UK watchdog urges halt to NHS referral scheme after linking it to two patient deaths
A UK health watchdog has called for an immediate pause in the expansion of NHS England’s “Advice and Guidance” referral policy after linking the scheme
A UK health watchdog has called for an immediate pause in the expansion of NHS England’s “Advice and Guidance” referral policy after linking the scheme to two patient deaths. The warning lands on a policy NHS England has placed at the centre of its elective recovery drive.
The Health Services Safety Investigation Body, or HSSIB, also pointed to near misses, delayed treatment and missed diagnoses. The findings amount to the sharpest challenge yet to a system that steers GPs to seek specialist input before sending patients for a hospital outpatient appointment.
How the scheme works
Advice and Guidance lets a GP send an electronic request to a hospital consultant for review before making a referral. Instead of a face-to-face appointment, the consultant can suggest management in primary care, recommend more tests, or decide a hospital appointment is not needed.
The model has existed for about a decade. But its use expanded quickly after the pandemic, and NHS England made it mandatory across 10 specialties from April this year under new GP contract terms, ending the enhanced service that had allowed direct referral to consultants.
Safety concerns build
HSSIB’s call for a pause focuses on patient safety as the rollout spreads further through the health service. The watchdog linked the policy to the deaths of at least two patients and said it had also identified a number of other cases where care was delayed or diagnoses were missed.
The scheme was built into NHS England’s elective recovery strategy as a way to manage demand and streamline referrals. But the watchdog’s intervention raises questions about whether the pressure to redirect patients away from routine outpatient slots is coming at a cost.
The latest findings will add pressure on NHS England at a sensitive moment for the policy. HSSIB has urged that expansion stop now. “The safety concerns identified” are serious enough, the watchdog said, to warrant a pause while the system is examined more closely.
