Health Services: Waiting Lists

National Health Service providers should only reject referrals in limited circumstances, including if they are deemed clinically inappropriate, the service the patient was referred to is inappropriate, or further information is required. Redirection should be considered as an alternative to rejection where the referral is appropriate, but where a more suitable clinic or service exists. Referrals should not be rejected due to capacity constraints.

NHS England has not issued a unified piece of national guidance setting out the prescribed circumstances in which NHS trusts may reject referrals. However, the relevant principles for this are set out in the NHS Standard Contract and a range of supporting documents.

Between July 2024 and May 2026, 37,815,595 referrals were received through the e-Referral Service. Only 1.1%, or 407,757, of those referrals were assessed by the receiving clinician as not clinically appropriate for the booked service and returned to the referrer for further action, which may include alternative management or re-referral.

The Department does not centrally hold data on the proportion of referrals rejected on administrative grounds or due to service capacity constraints. As above, providers should not reject a referral due to capacity constraints.

The Department has not made an assessment of the impact of rejected referrals on NHS waiting lists.