Can someone who knows about NHS referrals tell me what is going on?

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I took DS to the GP in February, although at our practice you only ever see nurses. It's impossible to see an actual GP. The nurse said she would make a hospital referral for DS. I was told it would be a while before I heard. I waited.

Then very recently DS had a related issue. We were away in another part of the country and ended up in A&E on the advice of 111.

Concerned about it happening again, I've now called the GP surgery to find out what was happening about the referral. The receptionist said she could see the 111 call and A&E visit on the system. She advised me to call the hospital and find out what was happening with the appointment.

I called the hospital and they told me the referral only came through the day after we were in A&E - 6 months after I was told it was being made, and surely prompted by this incident. I was told it would be months more until we get an appointment, unless I go back to the GP to try to get it speeded up.

What has gone on here? I'm going to complain to the GP but want to fully understand beforehand. Would the nurse have been able to make the referral or would she have had to request it via the GP? How could the referral not have been made and am I right in thinking it's no confidence that it only happened after we ended up in A&E?

Anyone?

Sounds like it wasn't sent initially.

Similar happened with our son. He had a lump on his neck and the GP initially did general blood tests, which came back OK, and then said they'd refer him for an ultrasound, but to "expect a long wait". After six months of hearing nothing, he phoned the GP surgery and the receptionist couldn't find a referral being made - the GP hadn't done it. So she said she'd get the GP to do it. He waited another 3 months, heard nothing, so phoned the GP surgery again, only for the receptionist to say the GP had done it a couple of days after the earlier phone chaser, but that the ultrasound dept had sent back a refusal letter saying they wanted a different blood test done first - but the GP surgery hadn't acted on that letter, so no one told my son he needed a different blood test, for which of course the GP surgery had a 4 week wait! So it was best part of 10 months before a valid referral was sent and accepted by the ultrasound dept!

Same happened when I first needed hearing aids. Had to go to GP for a referral to audiology, which they said they'd do, but again "expect a long wait". I waited 3 months before phoning audiology to chase it up, only to be told they had no record. So phoned GP surgery, and no, the referral hadn't been made!

These were two different GP surgeries - mine happened a few years ago, son's was last year, so it's not specific to one surgery and not just recent either.

Just last week, my OH went to collect his long term monthly chemotherapy prescription from the hospital, it's on a specific day, every 4 weeks for which a recurring appointment is made by them. He turned up only to be told "they" hadn't issued the prescription/approval, so he couldn't collect it, that was despite him being on the system with an appointment to collect it.

I think these days you really need to constantly chase up GPs and hospitals! Their systems and admin has gone to the dogs (and it was bad enough before!).

I want to understand if it is down to the GP or the nurse.

I'd like to move to a different practice. I've been considering it for a while. They scored badly in their survey which proves they aren't highly rated by their patients compared to other surgeries in the area.

2 things could have happened, either the referral wasn't made initially, or the referral was made but triaged and turned down but for some reason no one told you. The A&E attendance meant that your DS now met some threshold for the referral to be accepted, so he was re-referred and accepted.

I'm sure it's the latter. It's not an issue that would have been triaged and rejected. He needs surgery. When we were at A&E the doctor we saw was concerned we were still waiting for a referral and was going to try and escalate until I explained we were from another part of the country.

Practice nurses and ANP can make referrals to consultants although some won’t accept them or are reluctant to accept them (I’m talking about NHS Scotland probably applies NHS England as well). Consultants can also bounce back a referrals from GPS as well either asking for more information, suggesting a treatment or declining the referral completely because it hasn’t reached the threshold for a consultant opinion.
Of course non of this might be the case maybe the nurse simply forgot to do the referral. I’m afraid these things happen it doesn’t make it right or fair in you but it does happen. If this has happened hopefully your GP can get the hospital to expedite you.

