Shaping better health
REMEDY : BNSSG referral pathways & Joint Formulary

Expediting Referrals -interim guidance - DRAFT

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****Update November 2022****

The GPCB and acute trusts are currently discussing a system wide approach and patient leaflet to give guidance regarding requests to expedite referrals. These will be published here and communicated to practices once they are available.

During recovery from the COVID pandemic, providers continue to experience system pressures. It is therefore likely that waiting times for urgent and routine outpatient appointments in most services will remain long for some time to come. This can be a worrying and frustrating time for patients and it is important to try to manage patient expectation from the outset. 

A guide to approximate waiting times broken down by hospital and specialty can be found here. Please note that the My Planned Care website uses average waiting times and is not sub-specialty specific so please warn patients that there may be shorter or longer delays depending on other factors.

It is also important that patients should be given appropriate safety-netting advice and encouraged to contact their GP surgery if they develop new symptoms, or if existing symptoms become worse, particularly development of any red flags.

Requests from patients to expedite referrals without good reason should be politely declined and the patient advised that this is unlikely to speed up the process.


Suggested interim management

Patient has been referred but is on a waiting list and symptoms have significantly deteriorated.

If your patient’s symptoms have significantly deteriorated and you feel that your initial referral needs expediting then please consider one of the following options:

  • If symptoms develop that could indicate a diagnosis of cancer then consider a 2WW referral.
  • If there are new symptoms that could possibly be managed in primary care, then consider using advice and guidance (if available). A and G should be requested from the provider where the patient has been referred or where they are on a waiting list. A and G should not be used to directly request that an appointment is expedited.
  • Email or write to the provider directly explaining why the referral should be expedited and include a copy of the original referral to help the clinicians in hospital triage appropriately.

Please do not send a new referral on e-RS. This creates a duplicate referral, resulting in additional administration and paradoxical delays in patient care (e.g., multiple appointment dates, patient confusion and DNAs). If this is noticed during the triage process, the duplicate referral will be returned.


Patient is already under the care of a hospital or other provider but follow up has been delayed or possibly lost

  • If your patient’s follow up appointment is overdue or you suspect they have been lost to follow up, the patient should be advised to contact their named clinician's secretary (contact details should be included on previous communication/clinic letters) initially.
  • If you want to expedite your patient’s appointment because their symptoms have significantly deteriorated or they have health inequalities, then please email or send a letter directly to their named clinician secretary (contact details should be included on previous communication/clinic letters).
  • If you have requested and received urgent advice from a hospital clinician, e.g.via telephone calls, please follow this up with a letter sent directly to their named clinician, detailing the communication and request for expedition.

Please do not use send a new referral on e-RS (see reasons above).


Patients symptoms have not significantly changed since referral and there are no red flag or 2WW symptoms.

Please do not request that an appointment is expedited without a good clinical reason as this may be declined or may not change the speed at which the patient will be seen. It also creates an additional administrative burden.

Requests to expedite a referral should be justified on clinical grounds and clearly stated in any further communication to the provider.

Patients who have health inequalities and who are likely to be at increased risk due to a significantly delayed appointment may also be suitable for an expedited appointment if appropriate. Please state concerns clearly.