Many NHS treatments begin with a referral from a GP or another healthcare professional. This referral process helps patients access specialist services such as hospital consultants, diagnostic clinics, or mental health services. However, many people are unsure how NHS referrals work, when they are required, and what happens after a referral is made.
What is an NHS referral?
An NHS referral happens when a healthcare professional — usually a GP — sends a patient to another service for specialist care or further investigation.
According to NHS guidance, referrals are commonly used when a patient needs treatment or assessment from a clinician with specialist expertise. Examples include referrals to:
- hospital consultants
- mental health services
- diagnostic tests such as scans
- specialist assessment services (for example ADHD or autism)
After a referral is made, patients are typically placed on a waiting list before receiving their first appointment.
The NHS referral pathway
Most NHS specialist care follows a similar pathway. This process is often referred to as the Referral to Treatment (RTT) pathway within the NHS.
Step-by-step NHS referral pathway
When you need a GP referral
Many specialist NHS services require a referral before patients can access them. Common examples include:
- hospital consultants
- surgery
- neurology services
- ADHD assessments
- autism assessments
- specialist mental health services
The GP acts as the first point of contact, helping determine whether specialist assessment or treatment is appropriate.
Services you can self-refer to
Some NHS services allow patients to access care without a GP referral. These are often called self-referral services. Examples may include:
- NHS Talking Therapies (IAPT)
- physiotherapy services in some areas
- sexual health clinics
- maternity services
- smoking cessation services
Availability of self-referral services can vary depending on location.
Key point
A detailed guide to self-referring for NHS mental health and other services.
What happens after a referral is made?
After a GP sends a referral, the specialist service reviews the information and places the patient on a waiting list for their first outpatient appointment. During this appointment, the specialist may:
- assess symptoms or medical history
- arrange tests or investigations
- confirm a diagnosis
- recommend treatment options
18-week target
Understand the 18-week referral to treatment standard and your rights.
Can you choose where you are referred?
In many cases, NHS patients have the right to choose where they receive their first outpatient appointment. This is sometimes called patient choice. According to NHS guidance, patients may be able to choose:
- the hospital or clinic providing care
- the consultant or specialist team
- in some circumstances, alternative providers outside their local area
Right to Choose referrals
In England, the Right to Choose framework allows patients referred for their first outpatient appointment to request an alternative provider in some circumstances. This pathway is often discussed in relation to services such as ADHD and autism assessments, where waiting lists can be particularly long.
How to use Right to Choose to access an NHS-funded ADHD assessment.
How Right to Choose works for autism assessments in England, who's eligible, and how to request a referral.
NHS waiting times after referral
Waiting times vary depending on the type of service and the region. Some services, such as diagnostic scans, may have relatively short waits. Others — particularly specialist assessment services — may have much longer waiting lists.
Current NHS autism assessment waiting times across England.
Navigating NHS referrals
Understanding the NHS referral process can make it easier to navigate healthcare pathways and understand what options may be available. Find Care Compare provides information and tools to help patients understand referral pathways and explore available providers.
Find specialist services near you
Compare NHS and private specialist providers in your area.
- NHS waiting times
- Right to Choose options
- NHS and private providers
Sources
This guide draws on publicly available NHS information.
Sources referenced include:
- NHS — Referrals for specialist care (nhs.uk)
- NHS — Patient choice of hospital (nhs.uk)
- NHS England — Referral to treatment waiting times (england.nhs.uk)
- NHS Constitution for England (gov.uk)
- NHS Long Term Plan (longtermplan.nhs.uk)
Related guides
The complete guide to NHS Right to Choose
Understand how NHS patient choice works and when you can choose a different provider.
Read guide GuideThe complete guide to self-referral
A detailed guide to self-referring for NHS mental health and other services.
Read guide GuideNHS 18-Week Rule explained
Understand the 18-week referral to treatment standard and your rights.
Read guide GuideNHS waiting time targets explained
Understand the key NHS waiting time standards in England — from the 18-week rule and cancer targets to A&E and diagnostic test timescales.
Read guide