Your GP has declined a referral. Or it was made three months ago and nothing has happened. You're deteriorating in the gap — and nobody seems to be managing the situation.
This is one of the most common problems I help clients navigate. The system has processes for this. Most people don't know them.
Your legal right to a referral
Under the NHS Constitution, you have the right to be referred to a consultant if your GP thinks it's clinically necessary. If your GP disagrees, you have the right to ask for a second GP opinion within the same practice. If you're still unsatisfied, you can register with a different practice and request the referral there.
You also have the right to choose which hospital you're referred to for your first outpatient appointment — this is called NHS Choice, and it's underused. If the waiting list at your local hospital is 26 weeks, another trust may have availability in 8.
When a referral stalls
The NHS Constitution states that you should wait no more than 18 weeks from GP referral to the start of treatment. This is the Referral to Treatment (RTT) target. If you're approaching or exceeding this, you have grounds to escalate.
Start with the Patient Advice and Liaison Service (PALS) at the relevant hospital trust. Provide your referral date, the 18-week target, and request an update with a specific timeline. Document everything in writing.
Escalation framework
If PALS doesn't resolve it, escalate to a formal complaint through the hospital trust's complaints procedure. If the trust doesn't resolve it satisfactorily within the required timeframe, you can take it to the Parliamentary and Health Service Ombudsman.
For clinical commissioning disputes — where the issue is that your area's ICB won't fund a particular treatment — there are separate processes involving Individual Funding Requests (IFRs).
What I do for clients
I draft formal letters and complaints with clinical precision. I research the evidence supporting the referral to make the case as strong as possible. I track every stage of the process and follow up systematically. The goal is to move the bureaucracy — with evidence, persistence, and the right pressure applied to the right people.