GPs have been ordered to delay referring at least one in four patients to hospital as Labour scrambles to meet NHS waiting list targets.
Health officials say the move will reduce ‘unnecessary’ appointments and allow people with genuine need to see a specialist faster.
But critics warn the rationing is aimed at ‘massaging’ the figures and risks preventing sick patients from accessing critical treatment.
Under a new GP contract that comes into effect from Wednesday, family doctors will have to seek permission to refer some patients to hospital.
Critically, the decision on whether the patient can be referred, and therefore added to the official waiting list, will be taken by someone who has not seen them.
Dr Luke Evans, the shadow health minister and a former GP, told The Telegraph: ‘My biggest concern is about this single point of access, with a target to bounce back one in four referrals – that is bad for clinicians and it is really bad for patients.
‘It is hard not to see this as a way of simply controlling access to hospitals and massaging waiting lists.
‘We don’t even know if the planned 1 in 4 patients bounced back to the GP are recorded. Is Labour planning on effectively rationing secondary care – it seems like it.’
Dr Luke Evans, a shadow health minister and former GP, said the policy appeared to be aimed at massaging waiting lists
Over the past year, GPs have been paid £20 for every case where they seek ‘advice and guidance’ (A&G) from a consultant rather than sending a patient to hospital.
But from April 1, the previously voluntary scheme, which aims to ‘support elective recovery by reducing unnecessary referrals’, will become mandatory in the NHS.
Experts say the new rules, which will require GPs to stop 25 per cent of referrals, are dangerous and will make getting on to a waiting list even harder.
Dr Ankit Kant, a GP from West Norfolk, said some requests for A&G had taken eight months to receive a response, including a case where the patient died waiting.
The guidance then concluded the patient had not needed to see a specialist.
Dr Katie Bramall, chairman of the British Medical Association’s GP committee, said the risks of the scheme are ‘a huge concern for every single GP I meet and speak to’.
‘It should be a huge concern for every patient too,’ she added.
She said the policy was ‘awful for patients’ and politically driven.
Dr Katie Bramall, chairman of the British Medical Association’s GP committee, said the risks of the scheme are a huge concern for every single GP
GPs have raised concerns that their decisions to refer patients are being overruled by doctors without proper knowledge of the cases, resulting in delays in diagnosis.
Wessex Local Medical Committee said that GPs had highlighted risks where some hospital trusts had made A&G mandatory.
‘When a GP assesses that a patient needs specialist care, that assessment can now be overridden remotely – by a clinician who has not seen the patient,’ it said.
‘We have seen a case in our region in which an urgent cancer referral was converted to an A&G response more than once rather than accepted as a referral, and where we believe the diagnosis that followed was delayed.’
NHS trusts have been desperately trying to cut the size of their waiting lists in recent months after Labour made slashing waits a key focus of its general election campaign.
Millions of patients have already been taken off lists following the introduction of an NHS ‘cleansing’ scheme last year that saw hospitals paid £33 for each person they deleted.
The NHS has defended the approach, saying the process was designed to ensure waiting lists are accurate with people removed from them including those who have died, opted to go private or recovered without treatment.
More than 250,000 patients were slashed from NHS lists in January, nearly 15 per cent more than the month before, with health secretary Wes Streeting claiming the figures showed things were ‘finally starting to move in the right direction’.
GPs have raised concerns that their decisions to refer patients are being overruled by doctors without proper knowledge of the cases
Prime Minister Sir Keir Starmer’s plan for change pledged that 92 per cent of patients would be seen within 18 weeks of a referral for routine hospital treatment by July 2029.
The NHS waiting list in England hit a record high in September 2023, with 7.77million treatments waiting to be carried out for 6.5million patients.
The latest data show the waiting list has fallen for the third month in a row, with an estimated 7.25million treatments waiting to be carried out at the end of January, relating to 6.13million patients.
An NHS spokesman said: ‘While the NHS delivered record numbers of appointments in 2025 and reduced the waiting list to its lowest level in three years, we have much further to go to ensure planned care is easier to access for patients.
‘In addition to transforming how patients can book and manage their care through the NHS App, A&G has a major role to play in the coming years to support clinical decision-making and ensure patients are directed to the right specialist care as soon as possible.’
