHS England guidance, a Clinical Commissioning Group and a hospital trust, both in London, separately set out plans to cut GP referrals via A&G, by numbers that go beyond the NHS England target. 

NHS North Central London Clinical Commissioning Group proposed to reduce GP referrals across seven hospital trusts by 65%, according to a service specification seen by Pulse. Barts Health NHS Trust, in east London,  launched a trial spanning 13 specialties that requires GPs to use A&G before referring patients. The trust says the approach ‘could become the default for all services’ if successful.  


  1. Jenny I just want to say thank you for the enormous amount of work you
    do in bringing all these dire events to our attention. Please let me
    know if I can help with disseminating information.

    Stay well.


    Liked by 1 person

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