Private health and protection insurance expert and editor
If you’re not feeling 100% or you’re worried about your health, your GP (general practitioner) should be your first port of call, but what happens if your condition needs further investigation? To give you an idea of what might happen next, we look at how the GP referrals process works.
A GP referral is a written communication from your GP to another medical professional seeking their help to assess your needs. GPs make referrals because they believe your symptoms need further investigation by a specialist.
In their letter, your GP will set out your symptoms and medical history and explain why they are referring you. If you’ve had any tests beforehand, they’ll also list the results.
Your GP will refer you to a specialist, whether that’s to a department in a hospital or for another service such as physiotherapy.
However, your GP can also refer you to other more general wellbeing-led services, such as stop smoking and weight-loss programmes. Not all wellbeing services are free on the NHS so be aware that you may have to pay to access some of them. Your GP will let you know this when they discuss your options.
If you want a referral to a specialist, you’ll have to make an appointment to see your GP. They’ll discuss your concerns and ask you about your symptoms.
While you’re entitled to ask for a referral, your GP will only refer you if they believe there is clinical need. With this in mind, they may arrange for you to have some tests or try an alternative treatment first.
Your GP will have access to your medical history. Alongside any symptoms you’re experiencing, this extra information can give them a clearer idea of your overall health. They can then note down anything a specialist might need to know (for example, whether you have a family history of a certain condition or if you’ve experienced it before).
A GP referral is essentially your doctor asking a specialist to investigate your case. When they make your referral, they will set out relevant information, including:
If you want, you can also ask to see a copy of your referral form, or have a copy sent to you as well.
Your referral will be assessed (triaged) by the hospital or specialist that your GP has applied to. You should receive a letter within a couple of weeks detailing what will happen next. For example, you will either be contacted by the hospital or service you were referred to, or you will hear from your GP instead.
If your referral is successful, the hospital (or other service) will contact you directly. They will either ask you to contact them to make an appointment or give you a date and time to see the specialist. If you can’t make the appointment they’ve arranged, you should let the hospital know as soon as possible. They can then give that slot to someone else and rearrange yours. Of the 122 million hospital appointments that were made between 2021 – 2022, just over 6% were missed. That works out at around 7.8 million a year or 650,000 each month.
Alternatively, you may be given a reference number which you can use to make an appointment using the NHS e-referral service.
You may have a choice of who you see. If you do, your GP should discuss this with you at the time they make the referral.
If you have private health insurance, it’s still considered best practice to have a GP referral for specialist care, but it’s not always necessary.
Some health insurers will let you bypass your GP and allow you direct access to specialist care under certain circumstances. For example, with Bupa’s Direct Access scheme, you can refer yourself if you’re experiencing joint or bone pain or notice any early signs of cancer.
Each health insurer will have their own process for arranging consultations and diagnostics, so remember to check your policy documents first.
If your condition isn’t urgent, you should be seen within 18 weeks from your referral. It may be longer if it’s considered ‘clinically right’ for you to wait or if you choose to defer treatment.
If you’ve booked your referral using the NHS e-referral site, you’ll be able to track its progress online. If not, and you’re waiting for the hospital to contact you with an appointment, bear in mind that it could be a few weeks before you hear anything. However, if you’ve been waiting a while, you should contact the hospital directly.
If you’ve asked to be referred for private medical treatment, you should contact your provider for help.
Your GP is not obliged to refer your case to a specialist if they don’t feel you need to see one. If you don’t agree with your GP’s decision and would like another opinion, you can ask to see another doctor or health professional.
It’s worth noting the NHS makes it clear that you’re not entitled to a second opinion by law. However, doctors and health professionals will generally always refer your case to someone else if you’re not happy with their decision.
Open referrals generally apply to private health insurance. It’s when your GP does not specify a particular consultant by name. Instead, it will simply state what specialism is needed (for example, gynaecology).
This is because some private health insurance plans have restrictions on which hospitals or consultants you can see (known as guided lists or restricted lists). Leaving your referral open in this way, means you’ll be able to access private treatment according to what’s covered in your policy.
Most private health insurance policies provide access to a GP 24/7. This can mean you’re able to secure a referral faster compared to waiting for an appointment with a GP at your local practice.
This doesn’t automatically mean you’ll get a referral, it just means you may be able to see a GP quicker.
Don’t forget, some private health insurance policies also give you direct access to some specialists (such as physios). If this is the case, you’ll be able to self-refer rather than wait for a GP’s referral.
If you want more information about what private health insurance can offer and whether it’s right for you, we’ve put together these informative, in-depth guides:
Disclaimer: This information is general and what is best for you will depend on your personal circumstances. Please speak with a financial adviser or do your own research before making a decision.
Chris Steele is myTribe’s resident expert in private health insurance and healthcare, with over a decade of experience in the field. As a Chartered Insurance Institute (CII) qualified professional, he has helped countless consumers navigate private medical insurance. Regularly quoted by national media, Chris is a trusted voice in the UK insurance industry, with his insights featured in leading consumer finance publications.
Yes, GP referrals are free. Even if you need a referral to access private care, you will not be charged for it.
There may be some incentives for doctors who refer to particular hospitals or networks within the private sector. However, there are strict guidelines about what’s acceptable and healthcare professionals should not accept payments designed to encourage referrals.
