What is a downgrade from an urgent to a routine referral? 

A GP, after assessing a patient, may feel that a referral needs to be made to the hospital for further investigation; this can be a routine, non-urgent referral but some referrals are deemed urgent, such is in respect of suspected cancer. Another common urgent referral made by a GP is to cardiology.  

However, on receipt of the referral, the hospital holds the ultimate power to arrange review and investigation and on some occasions, the hospital does not agree with the GP as to the urgency of the referral. In such circumstances, they can downgrade the referral to a routine pathway, which would mean that assessment would not take place as quickly.

On the GP making an urgent referral, they typically state to patients to either chase the GP or the Hospital if they have not heard anything from the Hospital within 2 weeks. The reason for this that, although it should not happen, instances can occur where a downgrade is not notified to either the patient or the GP.  

Why may a downgrade happen? 

• Triage errors: The hospital’s triage team may have incorrectly assessed the referral as less urgent than it actually is. 

• Lack of capacity: The hospital may be facing capacity issues and might be downgrading referrals to manage the waiting list. 

• Missing information: The initial referral may have lacked sufficient information for the hospital to properly assess the urgency. 

At Williamsons, our Clinical Negligence department have experience in representing individuals and families of Deceased individuals who have suffered injury as a result of a downgraded referral. One such example is of an urgent cardiac referral being negligently downgraded to routine in spite of red flag symptoms for cardiac disease and also without notifying the patient; whilst awaiting cardiac assessment, the patient suffered a cardiac arrest and sadly died. This would have been avoided, had the urgent referral taken place. 

If you or a loved one has had an urgent referral downgraded, which has consequently resulted in greater harm, then please call our offices on 01482 323 697 to discuss how we can help.