My experience is that you need to call the GP surgery a few days after they promised to make a referral to check that the letter was sent. Usually they will say that it's not been sent and they will send it at that point. I don't know if it's a popular occurrence but this happened several times to me and my kids.

similar experience for my daughter. Only she saw a locum GP. Was told a referral for rheumatology would be made, but when she checked the NHS app several months later. She complained to the surgery, who investigated and our allocated GP had decided referral wasn’t needed as inflammatory markers weren’t that high. Referral finally made 6mths later and she had to wait another 5 mths for the appointment to come through.
I’d say the GP has either vetoed the referral or it has got lost in the system. Complain to the practice manager and ask them to investigate.

We are heavy NHS users so have been in the system for years. This is nothing new, just getting worse.

Whenever we’ve needed a referral, we ask the GP to copy us in on the referral letter. That lets them know you are serious and will follow up. After we’ve received the letter (a week or so later), we’ll contact the hospital department/consultants secretary to ensure they’ve received it. You also then get some idea of the waiting list.

You shouldn’t need to do this but it’s the only way we can get the system to work effectively.

100% this.

In my experience of the NHS, do not take anybody’s word for anything and do not wait long periods of time without making your own checks.

My own GP surgery have never once managed to process simple requests or referrals without making some kind of cock up, and the hospital is the same.

Follow everything up yourself.

It’s the only way.

sadly its often no time/incompetence/poor processes somewhere in the system - we have had 5 referrals in the last 3 years go awol ,either at GP end (1 sent to wrong service hence rejected and we never heard about it ; 1 not actioned by GP after secondary service asked for more info so referral was rejected; 1 rejected because GP hadn't sent important accompanying info) ; twice because we never received the appointment letter and so were discahrged without ever being seen. motto is definitely check and chase ,check and chase....but easier said then done when you can never speak to a GP and you dont know yourself what the correct processes are!!

I'm now going to do this after my GP didnt send my 'Urgent suspected Cancer' referral for a breast lump that she felt. (I saw the red heading of the letter later)
GP went on 2 weeks holiday & 'forgot to send it'. Not apologetic either. I raised it (weeks later when I was able to get a further appointment about something else) & she said: 'well, you didnt' have cancer so all's well that ends well'.

They will have forgotten. There is no accountability either.

Yep. My GP emails copies of referrals direct to me, usually the next day, but you have to ask. You can also request specific consultants and then ring up their secretary's, yes, even in the NHS. I've done it. Also if you are not happy with an allocated consultant, you can change to a different one.

I've got experience of having to chase up my own hospital referrals and appointments but naively thought in this case the silence was due to long waiting times. Lesson learned.

I don't fancy my chances of getting DS in front of anyone effective at the surgery. He's had recurrring issues. Each time we've seen a nurse and now having seen a doctor and having had tests done at A&E I think he's been misdiagnosed previously.

I’ve had exactly the same experience, took my DC to surgery for an issue.
Nurse practitioner said she would refer to surgeon at hospital.
10 months later no letter from hospital .
Called GP again , actually saw the Doctor this time , who typed out the referral to the surgeon as we sat there.
My DC had a surgery booked within 4 weeks.
I wish I didn’t wait so long from first appointment, but just kept thinking , oh the NHS is stretched , this must be the way it is.
Not sure whether nurse didn’t do referral or if it was rejected. Also Scotland and am aware consultants can reject / put back down the list any referrals.

I had a problem with a scan on my heart in april and was told GP was making a referral to cardiology - heart is abnormal and has a shadow and looks enlarged. The hospital didn’t receive the referral letter until end of May and I’m currently looking at a 12 week or longer wait. Or September or October - so 7 months… utter shambles

The NHS is a shitshow and the level of incompetence is staggering. Unless you are constantly pushing, you don't get anywhere. I had recent experience of a different system overseas which just served to reinforce how truly shit things are over here.

