Recurring concern
Unreliable referral urgency categorisation and prioritisation
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Request correctionFirst reported 27 Dec 2013•Latest report 17 Apr 2025
What this concern includes
Includes failures in the process for categorising, validating, prioritising or re-prioritising Emergency, Urgent and Routine referrals, including unclear or imprecise urgency guidance, categorisation by unqualified personnel, failure to review the assigned category, and failure to raise priority after failed contact or other material risk information.
Not included
- Excludes delays or failures in referral assessment, treatment or follow-up where the referral urgency categorisation and prioritisation process was reliable.
- Excludes generic staffing, workload, communication or documentation deficiencies unless they directly impair referral urgency categorisation or prioritisation.
- Excludes ambulance, emergency-department, specialist and mental-health triage systems unless the assertion specifically concerns the same referral-urgency categorisation and prioritisation process.
- Excludes the substantive quality of care provided after an appropriately prioritised referral has been accepted.
- Reports
- 12
- Individual concerns
- 15
- Date range
- 2013–2025
- Stated actions
- 27
Distinct published reports
A report can raise multiple concerns
First to latest report issue date
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
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Concerns raised1
Failure to ensure thorough, professional and adequately documented review of urgent referral grading
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
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Action
Introduce carers practice guidance and core practice guidance covering assessments, reviews, support planning and safeguarding.
Stated by Essex County Council -
Action
Implement risk-priority matrices for carers’ assessments, reviews and safeguarding referrals.
Stated by Essex County Council -
Action
Conduct a scheduled audit of referral progression through allocation and consider issuing further guidance on priority decisions and allocation timescales.
Stated by Essex County Council
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Action
Refresh the Quality Assurance Framework and conduct eight annual audit cycles covering assessments, reviews, mental capacity and safeguarding, with findings reported to the Practice Governance Board.
Stated by Essex County Council
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Concerns raised1
Failure to account for earlier referrals and existing delays when reassessing urgency of gynaecology contact
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
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Action
Update triage procedures and implement electronic triage to support consistent 24–48-hour allocation.
Stated by Cwm Taf Morgannwg University Local Health Board -
Action
Hold CTM gynaecology cancer oversight meetings to review performance, patients, escalations and waiting times.
Stated by Cwm Taf Morgannwg University Local Health Board -
Action
Strengthen harm reviews through robust clinical MDT review of patients waiting more than 104 days.
Stated by Cwm Taf Morgannwg University Local Health Board
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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Position
The Health Board disputes that the re-referral met urgent suspected cancer criteria, stating the case was reviewed by the GP and a specialist.
Stated by Cwm Taf Morgannwg University Local Health Board
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Concerns raised1
Inadequate decision making when downgrading urgent referrals
This report raised 12 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
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Action
Implement the updated Trust-wide CRHTT SOP and Clinical Harm Review SOP requirements for discussing urgent-referral regrading with another clinician.
Stated by Norfolk and Suffolk NHS Foundation Trust -
Action
Evaluate compliance with two-clinician referral regrading through management monitoring and a Patient Safety and Quality Team audit, with results reported through quality-assurance structures.
Stated by Norfolk and Suffolk NHS Foundation Trust
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Concerns raised1
Lack of guidance for urgent referral of children to hospital or tertiary care
This report raised 13 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
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Concerns raised1
Automatic categorisation of routine referrals as low risk
This report raised 14 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
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Action
Apply harm reviews to routine referrals waiting over four weeks and review continuing waits every four weeks until triage.
Stated by Surrey and Borders Partnership NHS Foundation Trust -
Action
Update and approve the Standard Operating Procedure manual to reflect new referral triage practices.
Stated by Surrey and Borders Partnership NHS Foundation Trust
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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Position
Routine referrals are not automatically treated as low risk; they are screened as low risk only after assessment and confirmation of protective factors.
Stated by Surrey and Borders Partnership NHS Foundation Trust
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Concerns raised1
Failure to give urgent adult social care assessment referrals sufficient priority within social services
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
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Action
Embed identification of inpatients needing social care support in discharge planning to enable timely assessment before discharge.
Stated by Milton Keynes City Council -
Action
Employ a link social worker for the acute mental health ward to coordinate required social care assessments before discharge.
Stated by Milton Keynes City Council -
Action
Monitor team practice and monthly performance, including assessment timelines and casework reviews, through the Adult Leadership Team.
Stated by Milton Keynes City Council
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Concerns raised1
Failure to discuss downgraded GP referral urgency with the patient or GP
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
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Concerns raised1
Imprecise guidance for categorising referral urgency
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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Action
Implement the telephone triage system and supporting procedures, including urgent face-to-face assessment within 72 hours where triage is uncertain or refused.
Stated by North West Boroughs Healthcare NHS Foundation Trust
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Concerns raised1
Lack of an intermediate urgent mental health referral timeframe
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.5
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Action
Enable Triage Team Leaders to book priority appointments directly.
Stated by Sussex Partnership NHS Foundation Trust -
Action
Require daily review of out-of-hours referrals and arrange appointments within 24 hours when clinically indicated.
Stated by Sussex Partnership NHS Foundation Trust -
Action
Fast-track referrals to the first available appointment based on risk assessment.
Stated by Sussex Partnership NHS Foundation Trust
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Action
Develop a Coastal West Sussex protocol documenting the improved referral system, with the inquest checklist and flowchart appended.
Stated by Sussex Partnership NHS Foundation Trust -
Action
Meet West Sussex mental health commissioners to jointly review the urgent care pathway in light of the improvements and current practice.
Stated by Sussex Partnership NHS Foundation Trust
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Concerns raised1
Delays in prioritising urgent referrals to the ‘hot foot’ clinic
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
Data last updated 7 September 2026