No More Lost Patients: Close the NHS Referral Black Hole for Good
By Professor Kevin Moore and Dr. Amar S. Bhogal
The “referrals black hole” described this week is not news to most clinicians, yet it remains unacceptable (1,2). Every day, patients are left waiting because referrals disappear into systems that are fragmented, outdated, and impossible to track. Emails route to personal inboxes that no longer exist. Requests vanish into unmanaged mailing lists (3). What does it mean? No oversight, no visibility, and no clinical safety net.
For over 20 years I have copied in patients to every letter and referral made on their behalf. It keeps patients informed so that they know a referral has been made. Yet GPs are compelled to make referrals via the electronic referral system [eRS] which does not send a copy of the referral to the patient. Why not? The eRS is poorly designed. It allows GPs to upload referrals that can be a mix of random data (over 100 pages) or a well-structured history and a call for help. In one referral I received, the triage doctor helpfully left a note to say the information for the referral was on page 84.
Referrals should be on one page to state the problem, outline previous treatments and pose the question being asked. What else? A few accompanying results or investigations.
If eRS copied the patient into every referral, it would keep the patient in the loop who would then know that a referral has been made. Expecting patients to simply rely on someone’s word that a referral has been sent is not good enough. As recent reports show, the current system can no longer be trusted. How have we gotten to this abyss where 14% of referrals get lost in the system?
Patients suffer the consequences: delayed diagnoses, stalled treatment, and avoidable harm (1-3).
This is precisely why we developed software such as Salutare ONE Referral. Better systems are urgently needed. It can work with the infrastructure already here and can be linked through eRS to generate the referral. GPs and hospital consultants can then update the comments and track progress.
As clinicians, we know how challenging the referral process can be. Hospital referrals sit hidden behind layers of complexity; some routed through email chains, dependent on personal inboxes that may no longer be monitored, or lost entirely in systems without proper safety checks. Patients are the ones who suffer when referrals fall through the cracks. It is damning that this figure lies close to 14% (1-3). We need to act now.
ONE Referral provides a simple answer to these systemic failures.
It is a centralised, streamlined software designed to simplify and safeguard referral pathways. Whether for Specialist referral, Multi-Disciplinary Team (MDT) discussions or inter-hospital referrals, ONE Referral creates a single, reliable route for referrals to be submitted, tracked, and reviewed. It delivers full transparency for the patient journey. The software has full tracking so that patients and clinicians can see exactly what has happened when for example when written, when received, and any new actions.
Now deployed across several NHS sites as part of a multi-centre evaluation in both cancer and non-cancer MDTs, ONE Referral is demonstrating real operational gains that come from replacing improvised systems with structured clinical workflows.
A good solution demands these elements
Asynchronous collaboration: Teams can progress cases without waiting for fixed meeting slots, ensuring decisions move at the pace patients need.
Collaborative input: Clinicians can involve the right specialists instantly; for advice, second opinions, task allocation, or joint decision-making. All within one coordinated workflow.
Data integrity and governance: ISO27001 and ISO9001 compliant, with COSD-ready data exports that support clinical governance, audit, and research while reducing administrative burden.
Modernising referrals is not an optional upgrade – it is a patient safety requirement. ONE Referral strengthens the backbone of safe clinical care, reducing risk, increasing efficiency, and ensuring that no patient is ever “lost in the system” again.
References
Healthwatch England. One in seven patients stuck in GP referrals ‘black hole’. 2025 Dec 8.
Campbell D. ‘Referrals black hole’ means patients in England miss out on healthcare, finds watchdog. The Guardian. 2025 Dec 7.
Healthwatch England. GP Referrals: Part 1 – The referrals black hole. April 2023 [cited 2025 Dec 15]. Available from: https://nds.healthwatch.co.uk/sites/default/files/reports_library/20230301%20GP%20Referrals%20Briefing1_FINAL.pdf nds.healthwatch.co.uk
About the Authors
Dr. Kevin Moore is a Liver Expert for the Courts, where he provides an independent opinion on the care provided by other doctors. As a Professor of Hepatology and Clinical Pharmacologist at University College London, his expertise in drug safety monitoring and adherence to national guidelines provides a unique perspective on the healthcare system's successes and failures. With over two decades of specialized experience in liver transplantation and general hepatology, he brings substantial clinical and academic authority to both patient care and medical-legal evaluations, along with a keen understanding of the practical challenges facing modern healthcare delivery.
Kevin Moore at UCL, Royal Free has authored over 100 research papers with an H index of 64 and is the author of the Oxford Handbook of Acute Medicine.
Dr. Amar S. Bhogal is a junior doctor in the United Kingdom, dedicated to enhancing patient outcomes through the integration of advanced healthcare technologies. He has a robust background in medical research, having served as a Research Assistant at University College London's Institute for Liver and Digestive Health. His work has been pivotal in exploring the application of remote technology to support acute inpatient and transitional care, particularly for individuals with chronic obstructive pulmonary disease (COPD).
Beyond clinical medicine, Dr. Bhogal has held leadership roles in both the publishing and education sectors. He worked with Elsevier as a commissioning and managing editor for oncology journals, playing a key role in curating and advancing high-impact scientific research. Additionally, he served as a director for an educational startup focused on supporting children from disadvantaged backgrounds, demonstrating his commitment to widening access to education and fostering opportunities for young learners.
Passionate about the transformative potential of healthcare technologies, Dr. Bhogal is focused on leveraging innovative solutions to improve clinical practices and patient care.
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