Referrals & Escalation

Overview

Making referrals and escalating concerns are everyday parts of NHS work — yet they are where many junior doctors feel least confident.

The goal is not to sound impressive.
The goal is to be clear, safe, and efficient.

This page shows you how.

The Purpose of a Referral

A referral is not about handing over responsibility.
It is about:

  • Getting specialist input
  • Protecting patient safety
  • Making shared decisions
  • Documenting that appropriate advice was sought

Good referrals improve care. Poor referrals delay it.

The Golden Structure: SBAR

Most hospitals expect you to use SBAR:

Situation – Who you are, where you are, who the patient is
Background – Relevant history
Assessment – What is happening now
Recommendation – What you are asking for

You do not need to be perfect.
You need to be structured.

Example of a Safe Referral

Instead of:

“Hi, I have a patient you need to see…”

Say:

“Hi, I’m the SHO on Ward 12. I’m calling about a 68-year-old man admitted with pneumonia who is now hypotensive despite fluids. I’m concerned about sepsis. Could you please review urgently?”

Clear. Concise. Safe.

When Should You Escalate to Seniors?

Escalate when:

  • You are worried
  • The patient is deteriorating
  • You feel out of depth
  • You are unsure of a management plan
  • You are asked to do something unsafe
  • A nurse expresses serious concern

You do not need to justify escalation.
Concern alone is enough.

What If Another Specialty Pushes Back?

This happens.

Stay calm and:

  • Re-state your concern
  • Use objective data (NEWS, bloods, scans)
  • Document the conversation
  • Escalate to your registrar if needed

You are advocating for the patient, not negotiating your ego.

Documentation After Referrals

Always document:

  • Who you spoke to
  • Time of discussion
  • Advice given
  • Plan agreed

This protects:

  • The patient
  • You
  • The team

If it’s not documented, it didn’t happen.

Common Mistakes

  • Calling without key information ready
  • Sounding unsure about why you’re calling
  • Failing to escalate when dismissed
  • Not documenting advice
  • Avoiding difficult conversations

These are skills — they improve with practice.

Reality Check

You will sometimes feel awkward.
You will sometimes be challenged.
That does not mean you are doing anything wrong.

Professional communication under pressure is a learned skill.

Reassurance

Clear, calm communication earns respect over time.
Even senior doctors once struggled with referrals.

With structure and practice, this becomes one of your strengths.