The Problem With Urgent Care Referrals

June 2026 was the busiest month on record for NHS A&E, with average daily attendances exceeding 80,000 for the first time. NHS England described it as a "summer onslaught." The standard response, when something like this happens, is to talk about capacity: more staff, more space, more resource. But a large proportion of those A&E attendances don't need to be there at all. They're there because the pathway that was supposed to catch them earlier didn't work fast enough.

What the urgent care referral pathway is supposed to do

The theory is straightforward. A patient presents to a GP, paramedic, or 111 service with something that needs a clinical review. The clinician assesses them and makes a decision: manage here, refer to a specialist, or send to A&E. That decision, made at the right time and with the right information, is what keeps urgent care pathways functioning.

The problem is that the decision is often made without the specialist input needed to make it confidently. A GP who isn't certain whether a presenting symptom needs emergency assessment has two options: refer to a specialist and wait, or send the patient to A&E and let them be triaged there. When the first option is slow, the second becomes the default.

Why urgent care referrals are too slow

Speed is important in urgent care in a way it doesn't always matter elsewhere. A referral that takes 48 hours to get a response might be perfectly acceptable in a planned care pathway. In urgent care, 48 hours means a patient either waited at home with unresolved clinical uncertainty, or ended up in A&E in the meantime.

The standard Advice and Guidance route through eRS was not designed for this. It's an asynchronous process: the GP submits a request, the specialist responds when they can. For planned care, that's manageable. For urgent decisions, it doesn't fit the clinical need.

The result is predictable. Clinicians stop using A&G for urgent cases because it isn't fast enough. The pathway defaults to A&E, which is available immediately, even if it isn't the most appropriate setting for the patient.

Why urgent care referrals are too complex

The other issue is information. A specialist receiving an urgent referral needs enough clinical context to make a safe decision quickly. In practice, referrals often arrive incomplete: missing imaging, insufficient clinical history, no indication of what the reviewing clinician actually needs to know.

This triggers back-and-forth. The specialist requests more information, the GP provides it, the clock runs. By the time a decision is reached, the clinical situation may have changed. The patient may already have presented elsewhere.

Reducing that complexity isn't about asking GPs to do more work at the point of referral. It's about giving them tools that make it easy to share the right information first time, so the specialist can make a decision without needing to ask for more.

What changes when the pathway works

Services that have redesigned their urgent care referral pathway around faster, better-informed clinical communication have seen results worth taking note of. 

When a GP or paramedic can reach a specialist directly, by message, call or shared image, and get a response in minutes rather than hours, the pathway starts to function the way it was designed to.

In fact, in Gloucestershire 87% of patients who went through Cinapsis avoided the Emergency Department, and were treated in the community - that’s £2.1m saved in appointments. 

Patients who need secondary care get there faster, with the specialist already briefed. Patients who don't need secondary care are managed safely without going to A&E. The specialist's time is used for cases that genuinely need their input, not for triaging referrals that shouldn't have been sent at all.

The question worth asking

When an urgent care pathway consistently routes patients to A&E, the instinctive response is to look at A&E: more capacity, faster triage, better flow. But the patients arriving at A&E made a journey to get there. Somewhere earlier in that journey, a different decision could have been made.

The question is whether the pathway gives clinicians the tools to make that decision confidently and quickly enough. In most cases, the honest answer is that it doesn't, not yet. Read how one ICB changed that with Cinapsis: Urgent Care Case Study. Or find out more about how the platform works.