How to Escalate Your NHS Dermatology Referral (and When)

The NHS Referral to Treatment (RTT) pathway gives you a constitutional right to start treatment within 18 weeks of referral for non-urgent conditions. This is not a guideline, it is a patient right. When the 18-week standard is breached, the NHS Constitution (Schedule 7) places an active obligation on your commissioner (ICB) to take all reasonable steps to offer a range of suitable alternative providers. You can hold them to this.

To check where you stand: contact your GP surgery and ask for the exact date your referral was submitted. Count 18 weeks forward. If that date has passed, or is approaching, you have clear grounds to act.

You don't need to wait for the 18-week deadline before escalating. Escalation is reasonable if:

• You've had no contact from the hospital after 8 to 12 weeks
• Your condition has significantly worsened since the referral was made
• Eczema is regularly disrupting your sleep (clinically significant, document this)
• You're missing work, unable to function normally, or your mental health is substantially affected
• You were given a rough wait time that has now passed

"I couldn’t wear jeans or walk to work because of the extreme discomfort," wrote one patient in June 2024, describing two years on the NHS waiting list while their skin went from small spots to a continuous full-body flare (u/ytho365, r/eczema, June 2024).

One more thing to know: referrals can be rejected by dermatology departments before you are ever seen. In November 2025, one patient received a text from their GP saying their referral had been rejected and they were advised to try different steroid combinations first, including applying steroids to their face for the first time, without ever being assessed. If this happens to you, ask your GP to write to the dermatology department explaining your case in more detail, and consider PALS if there is no movement (u/BebeNT, r/eczema, November 2025).

You are not making a fuss by escalating. You are using the system as it is designed to be used.

Start here. Ask your GP surgery to contact the hospital booking team directly and request an update on your position in the queue. GP practices can call and flag a patient's case, this sometimes prompts action, particularly if you mention that your condition has deteriorated since referral.

Be specific: give them the referral date, explain your condition has worsened, and ask them to note both. Ask for a callback with an update.

Also ask: Has your GP used the NHS e-Referral Service (e-RS) Advice and Guidance pathway? This allows GPs to get a dermatologist's written clinical opinion without putting you on the formal waiting list, and can sometimes lead to your condition being managed in primary care faster than waiting for the outpatient queue. If your GP hasn't explored this, it's worth asking.

A written request carries more weight than a phone call and creates a paper trail. Keep it brief and factual:

"I am writing to request an urgent review of my referral to dermatology, submitted on [date]. My condition has [worsened significantly / not improved] since referral, and it is now affecting my sleep and ability to work. I understand I have a right to start treatment within 18 weeks under the NHS constitutional standard. I would be grateful if you could urgently chase this referral and advise on the options available to me."

Email it or hand it in at reception and ask for a written or email response.

Every NHS trust has a Patient Advice and Liaison Service (PALS). They exist specifically for situations like this. PALS staff can escalate your case internally and find out exactly where you are in the system.

Find your hospital trust’s PALS team via the NHS website (search your trust name + PALS). Have ready: your full name, date of birth, GP practice, referral date, and a brief factual description. Be calm and specific, they respond to evidence, not frustration.

If PALS is unresponsive, escalate to your Integrated Care Board, the commissioner responsible for your care. The NHS Constitution places a direct duty on the ICB to offer alternative providers when the 18-week standard is breached. Write to your ICB’s patient services team citing this duty: "I am writing under the NHS Constitution Schedule 7, which places a duty on the commissioner to offer suitable alternative providers when the 18-week RTT standard is breached." Find your ICB at NHS.uk by entering your postcode.

One of the most underused options available. If your GP referred you via the NHS e-Referral Service (Choose and Book), you may be able to rebook to a different trust with a shorter wait, directly from the NHS App (Appointments, then Manage referral). Some hospitals in the same region have dramatically different waiting times.

Ask your GP whether your referral was made via e-Referral. If it was, ask them to either rebook you to a different provider, or give you access to rebook yourself. The NHS App is the primary access point as of 2025.

If your condition has deteriorated substantially since the original referral, severe prolonged flares, significant sleep disruption, face or hands affected in a way that wasn’t the case before, ask your GP explicitly whether they can resubmit as an urgent referral. A new urgent referral starts a fresh, shorter clock.

Don't go to A&E to chase your referral, it cannot move your outpatient queue forward. The exception is a genuine emergency: fever with rapidly spreading redness, feeling systemically unwell, or suspected eczema herpeticum (punched-out blistering erosions, particularly on the face, with burning pain and rapid spread). These are emergency presentations. Everything else, including a bad flare, should go through your GP.

Don't assume private dermatology is cheap. Initial consultant appointments cost £240 to £350 nationally and £300 to £500 in London (2026 data). Exhaust NHS steps first.

Don't assume silence means everything is fine. Several patients have discovered their referral was never received by the hospital, or was filed incorrectly. One patient spent four days trying to reach a hospital booking team after a 10-month stalled urgent referral, no answer, no queue system, no answering machine (Care Opinion, 25 June 2024). Another discovered that a dermatology appointment had been marked as attended, without them ever receiving an appointment letter or any notification (Care Opinion, circa 2019). Chasing is due diligence.

Call your GP surgery and ask for the exact date your referral was submitted. If it's been 8+ weeks with no contact, ask them to chase it today. That one call is where most escalation paths start.