How NHS GP referrals work

If your GP has referred you - or you think they're about to - it can feel like you've stepped into the unknown. Most patients aren't told what to expect next, how long things will take, or what to do if nothing seems to happen.

This guide explains how NHS GP referrals work in practice: what your GP actually does, how the e-Referral Service works, when your waiting time clock starts, and what to do if your referral seems to have stalled. This guide covers the NHS referral process in England.

A referral is when your GP asks another NHS service - usually a hospital consultant or specialist team - to assess or treat you.

Your GP refers you when your condition or symptoms need investigation or treatment beyond what they can provide in a standard appointment. Common examples include referrals to:

Being referred doesn't mean you'll automatically get a particular diagnosis or treatment. It's the start of an assessment - the specialist will then decide what happens next.

Most NHS referrals in England are made through the NHS e-Referral Service (sometimes informally referred to as "Choose and Book" - the predecessor electronic booking system it replaced in June 2015).

Here is what the process typically looks like.

At the end of your appointment - or sometimes a few days later - your GP sends your referral through the e-Referral Service. For most referrals, it goes electronically to the specialist service.

Your GP should tell you that a referral is being made and which specialty or service it is going to. In some cases they may also give you a referral letter or summary to keep for your records.

Once your referral is processed, you should hear from the NHS e-Referral Service - usually by letter, text, or email. This will include a booking reference number and a password so you can arrange your appointment.

You can use these to book your appointment online at the NHS e-Referral website (refer.nhs.uk), by phone, or sometimes through the NHS App.

The e-Referral Service typically offers you a choice of providers - often including NHS hospitals and, in some cases, independent sector providers that are NHS-funded. You choose one and book a time that suits you.

This is also where your Right to Choose comes in. In England, you can choose any clinically appropriate provider that meets NHS standards - including some private hospitals that offer NHS-funded care. You don't have to take the first option you're given. Note that this right does not apply to urgent suspected cancer referrals.

Your first appointment with the specialist is called an outpatient appointment or first outpatient attendance. This is usually an assessment rather than treatment - the specialist will review your situation and decide what, if anything, happens next.

This is one of the most important - and most misunderstood - parts of the NHS referral process.

The NHS has an 18-week Referral to Treatment (RTT) standard. From the point your referral is received, the NHS aims to start your treatment within 18 weeks. Once your referral is accepted, you are added to an NHS waiting list for your specialty. In practice, many patients currently wait longer than 18 weeks - the NHS is working to restore full compliance with this standard.

For most referrals, the clock starts when the referral is formally received by the specialist service. For NHS e-Referral Service bookings specifically, it starts on the day you book your appointment using your booking reference - or, if no appointment slots are available when you try, the day you first attempt to book. In all cases, the clock does not start when your GP agrees to refer you, and not when you receive a booking letter.

There are also circumstances where the clock can be temporarily stopped - for example if you are unavailable for appointments for a period of time.

If several weeks have passed since your GP agreed to refer you and you have received nothing from the e-Referral Service, do not wait.

Start by calling your GP surgery. Ask reception whether the referral has been sent, when it was sent, and which service it went to. Some surgeries will keep you updated - many won't.

Check the NHS App. As of April 2026, the NHS App shows referrals and appointments at every acute NHS trust in England, with around two-thirds of hospital appointments currently visible. Some referral and appointment information may take a few days to appear. Check the NHS App to see whether your referral or appointment details are available.

Contact the hospital or service directly. If you know which service you have been referred to, you can call their appointments team directly and ask whether a referral has been received in your name.

If the referral was never sent, ask your GP to send it immediately and confirm the date it was submitted. Your 18-week clock should start from the date the referral is received by the specialist service.

Not all referrals follow the same process. It helps to know which type you have been given.

The most common type. Used for non-urgent conditions where waiting several weeks or months is clinically acceptable. These follow the standard e-Referral process described above.

Used when your GP believes you need to be seen more quickly - typically within a few weeks. The referral is flagged as urgent and the specialist service is expected to prioritise it.

If your GP suspects cancer or needs to rule it out, they can refer you urgently onto a suspected cancer pathway. The current standard is the Faster Diagnosis Standard (FDS): you should receive a diagnosis, or have cancer ruled out, within 28 days of your referral. Receiving this type of referral does not mean your GP thinks you have cancer - it is a precautionary step to investigate symptoms that could, in some cases, indicate cancer.

Some services - such as physiotherapy, talking therapies, and certain diagnostic services - allow patients to self-refer without going through a GP at all. These are covered in the FCC guide to NHS self-referral services.

The NHS Constitution sets out rights that apply to you as a patient during the referral process.

If you feel your referral has been unreasonably delayed, your first step depends on where the problem lies. For problems with your GP sending the referral, speak to your GP practice manager. For delays after the referral has been received by the hospital, contact the provider's Patient Advice and Liaison Service (PALS), which can investigate on your behalf. You can also contact your local Integrated Care Board (ICB) - the NHS organisation responsible for commissioning services in your area; if you have waited beyond the 18-week maximum, the ICB has a legal duty to take reasonable steps to offer you a suitable alternative provider. Complaints not resolved locally can be escalated to the Parliamentary and Health Service Ombudsman.

This article summarises publicly available information from UK health authorities.