First reported 9 Jun 2014•Latest report 21 May 2025
Definition
What this concern includes
Includes failures of the district nursing referral process that prevent or delay appropriate referral, including failure to initiate, accurately communicate, transmit, accept, direct or action referrals.
Not included
Excludes generic district nursing staffing, monitoring, communication or care-quality deficiencies not specifically tied to the referral process.
Excludes referrals to services other than district nursing unless the assertion directly concerns a district nursing referral.
Excludes failures occurring solely after a valid referral has been accepted, such as the quality of subsequent nursing treatment.
Reports
11
Distinct published reports
Individual concerns
14
A report can raise multiple concerns
Date range
2014–2025
First to latest report issue date
Stated actions
24
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.
NHS England2
Betsi Cadwaladr University LHB1
Care Quality Commission1
Central and North West London NHS Foundation Trust1
Central London Community Healthcare NHS Trust1
City Health Care Partnership CIC1
Department of Health and Social Care1
Hull University Teaching Hospitals NHS Trust1
Kent County Council1
Lewisham and Greenwich NHS Trust1
London Borough of Lewisham1
Lower Clapton Group Practice1
Medway NHS Foundation Trust1
Milton Keynes University Hospital1
NHS Greater Manchester Integrated Care Board1
NHS trust6
Healthcare site4
Executive non-departmental public body2
Community interest company1
English county council1
Health and care professional regulator1
Health and social care service regulator1
Integrated care board1
Local health board1
London borough council1
Ministerial department1
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.
Northumberland
Concerns raised2
Failure to transfer comprehensive discharge and ongoing treatment information to community nursing services
Failure of hospital systems to enable electronic referrals to community nursing services outside the usual geographical area
Responses linked to these concerns
Each 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
Action
Develop and lead the Frontline Digitisation Programme to support adoption and safe deployment of electronic patient record systems.
Stated by NHS EnglandStated completedThe respondent said that this action was complete when they made their response on 29 May 2025.
Action
Develop and implement the national Booking and Referral Standard to digitise and standardise referrals and bookings across care settings.
Stated by NHS EnglandStated in progressThe respondent said that this action was in progress when they made their response on 29 May 2025.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Interoperability configuration and management are assigned to local provider organisations and regional centres, rather than being led nationally by NHS England.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Inner South London
Concerns raised2
Failure to make accurate referrals to the District Nursing team
Delays in District Nursing assessment after referral
This report raised 7 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each 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
Action
Establish and disseminate an escalation and information-sharing pathway across community services, with ongoing monitoring and audit.
Stated by Lewisham and Greenwich NHS Trust and London Borough of LewishamStated completedThe respondent said that this action was complete when they made their response on 29 January 2025.
Action
Deliver training for community therapy services and District Nurses on available services and referral procedures.
Stated by Lewisham and Greenwich NHS Trust and London Borough of LewishamStated plannedThe respondent said that this action was planned when they made their response on 29 January 2025.
Action
Maintain regular Discharge to Assess–District Nursing meetings and a communication champion to oversee information exchange and care-plan adherence.
Stated by Lewisham and Greenwich NHS Trust and London Borough of LewishamStated completedThe respondent said that this action was complete when they made their response on 29 January 2025.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
The District Nursing referral was timely and correctly recorded both the foot ulcers and sacral ulcer, contrary to the concern.
Stated by Lewisham and Greenwich NHS Trust and London Borough of LewishamDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Manchester South
Concerns raised2
Delays in referral for District Nursing input
Lack of understanding of the need for prompt referral to District Nursing services
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each 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
Action
Deliver a Masterclass on timely vascular and District Nursing referrals, including required referral information and examples of good referrals.
Stated by NHS Greater Manchester Integrated Care BoardStated plannedThe respondent said that this action was planned when they made their response on 19 March 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Position
The GP practice considers that Mr Smith’s leg-swelling management, compression hosiery and District Nursing referral were clinically appropriate.
Stated by NHS Greater Manchester Integrated Care BoardDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
District Nursing referrals are triaged and prioritised by clinical need, with enquiries from GPs welcomed and visits arranged where indicated.
Stated by NHS Greater Manchester Integrated Care BoardExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
East Riding and Hull
Concerns raised1
Failure to make post-discharge referrals for patients needing district nursing care
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 concerns
Each 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.6
Action
Finalize and roll out an electronic nursing discharge pro forma prompting community-nursing referral consideration and recording referral recipients.
Stated by Hull University Teaching Hospitals NHS TrustStated in progressThe respondent said that this action was in progress when they made their response on 14 May 2024.
Action
Discuss the appropriate level of information about community-nursing referrals for inclusion in medical discharge summaries.
