Referrals: improving experiences and closing “black holes”

In 2023, we researched how difficult the process of getting a referral can be. People described how they ended up trapped in “referral black holes”, left without updates about their care.

In this follow-up report, we look at whether experiences of referrals have improved, and make recommendations to ensure referral processes work for patients and NHS teams alike.

Download report

Background

Since our last research, there have been national changes to referrals. These include more visibility of referral journeys through the NHS App, pharmacy referral pilots for suspected cancer and a greater drive to increase referrals into community rather than specialist services. 

There’s evidence that some of these changes are already having a positive effect, while others carry risks. We’ve also continued to hear from people who feel forgotten throughout the referral process.

Our key findings

Over six in ten (62%) were satisfied with the referrals process. But almost one in four (23%) weren’t satisfied, and only 7% of those experiencing a referral issue were satisfied with the process. 

One in seven (14%) people ended up in a ‘referral black hole’ – i.e. their referral is delayed, lost, rejected, or not sent. Three in four people (75%) who had an issue with their referral reported at least one negative impact on their health and wellbeing, compared with 36% of those who had no referral issues.

Earlier referral leads to better experiences. Of the 59% of respondents referred during their first GP appointment, 71% went on to be satisfied with the referral process. Satisfaction was 67% when people were referred between their first and third appointment. Only 47% of those needing more than three appointments were satisfied with the overall process. 

Quicker referral confirmation leads to better experiences. People who had referrals confirmed within a month were significantly more likely to report satisfaction with the referral process. For those confirmed within a week, satisfaction was high at 88%. 

The right information and choices lead to better experiences. Satisfaction rose to 83% when people got all the information they needed along with a referral. Satisfaction also jumped from 62% to 77% when given any sort of choice (e.g. of location, consultant, or appointment time) at the point people were told they were being referred. 

Regular updates and support after referrals lead to better experiences. Nearly half (47%) said clear communication was among their top three important aspects of a referral. Regular communications after referral increased satisfaction. 

Earlier referral with quicker confirmation and better information and choice leads to almost universal satisfaction. Satisfaction rose to 98% for those who were referred between their first and third GP appointment, had their referral confirmed within a week, said they were given enough information, and were given choices.