Patient referrals in the NHS - how it works

Here’s why GPs in the NHS usually refer patients first to a local specialist (e.g. a local respiratory team) rather than directly to a national centre like the National Aspergillosis Centre (NAC):

🏥 1. The NHS Referral Pathway Is Tiered (Local → Regional → National)

• The NHS is designed to escalate care through “levels”:

  • GP → Local Consultant → Tertiary/National Centre

• This structure ensures efficient use of resources and prioritises local care where appropriate.

• National centres are not intended to be the first point of contact, except in emergencies or highly specialised pre-agreed pathways.

🧠 Analogy: You don’t go straight to a brain surgeon for a headache — you start with your GP.

📝 2. Referral Criteria for NAC Require Specialist Input

• The NAC (based in Manchester) is a nationally commissioned tertiary centre, which means:

  • It only accepts referrals from consultants (not GPs directly)

  • It expects that basic tests (CT scan, IgE, Aspergillus-specific IgE/IgG, eosinophils, spirometry) have been done

  • Local teams should attempt initial diagnosis and management, and refer on if the case is complex, resistant, or unusual

📄 The NAC’s referral form specifically asks for consultant details and supporting investigations.

⚖️ 3. Clinical Governance and Local Responsibility

• Local respiratory consultants are responsible for:

  • Ruling out common conditions first

  • Starting standard ABPA or CPA treatment (e.g. steroids, itraconazole)

  • Monitoring early response

• This ensures that patients who are referred to the NAC are those who really need advanced care, e.g.:

  • Antifungal resistance

  • Multiple relapses

  • Atypical radiology

  • Drug intolerance or failure

  • Need for biologics, surgery, or MDT input

🧭 4. NHS Resource Planning and Fairness

• National centres are funded to manage only the most complex or rare cases across the UK.

• If GPs referred patients directly, national centres would become overwhelmed — and many patients would bypass the local care they actually need.

💡 It’s not about gatekeeping — it’s about managing capacity and focusing expertise where it’s most needed.

🛠️ What Can Patients Do?

If you suspect ABPA or CPA and your GP doesn’t know about NAC:

1. Ask to be referred to a local respiratory team — ideally one with fungal disease knowledge.

2. Share NAC information NAC referral criteria & guidance, Support for professionals

3. If already under a consultant and you’re not improving, ask:

   “Would you consider referring me to the National Aspergillosis Centre for specialist input?”

4. If you’re already diagnosed with ABPA or CPA and not improving, you can request your consultant refer you to NAC, citing lack of progress or drug intolerance.