When is a referral urgent?

queue of people in london

Contact

Stephanie Prior

Table of Contents

What is a referral and how is it arranged?

Patients are entitled to ask to be referred for specialist treatment on the NHS. However, whether the referral is made and whether that referral is treated as a priority depends on whether the GP thinks it is clinically necessary. Generally, a patient cannot generate a referral without a letter from a GP, save for matters treated by sexual health clinics or A&E departments.

A medical professional’s decisions on prioritising referrals as urgent or non-urgent are no doubt challenging. It is the responsibility of the doctor alone to decide the urgency of a patient’s needs which they will usually do via their own initial assessment, understanding of the patient’s history, examination, and NHS guidelines.

At the heart of the decision-making process is whether the patient’s health issue requires priority treatment. This includes considering whether the patient’s health is overall stable and whether waiting for an appointment is likely to cause the patient harm.

 

Urgent referrals

An urgent referral is that which clinicians consider being of sufficient seriousness to justify a rapid investigation. On occasion, a specialist is needed because the GP decides the symptoms need further investigation, the treatment explored so far has not been effective, and the investigations already arranged have shown unusual results. The urgent referral pathway is usually (but not always) reserved for suspicions of cancer but most urgent referrals do not end in a diagnosis of cancer. The referral is considered urgent because the specialist needs to arrange investigations quickly to try to establish what is wrong. An urgent referral means that the patient will be offered an appointment at a hospital within two weeks.

It is important when sending a referral letter that it is marked clearly as urgent or non-urgent. I recall one case involving a patient with very serious neurological injuries where the optometrist marked the form to the GP seeking that the patient be referred as non-urgent but recommended the patient be seen “asap” and the patient was therefore referred on a non-urgent basis. This is a perfect illustration of a referral recommendation lacking in clarity as to whether this was an urgent case.

If a patient has received an urgent referral, it is sensible to ensure that the doctor has the correct address and contact details for the patient. Particularly since the pandemic, some Trusts are communicating by email only. It is vitally important to ensure they have a current and correct email address for contacting the patient.

It is also important that the patient ensures they are available in the following two weeks to attend an appointment and that if they are not available, to make that clear to the doctor.

If English is not the patient’s first language, and a translator is required, the patient should let the hospital know and the hospital should arrange for a translator to attend the appointment.

The hospital should send notice of an appointment, usually by letter, within a few days but sometimes this is fixed by telephone.

If the appointment is made on an urgent basis, the patient will normally be seen by a specialist though tests may be required first to establish the cause of the symptoms.

Non-urgent referrals

It is often the case that a non-urgent referral is one that can be scheduled in advance as it does not involve a medical emergency.  This is often described as “elective”. That is not to detract from the seriousness of a condition that could be causing daily discomfort and which the patient would like to be treated sooner than later – but ultimately the NHS has to prioritise.

If a patient is referred for non-urgent treatment with a specialist, guidelines published in January 2020, set the maximum waiting time at 18 weeks. This is known as the “18-week target”. This is the waiting time which starts once a hospital has received a referral from a GP or other community health professional.

COVID-19 and impact on urgent and non-urgent referrals

Whether the 18-week target is now aspirational and put on hold since the pandemic, there is not enough clear guidance or data to be able to comment. Certainly, at the outbreak of the COVID-19 pandemic, many of the NHS Trusts as part of their response to the pandemic, endorsed GPs no longer referring patients for routine hospital appointments and would only consider urgent referrals. Waiting lists were largely closed for outpatient appointments, diagnostic tests, and even for certain cancer services.

Non-urgent referrals and the associated treatment are far more likely to be subject to serious delays due to the hospitals’ priorities changing since the pandemic.

Urgent referrals and associated treatment remain available, primarily for cases of cancer, mental health and paediatric patients, even in the height of the pandemic, however, GPs have reported that large numbers of urgent referrals are being rejected.

The already challenging task of allocating referrals between urgent and non-urgent has no doubt become fraught with far more uncertainty since the pandemic as each NHS Trust has its own set of rules and protocols on the treatment of referrals. That is compounded by NHS Guidance swiftly changing its approach to referrals in response to the fluctuations of the pandemic.

For further advice from our London lawyers or to discuss any queries, you may have, please call us and ask for our specialist medical negligence solicitors.

Share this article

  • “Small but very effective and experienced team so every client benefits from the personal touch but also highly skilled litigation know-how. Capability of the team means they can handle all aspects of very complex cases as well as straightforward matters.”

  • “Osbornes Law is an established firm which handles a breadth of complex and high-value clinical negligence matters.”

Get Expert Legal Advice Today Our experienced team offers clear, practical advice tailored to your needs Get Expert Guidance

Contact us today

Email us Send us an email and we’ll get back to you






    Related InsightsVIEW ALL

    1. child in hospital
      4.2.2025

      Claim Settled for Child’s Surgery Injuries

      Osbornes secures settlement for child’s surgery-related injuries Osbornes Law successfully represented a minor, X, in a claim against two...

      Read more
    2. ankle injury
      29.1.2025

      £27,000 DVT Claim Settled Against Royal Free London NHS

      Successful settlement for DVT case against Royal Free London NHS Foundation Trust Successful Settlement of £27,000.00 for DVT Claim against Royal...

