NHS referral advice system to undergo independent safety review

NHS England has commissioned an external evaluation of its advice and guidance system amid concerns that poorly managed referral pathways may expose patients to delays and harm.

Advice and guidance allows GPs to seek specialist input before making, or instead of making, a hospital referral. Under changes to the GP contract for 2026/27, practices must use the process before or in place of a planned-care referral when it is clinically appropriate.

From October, requests for specialist advice and most routine elective referrals are also being directed through consultant-led single points of access. Specialists can then advise the GP, arrange diagnostic testing, accept the referral or direct the patient to another service.

NHS England said the evaluation began in August and had been designed to run alongside implementation of the system. Interim written findings are expected in December 2026 and March 2027, followed by a final report in summer 2027.

The review began before the Health Services Safety Investigations Body published an interim report raising significant concerns about the way advice and guidance had been introduced and monitored in parts of England.

Investigators found evidence of near misses and incidents of physical and psychological harm, including delayed or missed diagnoses, avoidable surgery and delays affecting cancer care. The safety body called for a rapid evaluation of the system and its use within single-point-of-access pathways.

Dr Emma Rowland, NHS England’s executive director of performance and delivery, told its board that the emerging safety findings had now been incorporated into the evaluation. She said running the review alongside delivery would allow the NHS to identify benefits and challenges while responding quickly if further concerns emerged.

Supporters argue that specialist advice can prevent unnecessary hospital appointments and help patients reach the right service sooner. However, GPs have warned that unclear responsibilities, additional administrative work and inadequate monitoring can leave patients caught between primary and secondary care.

NHS England has maintained that GPs retain responsibility for referral decisions and should make a direct referral whenever they believe it is in the patient’s best interests. The evaluation will now examine whether the model is delivering faster, safer care in practice.

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