Patients are increasingly turning to private healthcare to escape a referrals “black hole”, GPs have warned, as the NHS struggles with a shortfall of available appointments. The most recent figures show GP practices make about 400,000 referrals a month to outpatient clinics that are fully booked. Some patients will be able to choose an alternative provider, some will be booked at a later date, but many end up being bounced back to their local surgery. Dr Dean Eggitt, a Doncaster GP and chief executive of the city’s local medical committee, said: “I think the NHS has collapsed because it is no longer providing universal care. I will say to a patient, ‘I can refer you, but it’s not going to get sorted for a year and I can just help you cope.’” Eggitt said he discussed with patients the options of care in the private sector, with many choosing to pay for some of their care. Analysis published by the Nuffield Trust in May revealed a 30% increase in people paying for hospital care across the UK since the pandemic. GPs typically refer patients to ­outpatient clinics using the NHS e-referral service, which can also be used by the patient to book a suitable appointment. The most recent figures, for July, show there were more than one million appointments booked in England, but 407,173 cases in which no slots were available. The number of unavailable slots has risen by 78% since July 2018, when the comparable figure was 227,937. There were severe shortages of appointments in orthopaedics, cardiology and diagnostic imaging. NHS England has warned the lack of available appointments “creates a significant amount of avoidable administrative work and can cause patient safety issues”. Providers are contractually required to ensure that sufficient appointments are available for first outpatient appointments. GPs are struggling with patients who become increasingly unwell because they cannot get NHS appointments. They are also concerned about patients who are being systematically rejected for appointments. Dr Ellen Welch, a GP in Carlisle and vice-chair of the Doctors’ Association UK, a professional association, said: “Patients may be waiting years to see a specialty team about a problem and they return to see us again and again for their care in general practice. “We have found referrals have been repeatedly rejected by hospital teams – very often for bureaucratic reasons.” GPs across the country have warned they consider there is now effectively “rationing” of referrals to outpatient clinics. Prof Kamila Hawthorne, chair of the Royal College of General Practitioners, said the latest figures for unavailable slots were concerning. She said: “GPs are highly trained to refer appropriately and when necessary, so that patients get the specialist care they need. While we recognise that secondary care is under enormous pressure, it’s essential that GP referrals are taken seriously and not rejected without a very good reason.” Healthwatch England, which gathers the views of health and social care users in England, warned last year that an online survey had found one in five patients referred for specialist care had fallen into a “black hole”, and were bounced back to their general practice. This included patients whose appointments were cancelled, or who were referred to the wrong service, were removed from the waiting list or did not hear anything further about the referral. Helen Hughes, chief executive of the charity Patient Safety Learning, said there were concerns about the safety of patients unable to get timely specialist care. She said: “Patients waiting for care need to be monitored and reprioritised as their level of need is likely to change as they wait.” NHS England said some patients might be rejected for appointments when there were more suitable care options, but this only occurred for about 2% of referrals. An NHS spokesperson said: “While NHS staff work hard to deliver tens of millions of outpatient appointments every year, it is clear there is more to do to provide more timely care for those who need it.” A Department of Health and Social Care spokesperson said: “We inherited a broken NHS and it is unacceptable that so many people are waiting longer than needed for care. “We know that waiting lists are too high, and it is one of the reasons the health secretary ordered a full independent investigation into the state of the NHS to lay bare the scale of the problem.”