Simply put, a referral is necessary when the guidelines say so (more often or not produced by NICE). So for example, a patient over 40 years old with abdominal pain and weight loss should lead to a referral to a consultant within two weeks. If not, the GP may have a case to answer. GPs must set out a clear plan with each of their patients. Are further tests necessary, if so why, and what will those tests consist of? A GP must then follow up those tests with further review and advice.
GPs are responsible for the acts and omissions when dealing directly with patients but, as they often run a surgery in partnership with others, they also have responsibility for the proper functioning of systems in place.
Therefore, a failure to provide a follow-up letter or to arrange a test may lead to a GP being found liable for negligence in litigation.