Around 127,000 patient referrals disappeared from the NHS e-Referral system (e-RS) between February and July, according to a report by the Health Services Safety Investigations Body (HSSIB). This technical flaw means that patients may have been left waiting for specialist care, guidance, or advice that never reached them.
Doctors have described the issue as "dangerous," warning that some patients' conditions could have worsened considerably as a result of the delays. Dr. Dean Eggitt, a senior GP, told the Daily Mail that this situation could lead to patients feeling sicker or even facing death if they do not receive timely medical attention. The e-RS is utilized by healthcare professionals in England to refer patients to hospital specialists for further evaluation.
System Flaw and Pressure
The e-RS has an integrated 180-day rule, which automatically removes referrals if no action is taken within six months. This measure was originally implemented in 2004 to manage unprocessed referrals when waiting lists were significantly shorter. Currently, the NHS is facing immense pressure, with nearly 7.4 million people awaiting routine hospital care, including over 113,000 who have been waiting for more than a year. The HSSIB report indicates that this excessive demand on the health service increases the risk of patients "dropping off" the electronic system.
During the period from February to July, the HSSIB identified that over 1.3 million referrals were removed after exceeding the 180-day limit. While NHS England stated that most of these had likely been processed, approximately 127,450 were new referrals that may not have been reviewed by hospitals, leaving patients waiting for appointments.
Recurring Incidents
The issue only came to light after GPs reported concerns about patients not hearing back from specialist services. The investigation also uncovered similar incidents in previous years, including 72 referrals vanishing in 2018 and over 1,000 patients potentially being removed from waiting lists in 2019. Between 2023 and 2024, another 1,000 patients had to be reinstated after disappearing from the system.
Rachel Power, chief executive of the Patients Association, commented that patients frequently feel "forgotten by the NHS." She emphasized that managing referrals is a critical part of clinical care, and failures in this process can lead to significant harm. While the HSSIB found no direct evidence of harm, it could not exclude the possibility that some patients' conditions deteriorated while they waited, potentially requiring more aggressive treatment.
NHS Response
NHS England acknowledged that the e-RS was not designed to handle the current volume of referrals. The service stated it would update guidance on the risks associated with the 180-day rule and share it with local providers. They also affirmed that no patient should ever wait 180 days for a referral to be processed and that NHS guidance prohibits using e-Referral services for managing waiting lists. Efforts are underway to ensure NHS trusts identify and act on behalf of patients with the longest waiting times.