There is sometimes insufficient background data about the patient from GP to enable secondary care to determine priority.
GP letters are sometimes poorly structured or difficult to read.
Test results may not be included in the referral information which leads to risk of unnecessary duplication.
Failure to include details of treatment past or current may lead to inappropriate treatment recommendations.
Failure of GPs to notify specialists of changes in treatment, possible side effects identified or new investigation results may lead to inappropriate interventions.
Some single condition clinical pathways mandate investigations required by primary care prior to patient acceptance for a secondary care opinion and this may delay referral.
Receiving clinicians may expect that a GP has seen the patient immediately before making an urgent referral even when there has been a recent encounter by another competent health professional or a suitable remote consultation.
There is lack of time put aside in consultant job plans to handle e- referrals. Non face to face interactions with patients are not counted in clinical activity. There is sometimes a lack of audit trail for e-referral triaging and recording information in hospital notes.