Writing effective referrals to secondary care

Guidance for GP practices on writing effective referrals to secondary care, including use of local pathways, key clinical information, and practical tips to support safe triage and reduce delays.

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Good referrals help ensure that patients reach the right service with the information specialists need to make safe and timely decisions. Clear referrals can also reduce unnecessary delays, repeated requests for information, and unnecessary back-and-forth through Advice and Guidance exchanges. 

This page sets out practical guidance on what makes a helpful referral to secondary care.
It is intended as support rather than a prescriptive rule set. Clinical judgement should always take precedence.

Start with the pathway 

Before referring, check whether a local pathway or referral criteria exist. Where pathways exist, they should be clear, accessible and clinically reasonable. 

Local pathways may describe: 

  • referral thresholds 
  • recommended initial investigations 
  • information needed to triage safely 
  • alternative community services that may be appropriate 

Including key investigations or information requested in the pathway will usually help the receiving team triage the referral more efficiently and reduce avoidable delays or rejection. Pathways should also remain clinically appropriate and proportionate, and should not require investigations or processes that would normally sit within secondary care.

What specialists usually need to know 

Most specialists are looking for three things:

The clinical problem

What is happening with the patient?

The reason for referral:

What input is being sought? What question do you want the specialist to answer?

Relevant clinical information

A concise summary of key findings. Short, focused explanations are usually more helpful than full consultation transcripts. 

Common reasons for a referral include:
  • diagnostic advice 
  • management advice 
  • consideration of a specific intervention 
  • assessment for a procedure 

A practical “minimum information” checklist 

Although requirements vary by specialty, most referrals benefit from including the following information where relevant. 

Reason for referral

A brief statement of the clinical question or purpose of the referral. 

Relevant history

Key symptoms, duration, and any important positive or negative findings. 

Examination findings. 

Relevant physical examination findings.

Investigations already performed

Results and dates if applicable. 

Management already tried

Treatments already initiated in primary care and response. 

Relevant background information, for example: 

  • significant past medical history 
  • medication where relevant 
  • allergies if relevant to treatment decisions 
  • functional impact where relevant (for example mobility, work or daily activities)

Urgency and risk factors

If the referral is urgent, briefly explain why. 

Referral templates and forms 

Many services provide referral templates or structured forms. These should normally be developed through appropriate local governance processes, including ICB oversight and engagement with LMCs, to ensure they are clinically appropriate, proportionate and workable in practice.

When forms are helpful

These can be helpful where they clearly set out the information needed to triage referrals safely and efficiently. Practices may therefore find it useful to use these forms where they are well designed and aligned with local pathways. Many forms will also auto-extract relevant coded information to support the referral. 

Referrals are not dependent on forms

It is important to remember that a referral is fundamentally a clinical communication between professionals. A clear and well-structured referral letter that contains the relevant information remains a valid referral even if it is not submitted on a specific template. The quality of the clinical information is therefore more important than the format used. 

Avoid rejecting referrals on format alone

Equally, services should avoid rejecting referrals solely because a particular form has not been used if the referral itself contains the necessary clinical information. 

Advice and Guidance

Advice and Guidance (A&G) systems allow clinicians to seek specialist advice about a patient before or instead of referral. A&G can be helpful in some situations but is not intended to replace referral where specialist assessment is required. 

A&G may be helpful where: 

  • a specific clinical question exists 
  • advice may allow the patient to be managed in primary care 
  • clarification of investigation or management is required 

Where A&G is used, a clear clinical question and relevant clinical information will help the specialist provide a useful response. 

Further guidance on the use of A&G and evolving contractual expectations is published separately on the SSLMC website. 

Referrals from multidisciplinary teams 

In many practices, referrals may be initiated by clinicians from a range of professional backgrounds. 

Practices should ensure appropriate clinical supervision and governance arrangements are in place for non-medical referrers. 

This helps ensure referrals are clinically appropriate and provides reassurance to secondary care teams who may not be familiar with individual clinicians’ experience.

Working well across the primary–secondary care interface 

Improving referrals is part of a broader effort to strengthen collaboration across the primary–secondary care interface.

National work led by the Getting It Right First Time (GIRFT) programme highlights the importance of clear communication, agreed pathways and shared understanding between services to improve care and reduce delays.

Referral quality is therefore a shared system responsibility, supported by: 

  • clear pathways 
  • accessible diagnostics 
  • timely specialist advice 
  • good communication between clinicians 

Further information

Useful national guidance includes: 

Practices should also refer to local clinical pathways and referral guidance where available.