The Healthwatch report revealed 14% of patients are stuck in a ‘black hole' between their GP and hospital teams.

Chris McCann, deputy chief executive at Healthwatch England, said: ‘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.'

The findings followed the introduction of several initiatives 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 research found that while the percentage of patients falling into the referrals black hole had fallen from one in the five (21%) in 2023, many patients still reported poor communication and delays.  

Healthwatch called for 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.

Professor Victoria Tzortziou Brown, chair of the Royal College of GPs, said: ‘GPs refer patients to specialist care only when there is clear clinical need, so any breakdown in communication between primary and secondary services that leads to referral requests being misplaced is deeply concerning and must be urgently resolved. We agree with Healthwatch that good communication and transparency across the referral pathway is key. As such, we want to see meaningful investment across the whole pathway, including into upgraded digital systems in both primary and secondary care and robust processes implemented to prevent patients falling through the cracks.

 

‘With the right support, resources and technology in place across the whole system, GPs can continue to provide safe and timely care - and patients can move more smoothly through their treatment journey.'

Kat James, managing director of Consultant Connect, said: ‘Not only are these findings a sign of hospital services being overwhelmed, but it shows 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 will shift 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"'. 

A Department of Health and Social Care spokesperson said: ‘This is not acceptable and we have been clear it will take time to turn around the NHS but we are starting to see improvements.

‘We are supporting general practice with an additional £1.1bn, recruiting more GPs and cutting red tape so they spend more time treating patients.

‘Since this polling was conducted in March, patient satisfaction with primary care has risen from 60% in July 2024 to 75% today.

‘Thanks to our record investment in the NHS, waiting lists have fallen by over 230,000. There's a long way to go, but we are beginning to see the green shoots of recovery in the NHS.'

The Government has published advice to support doctors to go direct to specialists.

Jess' Rule, which was launched in September, asks GPs to think again if, after three appointments, they have been unable to offer a substantiated diagnosis, or the patient's symptoms have escalated.