Your rights
You do not have an absolute right to any specific referral, but you do have the right to have your request considered fairly and to be given a clear clinical reason if it is refused. The NHS Constitution says you have the right to access clinically appropriate services.
A GP refusing a referral because of cost, wait times, or personal preference is not a valid clinical reason. You are entitled to challenge this.
Valid vs invalid refusal reasons
Valid reasons:
- The condition does not require specialist input and can be safely managed in primary care.
- The requested treatment is not available on the NHS or is not indicated for your condition.
- There is a specific clinical contraindication to the referral.
Invalid reasons:
- "The wait is too long." (Not your problem — use Right to Choose.)
- "We don't refer to that service." (Unless it is not NHS-funded, they must consider it.)
- "You don't meet the criteria." (Ask for the criteria in writing and check they are applying them correctly.)
- "It's a waste of NHS money." (Resource allocation is not a GP's basis for refusing individual referrals.)
How to appeal
Step-by-step:
- 1. Get it in writing. Ask the GP to document the refusal and clinical reasoning in your record or in a letter.
- 2. Second opinion. See a different GP at the same practice. Bring evidence of why referral is needed.
- 3. Practice manager. Write setting out the facts and ask for a formal review of the decision.
- 4. Right to Choose. In England, pick any NHS-funded provider and ask your GP to process the referral.
- 5. ICB involvement. Contact your Integrated Care Board if the practice is systematically refusing referrals.
Right to Choose
Right to Choose is one of your strongest tools. Your GP must refer you to any NHS-funded provider in England that offers the service. They cannot refuse because it is not local or because they prefer another provider.
Private alternatives
If the NHS route is completely blocked and you can afford it:
- Pay for a private specialist consultation.
- Ask the private specialist to write to your NHS GP with their findings and recommendations.
- Some GPs will take over prescribing or monitoring under shared care once a specialist has assessed you.
When to complain
A single refusal with a clear clinical reason is not a complaint matter. A pattern of refusal, refusal without documented reason, or refusal that ignores NHS guidance is.
- Stage 1: formal complaint to the practice manager.
- Stage 2: escalate to the Integrated Care Board (ICB).
- PHSO: if the ICB does not resolve it and you have evidence of harm or systemic failure.
Frequently asked questions
›Can a GP refuse to refer me to a specialist?
Yes, but only if they have a documented clinical reason. A GP cannot refuse a referral because they think the wait is too long, because they personally disagree with the specialty, or because they are trying to save money. If you disagree with the refusal, you have options.
›What is the appeal process for a refused NHS referral?
Step 1: ask for the refusal in writing with clinical reasoning. Step 2: request a same-practice second opinion. Step 3: ask the practice manager to review the decision. Step 4: use NHS Right to Choose in England to pick any NHS-funded provider. Step 5: file a Stage 1 practice complaint if the refusal is unreasonable.
›Does Right to Choose apply if my GP refuses a referral?
Yes. In England, you can use Right to Choose to self-refer or ask your GP to refer to any NHS-funded provider. Your GP must process the referral if the provider is NHS-funded and offers the service. A GP cannot refuse solely because they do not agree with your choice.
›Can I go private if the NHS referral is refused?
Yes. You can pay for a private consultation and ask the private specialist to write to your GP. Some GPs will then take over care under shared care arrangements. You cannot force this, but a clear specialist letter helps.
›How long do I have to appeal a referral refusal?
There is no formal statutory deadline for challenging a referral refusal, but the sooner you act the better. If you end up at PHSO, they usually expect you to complain within 12 months of the event.