Chart of the week: The alarming drop in referrals from GPs to hospital services since the Covid-19 outbreak

Each week, we'll be taking a look at a different aspect of the Covid-19 pandemic, presenting our analysis of the data in chart form to illustrate some key issues and invite discussion. This week, Jessica Morris highlights how the fallout from Covid-19 and calls to scale back services to protect the NHS from overload led to a major fall in GP referrals to hospital services.

Data story

Published: 18/06/2020

Covid-19 has brought significant changes to the NHS, from the need to delay planned services to free up inpatient and critical care capacity, to stopping face-to-face outpatient appointments unless absolutely necessary.

We’ve used weekly data from NHS Digital to investigate how the number of GP referrals to these kinds of services has changed since last autumn.

The chart shows a sharp drop in GP referrals over the Christmas and New Year period, which is generally the case, and then a rapid recovery to a peak of 380,503 referrals in the week beginning 20th January. Following the Covid-19 outbreak, partly in anticipation of the scaling back of hospital care, but also possibly due to fewer people presenting at GP surgeries, the number of GP referrals started to fall dramatically from the beginning of March. 

By mid-April, all referrals had fallen significantly, with routine referrals decreasing by 90%.  Urgent referrals and two-week referrals for suspected cancer had fallen by 78% and 67% respectively. Although these services have been protected to some extent, these falls are especially worrying given the higher risk of harm to patients from treatment being delayed.  

Referrals have started to increase again at a much slower rate than which they fell. Unfortunately, the lack of ability to bounce back to the normal level of GP referrals is likely to create a large backlog of cases that will cause waiting lists to soar, and shows that the NHS will not be returning to normal any time soon.

GP referrals during Covid-19 outbreak 17/06/2020



Suspected cancer refers to patients on a pathway with a maximum two-week wait target.


Nuffield Trust analysis of NHS Digital data.

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This chart uses weekly data from NHS Digital on referrals performed through the NHS e-Referral Service (e-RS) in England. The NHS e-RS is a digital platform used to refer patients from primary care into elective care services. All GPs in England use e-RS to make referrals for outpatient services, and it provides a way for patients to choose their first hospital or clinic appointment. Bookings can be made online, by telephone, or at the GP surgery at the time of referral.

The data includes referrals for all priorities, specialties, and clinic types. Referrals for suspected cancer are separate as these patients are on a pathway with a maximum two-week wait target for a first consultant appointment. The data does not include information on patients that have had a referral outside of e-RS.