On 22nd July 2025, NHS England published data that revealed an uncomfortable truth about healthcare access in England: for the first time ever, official statistics showed that patients in the poorest communities and those from Asian or Asian British backgrounds are more likely to wait longer for treatment. This isn't just a statistic – it represents thousands of patients whose postcode or ethnicity influences their healthcare experience in ways that should be unacceptable in a universal health service.
The data, published by NHS England in July 2025, exposes systematic inequalities that go beyond simple capacity issues. When patients from different backgrounds face different waiting times for the same conditions, we must examine whether our healthcare processes themselves are contributing to these disparities.
This data release validates concerns that have been emerging across different NHS trusts about systematic barriers within referral processes.
Healthcare inequalities often begin at the point of referral. Traditional referral processes can inadvertently create barriers that disproportionately affect certain patient groups. These barriers might include:
Complex referral criteria that vary between providers, creating confusion that particularly affects patients whose first language isn't English or who have lower health literacy. GPs working in areas with higher deprivation may be less familiar with specialist service criteria, leading to higher rates of inappropriate referrals and subsequent delays for their patients.
Inconsistent information requirements across different trusts mean that referrals from practices serving diverse communities may face higher rejection rates, not because the clinical need is different, but because local referral processes aren't standardised.
Evidence shows that practices in more deprived areas often experience higher referral rejection rates, not due to clinical judgement, but due to process variations that disproportionately affect these communities.
One of the most concerning aspects of healthcare inequality is the "postcode lottery" – where identical clinical presentations receive different treatment depending on location. This often stems from variations in local referral processes, criteria interpretation, and administrative efficiency.
Research across NHS trusts reveals how these variations play out in practice. Before implementing standardised referral processes, some services experienced rejection rates of over 30%, with rejections often clustered in practices serving more deprived communities. This wasn't because these patients had less clinical need – it was because referral processes weren't designed to ensure equity.
The pattern was clear: same clinical need, different outcomes based on location. That's not acceptable in a universal health service.
The NHS 10-Year Health Plan emphasises that "digital tools must work for everyone—regardless of background, location, or digital literacy." This principle should be central to any technology solution in healthcare, but it's particularly crucial for referral management systems that directly influence patient access to specialist care.
The risk with poorly designed digital solutions is that they can actually exacerbate inequalities. If digital referral tools are complex, require specific technical knowledge, or assume certain baseline understanding, they may work well for some practices whilst creating additional barriers for others.
That's why equity has been central to our design approach from day one.
Our SMART referral platform has been designed with equity as a core principle. This means more than just ensuring the system works technically – it means ensuring it works equally well for all patients, regardless of which practice submits their referral.
Zero digital bias functionality ensures that the same clinical presentation will generate the same referral outcome, regardless of which practice submits it. Standardised mandatory fields mean that essential information is captured consistently, preventing rejections that disproportionately affect certain patient groups.
Patient validation logic provides intelligent checking that helps identify potential eligibility issues before submission, whilst clinical calculations ensure accuracy regardless of practitioner experience. Show and hide functionality means all forms adapt intelligently to clinical selections, ensuring every GP captures exactly the right information whilst avoiding unnecessary complexity.
But the real test is in the results.
One of the most powerful ways to reduce healthcare inequalities is through standardisation. When referral processes are consistent across all providers and practices, it eliminates many of the systemic factors that can disadvantage certain patient groups.
At East Suffolk and North Essex NHS Foundation Trust, implementing standardised SMART referral forms eliminated inappropriate referrals entirely – from 36% to 0%. This improvement demonstrated that when referral processes are properly designed, clinical need becomes the only factor determining access – which is exactly how it should be.
SMART Assist functionality provides hyperlinks to clinical pathways and NICE guidance directly within the referral process. This is particularly valuable for GPs working in high-turnover environments or those who may not regularly refer to certain specialities.
By providing contextual clinical support at the point of referral, we ensure that all GPs have access to the same level of decision support, regardless of their location or experience with specific conditions. This levels the playing field and helps ensure that appropriate patients are identified and referred consistently.
It's about making excellence accessible to everyone, not just those with extensive speciality knowledge.
The July 2025 data release should be a wake-up call for all of us working in healthcare technology. As the NHS works to address the inequalities revealed in recent data, referral management must be part of the solution.
The technology exists to ensure that clinical need, rather than geography or demographics, determines access to specialist care. But we have a responsibility to ensure our solutions actively promote equity rather than accidentally undermining it.
Healthcare organisations face a choice: embrace tools that actively promote equity or continue to accept that "postcode lottery" effects are an inevitable part of healthcare delivery.
If you're working to address healthcare inequalities in your organisation, we'd welcome the opportunity to discuss how our approach to referral management can support those efforts.
Want to discuss how SMART referrals can support equitable access in your organisation? Get in touch – hello@dxs-systems.co.uk.