      Read more
    3. Hospital sign MATERNITY
      14.10.2024

      Multi-Million Settlement in Cerebral Palsy Negligence Case

      Judge awards multi-million settlement in cerebral palsy medical negligence claim Jodi Newton, Partner and specialist medical negligence lawyer at Osbornes...

      Read more
    4. women and cardiovascular disease
      1.10.2024

      Women are “under-treated” for Cardiovascular Disease

      Women are under-recognised and under-treated when it comes to cardiovascular disease Academics investigating the current state of the NHS have...

      Read more
    5. Vulnerable Patient - GP
      19.9.2024

      Vulnerable Patients at Risk due to Online GP...

      Vulnerable patients ‘locked out’ of GP practices due to online only system Being unable able to get a GP appointment...

      Read more
    6. surgeon
      12.9.2024

      Medical Negligence Investigation at Great Ormond Street Hospital

      Great Ormond Street Probe Underway Following a String of “Inappropriate and Unnecessary” Child Orthopaedic Surgeries An urgent review involving 721 children...

      Read more
    7. Landscape black and white
      10.9.2024

      Why are Suicidal Behaviours and Tendencies Overwhelmingly Ignored?

      Social media can often glamorise the idea of suicide, misleading young impressionable minds to romanticise suicide and encourage suicidal thoughts...

      Read more
    8. flowers in a field
      29.8.2024

      AB v Central London Community Healthcare NHS Trust

      Background Our client, AB, had been using the Nexplanon contraceptive device for 6 years. She had a Nexplanon device inserted into...

      Read more
    9. ICU
      30.7.2024

      Women in ICU Face High Risk of Stillbirth

      High stillbirth rates and repeated mistakes Researchers at the University of Edinburgh carried out numerous studies regarding pregnant women being...

      Read more
    10. Physician Associate
      30.7.2024

      What Is the Role Of a Physician Associate?

      What does the Position of Physician Associate Mean for the NHS? There are many different jobs within the NHS, each...

      Read more
    11. wrist fracture
      17.7.2024

      Settlement for Delay in Wrist Fracture Treatment

      Our Clinical Negligence team have recently agreed the settlement of a case relating to a delay in the treatment of...

      Read more
    12. flowers
      28.6.2024

      £55,000 Settlement for Stillbirth Claim Against Chelsea and Westminster...

      Successful Settlement for Stillbirth Claim Against Chelsea and Westminster Hospital NHS Foundation Trust Background Nick Leahy, an Associate in our...

      Read more
    13. baby
      13.5.2024

      Birth Trauma Inquiry: Is poor maternity care the...

      Call for overhaul of maternity and post-natal care An All-Party Parliamentary Group has called for a huge overhaul of maternity...

      Read more
    14. surgery
      9.5.2024

      Claim Against Royal Free London NHS Foundation Trust...

      Client obtains settlement after being victim of a surgical negligence Jodi Newton, Partner in our Clinical Negligence department, recently settled...

      Read more
    15. baby
      30.4.2024

      Settlement In Neonatal Death Case

      Settlement in fatal medical negligence case against King’s College Hospital Nick Leahy, Associate in our Clinical Negligence department, recently...

      Read more
    16. surgeons operating on a patient
      8.4.2024

      Epilepsy Negligence Compensation Claim

      Nicholas Leahy, an Associate in the Clinical Negligence team at Osbornes Law, has recently settled a long-running fatal medical negligence...

      Read more
    17. supreme court ruling
      11.1.2024

      New UK Supreme Court Ruling regarding Secondary Victims...

      The Supreme Court has today, on the 11th January 2024, upheld the Court of Appeal’s order to dismiss the claims...

      Read more
    18. Supreme Court Ruling pic
      11.1.2024

      UK Supreme Court Ruling regarding Secondary Victims in...

      Introduction to the Supreme Court’s Decision on Secondary Victims in Clinical Negligence Cases The Supreme Court has today, on...

      Read more
    19. 5.1.2024

      Delayed Pre-Eclampsia Diagnosis Resulting in Tragic Baby Loss

      Introduction to the Case Nick Leahy, Associate in our Clinical Negligence department, has recently settled a birth injury claim against...

      Read more
    20. Ambulance UK
      12.12.2023

      NHS Compensation Payouts Guide

      What Are NHS Compensation Payouts? In the UK, the National Health Service delivers the vast majority of healthcare services. When...

      Read more
    21. 23.11.2023

      Claim against Bradford Teaching Hospitals NHS Foundation Trust

      Osbornes acted for a Claimant, C, in her birth negligence claim against Bradford Teaching Hospitals NHS Foundation Trust for negligent...

      Read more
    22. Cancer treatment in a modern medical private clinic
      21.9.2023

      Large Compensation for Delayed Laryngeal Cancer Diagnosis

      Actress receives financial award after life-changing missed cancer diagnosis. Jodi Newton acted for a client who was belatedly diagnosed with...

      Read more
    23. Fatal Medical Negligence Claim
      21.9.2023

      Delayed cervical cancer diagnosis client story

      Introduction Jodi Newton acted for a woman who died following a delayed cervical cancer diagnosis. The deceased could have been...

      Read more
    24. hospital
      19.9.2023

      Appendicitis Compensation Claim

      Failure to diagnose appendicitis case settles for 5-figure sum Stephanie Prior was instructed in a claim against Bedfordshire Hospitals NHS...

      Read more

    VIEW ALL