About one in four patient referrals from general practitioners (GPs) to hospitals are being rejected and returned to the referring doctors, according to a recent poll of 712 GPs. The survey, conducted by healthcare magazine Pulse, found that 26% of referrals were bounced back under the category of advice and guidance (A&G), a system intended to provide specialist input before a formal referral is made.
A&G is designed to allow GPs to seek advice from specialists to determine the best course of action prior to referring patients to hospital services. However, the unsolicited return of referrals flagged for A&G means patients who GPs had planned to send directly to hospital are required to return to their GP for additional specialist consultation. This process is causing concern among family doctors, some of whom report delays in diagnosis and treatment for serious conditions, including suspected cancers.
More than a third of the bounced-back referrals involved requests for GPs to perform work outside their typical scope of practice. One GP in London expressed apprehension about the increasing risks, stating that the system felt “more risky and unsafe” and influenced their decision to leave general practice. Similarly, a GP in the North East warned that A&G was creating “increasing barriers” to urgent two-week wait referrals for gastrointestinal conditions with red-flag cancer symptoms.
Dr. Clare Bannon, chair of the GPs committee at the British Medical Association (BMA), emphasized that hospital trusts are contractually obligated to accept referrals from general practice except in certain limited circumstances. She stressed that referrals should not be routinely rejected with demands for additional GP actions unless this is part of an agreed local pathway.
A Department of Health and Social Care spokesperson defended the A&G model, stating that under the current government it has enabled millions of patients to receive care in the most appropriate settings without having to join elective waiting lists. The spokesperson added that the process helps more patients access timely care in primary and community settings.
The findings highlight ongoing tensions between general practice and secondary care providers regarding referral management, with some clinicians warning that the current A&G approach may inadvertently delay critical diagnoses and treatment.