Shaping better health
REMEDY : BNSSG referral pathways & Joint Formulary

Expediting Referrals - DRAFT

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****Update May 2023****

Waits for many outpatient clinics remain very long. The GPCB, One Care and acute trusts have jointly produced a leaflet to give guidance to patients about what they should do while they are waiting. This leaflet will be sent out with patient booking letters (for practices using the BNSSG Referral Service).

While You Are Waiting - Patient Leaflet

Patients can also be encouraged to address any lifestyle factors that may help to improve their health while they are waiting to be seen:

Live Well - NHS (


Waiting times in BNSSG

A guide to approximate waiting times broken down by hospital and specialty can be found here. Please note that these are 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.

Safety- netting

It is 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.

Expediting Referrals

Requests from patients to expedite referrals without good reason should be politely declined and the patient advised that this will not speed up the process. Please see scenarios below for suggested management if a patient's condition does change.


Suggested 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.
  • If the above options are not appropriate then 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 follow up 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 to expedite. Please do not send a new referral on e-RS (see reasons above).


Patient 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.


Patient whose symptoms have got better of if they have had treatment elsewhere (e.g. by another provider or privately)

  • If a patient no longer requires an appoinment then please ask the patient to cancel it so that their appointment can be freed up for someone else.