More than 120,000 referrals ‘disappeared’ from NHS system this year – ‘dangerous’ process means patients are waiting for care that will never arrive

Patients awaiting specialist NHS care completely disappeared from an electronic NHS system earlier this year, a safety watchdog has found.

A report by the Health Services Safety Investigations Body (HSSIB) has revealed that around 127,000 referrals vanished between February and July. 

That means patients may have been waiting for care, guidance or advice that never arrived.

Doctors have described the flaw as ‘dangerous’, adding that some will have seen their condition worsen considerably as a result. 

‘This will contribute to patients feeling even more unwell, or possibly even death if they’re not seen when they need to be,’ Dr Dean Eggitt, a senior GP working in Doncaster, told the Daily Mail.

The report relates to the NHS e-Referral Service (e-RS), used by GPs and other professionals in England to refer patients to hospital specialists. 

For example, a patient suffering persistent headaches may be referred through the system to a neurologist for further investigation.

Concerns have been growing about pressure on the system, with referrals up by around 40 per cent between 2019 and 2025. 

The tech has an in-built 180-day rule – referrals are automatically removed after six months if no action has been taken.

This was introduced in 2004 to prevent a backlog of unprocessed referrals, when waiting lists were far shorter than they are today. 

Currently, almost 7.4 million are awaiting routine hospital care, including more than 113,000 who have waited more than a year. 

This excess demand on the health service has increased the risk of patients ‘dropping off’ the electronic system, the report said.

From February to July, the HSSIB said 12.4 million referrals and requests for specialist advice were submitted through the system. 

More than 1.3 million were removed after sitting in the system for more than 180 days, most of which had likely been reviewed or processed, according to NHS England.

However, around 127,450 were new referrals that may not have been looked at by hospitals.

These patients are likely to have been waiting to hear about an appointment.

The HSSIB said the problem only came to light after GPs raised concerns that patients had not heard from the specialist services they had been referred to. 

The investigation also uncovered similar incidents dating back several years.

One involved 72 referrals vanishing in 2018, while another saw more than 1,000 patients potentially drop off a waiting list in 2019. 

Between 2023 and 2024, another 1,000 patients had to be reinstated after ‘disappearing’.

Rachel Power, chief executive of the Patients Association, said patients regularly feel ‘forgotten by the NHS’.

‘The public should not have to worry that the NHS will lose track of them,’ she continued.

‘Managing referrals is too often treated as an admin task, but it is part of patients’ clinical care and when it fails, people can come to real harm.’

Although the HSSIB found no evidence of direct harm, it could not rule out that some patients’ conditions worsened while they waited.

As a result, this means they may have needed more aggressive treatment than if they had been seen sooner. 

NHS England told the HSSIB e-RS was not designed for the volume of referrals it now receives. 

It said it would update guidance on the risks of the 180-day rule and share it with local providers.

‘But no one should ever wait 180 days for their referral to be processed in any circumstance,’ the health service added in a statement.

‘NHS guidance is clear that e-Referral services should not be used to manage waiting lists and we are working with NHS trusts to ensure they identify patients who are waiting the longest and take appropriate action to get them the care they need.’