Stated by Hull University Teaching Hospitals NHS TrustStated in progressThe respondent said that this action was in progress when they made their response on 14 May 2024.
Action
Explore enabling external SystmOne users to send referrals directly into CHCP’s SystmOne system.
Stated by City Health Care Partnership CICStated in progressThe respondent said that this action was in progress when they made their response on 14 May 2024.
Action
Share referral criteria, available services and referral instructions regularly with GPs and other healthcare organisations.
Stated by City Health Care Partnership CICStated completedThe respondent said that this action was complete when they made their response on 14 May 2024.
Action
Share the review findings with CQC’s Primary and Community Care operations team for consideration in its regulatory response.
Stated by Care Quality CommissionStated plannedThe respondent said that this action was planned when they made their response on 14 May 2024.
Action
Implement mandatory use of SystmOne task functionality for structured communication, monitored task handling, and patient-record traceability.
Stated by St Andrews SurgeryStated completedThe respondent said that this action was complete when they made their response on 14 May 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.4
Position
The material risk arose from missed community nursing referrals at discharge, not insufficient information in the immediate discharge summary.
Stated by Hull University Teaching Hospitals NHS TrustDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
Feedback on the concerns cannot be provided because no referral was made to Community Nursing, and the referral hub manages all CHCP referrals.
Stated by City Health Care Partnership CICUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
Routine monitoring and risk-based inspections are considered sufficient to identify and address further concerns about the services.
Stated by Care Quality CommissionExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Position
Oversight of the GP practice is assigned to the integrated care board, while findings inform CQC’s regulatory response.
Stated by Care Quality CommissionRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Milton Keynes
Concerns raised1
Failure to action appropriate referrals for district nurse visits and assessments
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 concerns
Each 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
Action
Review the referral process with staff to identify learning.
Stated by Central and North West London NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 21 November 2022.
Action
Amend the Standard Operating Procedure to require tighter follow-up when additional referral information is requested.
Stated by Central and North West London NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 21 November 2022.
Inner North London
Concerns raised1
Failure to use specific language distinguishing catheter change from catheter care in requests
Responses linked to these concerns
Each 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
Action
Highlight instructions for other clinical teams and send the original correspondence with onward referrals.
Stated by Lower Clapton Group PracticeStated completedThe respondent said that this action was complete when they made their response on 18 May 2021.
Action
Communicate the revised processes to the team and incorporate them into the induction programme.
Stated by Lower Clapton Group PracticeStated completedThe respondent said that this action was complete when they made their response on 18 May 2021.
Mid Kent and Medway
Concerns raised1
Failure to make district nurse referrals for specialist wound care
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 concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
South London
Concerns raised1
Failure to respond to community referrals for wound management
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 concerns
Each 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
Action
Implement updated triage procedures requiring checks for other services and coordinated review of referrals received by multiple teams.
Stated by Central London Community Healthcare NHS TrustStated completedThe respondent said that this action was complete when they made their response on 27 March 2020.
Action
Improve referral processes from primary care into District Nursing and Tissue Viability Nursing teams.
Stated by Central London Community Healthcare NHS TrustStated in progressThe respondent said that this action was in progress when they made their response on 27 March 2020.
Action
Develop electronic patient-record reminders in EMIS Health to improve referral management and responsiveness.
Stated by Central London Community Healthcare NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 27 March 2020.
Action
Establish multidisciplinary review processes for people referred to multiple teams.
Stated by Central London Community Healthcare NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 27 March 2020.
Manchester South
Concerns raised1
Failure to provide timely referrals for discharged patients requiring community nursing 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 concerns
Each 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
Action
Move all Trust referrals to District Nurses onto an electronic portal.
Stated by Tameside and Glossop Integrated Care NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 28 July 2019.
Action
Tighten referral processes while migrating from fax machines to electronic communication systems.
Stated by Tameside and Glossop Integrated Care NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 28 July 2019.
Action
Reinforce clinical incident reporting for missed referrals to support investigation, learning and training.
Stated by Tameside and Glossop Integrated Care NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 28 July 2019.
Action
Track missed-referral incidents and escalate identified trends or themes through divisional meetings for timely action.
Stated by Tameside and Glossop Integrated Care NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 28 July 2019.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Missed referrals are not considered common, based on team experience, incident review and evidence from the referral service.
Stated by Tameside and Glossop Integrated Care NHS Foundation TrustDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
North Wales (East and Central)
Concerns raised1
Lack of a procedure to ensure that referrals are received and actioned
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 concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
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Includes failures of the district nursing referral process that prevent or delay appropriate referral, including failure to initiate, accurately communicate, transmit, accept, direct or action referrals.