Sadly true. The more administrators and managers they get, the more shambolic the organisation and administration! My OH has cancer and has written himself a page full of different names and phone numbers for all the administrators he's had to have dealings with regarding his various appointments for consultations, different treatments, blood tests, scans, receptionist, medication requests, prescription issues, etc., You just get passed around from pillar to post being fobbed off trying to do the simplest of things, like change an appointment time. Even asking for a blood test form means asking one person who ticks a box on a screen to issue it and then he has to phone someone else to look at the screen and actually print it out! Talk about a job creation exercise and that's just one example. Isn't there a phrase about too many cooks....

Any sort of private organisation would never survive such mass scale incompetence.

Is it any wonder that the NHS just needs more and more money thrown at it, without any sign of any of it actually improving the service?

I've finally had my overnight sleep study re apnea. Been waiting since Nov 21.
Morning after I asked for my results (I had this done in 2016 & was just below the cut off for it being a driving licence issue) because I wanted to be responsible. Apparantly, 'someone will call me in November'. So, 2 years in all.
The nurse who put all the leads & monitors on me (there are a lot, it takes about an hour) was saying, & I quote 'what a breeze this is compared to Ortho where I actually had to work'. The leads came off x3 in the night: who knows if it worked.

So true. But the NHS seems to be unaccountable and inefficiency/incompetence is just shrugged off. My OH should have started this month's round of chemo drugs last week, but he still hasn't got them. He went through to the hospital for the pre-set appointment to pick them up, and sat there like a lemon for two hours until they came back and told him the prescription hadn't even been issued - he asked why no one had phoned him so he hadn't wasted his time but they shrugged, he asked why it had taken two hours for them to discover it hadn't been issued, they just shrugged!

He phoned the next day to be told it still hadn't been issued. And the next day. Finally they said it had been issued, but someone else had to approve it and they weren't in that day! Ten days later and he's still not got the bag of drugs he needs to keep his cancer under control and keep him alive! Apparently it's with the pharmacy now and they've got a backlog so it may be another couple of days!

No one cares - they all blame someone else. He actually had his telephone appointment with his haematologist this morning to whom he gave a right ear bashing - yes, he knows it's not her fault, but someone in a position of authority such as the consultant haematologist herself needs to be told of the sheer scale of the administrative cock-ups in their department and start taking responsibility for their department and start banging heads together. Being nice doesn't work when the staff are seemingly incapable of doing the simplest of things! The haematologist didn't even know he hadn't started this months' chemo treatment!

This comes after similar cock ups at the start of Covid when his chemo treatment infusions should have started late March 2020, but he got a phone call saying not to go in and "they'd ring him back", but they never did. He phoned them weekly, leaving messages asking for the revised start date, but they never called back. It was July when he finally spoke to someone to discover they'd closed down the department and moved it all to a different hospital, but obviously hadn't bothered telling him, and no-one had checked his notes to see treatment hadn't started - apparently they'd never stopped, just moved, so he was five months' behind when they finally got him back on track, during which time, his blood levels etc had all worsened considerably!

Don't forget this is cancer treatments - you'd think that, if any department, it would be the cancer dept that should be on top of things. But they're not, they're a complete shambles.

I'm very fortunate that the way that I manage my ILs' and family's health needs is through the NHS app that lets us see the records and where I can see which letters have been sent and even lab results/reports.

It's the only way that I can be sure something hasn't failed to be

• sent
• followed-up.

There are just so so many stories like this.

It really gets me down.

We all pay through the nose for this service. What is the point?

The worst part about it is that it is so rare to find any admin / management staff in the NHS who seem to have any understanding of the consequences their cock ups have; and any accountability up the reporting line for making it right.

The accountability for it just goes all the way up to the top of the trust who will then just shrug and go “underfunding innit”.

So why would anyone in an admin role (who to be fair are mostly paid peanuts) give a toss. They obviously don’t have any consequences to face in their role.

You have to chase things up, I waited nearly a year for an operation in 2016, chased it up repeatedly with GP and consultants office - GP said to emphasise it was affecting my ability to work, I was more concerned about it affecting my ability to be a parent, but hey, whatever works. Was eventually offered to be out on a list of those able to come in on short notice if there was a cancellation, soon after got offered a date.