As we approach the end of 2025, I find myself reflecting on an unusual year for NHS headlines. We’ve seen everything from groundbreaking policy announcements to challenging reorganisations, from inspiring innovation stories to sobering statistics about healthcare inequalities. And somewhere in the middle of all that, those of us working in healthcare technology have been trying to figure out which trends actually matter, and which are just noise.
The good news? Some clear themes have emerged that will shape 2026 and beyond. The even better news? They all point to the same fundamental truth we’ve been banging on about all year: getting referrals right first time isn’t just good practice – it’s becoming essential infrastructure for everything the NHS is trying to achieve.
So, before we all disappear for mince pies and questionable office party antics, let’s look at what 2025 revealed about referral management and what it means for the year ahead.
The year inequality became impossible to ignore
Back in July, NHS England published data that many of us had suspected but couldn’t prove, 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 wasn’t just another concerning statistic to add to the pile. It represented a fundamental challenge to the principle of a universal health service – the idea that clinical need, not postcode or ethnicity, should determine access to care.
Throughout our work this year, we’ve seen how referral processes can inadvertently reinforce these inequalities. Complex referral criteria that vary between providers disproportionately affect patients with lower health literacy. Inconsistent information requirements mean that referrals from practices serving diverse communities face higher rejection rates – not because the clinical need is different, but because local processes aren’t standardised.
The 10-Year Health Plan’s commitment to “halve the gap in healthy life expectancy between richest and poorest regions” isn’t just ambitious policy language. It’s a recognition that system-wide change is needed, starting with the fundamentals, such as how patients enter specialist care pathways.
Our zero digital bias, which ensures the same clinical presentation generates the same referral outcome regardless of which practice submits it, directly addresses this equity challenge. It’s not a complete solution to health inequalities – nothing could be – but it’s an essential building block.
Standardisation emerged as the strategic imperative
October brought the announcement that NHS England was consolidating its improvement functions under the Getting it Right First Time (GIRFT) programme. On the surface, it looked like just another NHS reorganisation. But the strategic message was clear: variation reduction and standardisation will drive sustainable transformation.
The GIRFT principle – that clinical outcomes often stem not from legitimate differences but from inconsistencies in process, pathway design, and information capture – resonates deeply with what we see in referral management. When we eliminated inappropriate referrals from 36% to 0% at East Suffolk and North Essex, we didn’t change clinical guidelines or add capacity. We standardised the referral process so that every GP captured the same essential information in the same structured way.
The paradox of 2025’s elective care data tell the same story. NHS England reported record activity over the summer – 4.6 million cases managed between June and August. Yet waiting lists rose for the third consecutive month, reaching 7.41 million in August. Working harder wasn’t enough. The NHS needs to work smarter, ensuring every referral, every pathway, and every clinical interaction is optimised.
This is where referral management sits at the heart of elective recovery. Every inappropriate referral wastes specialist capacity that could have been used for patients who genuinely need it. Every delayed or rejected referral extends waiting times for patients already in distress. Every administrative query consumes time that clinicians could spend on patient care.
What 2026 will demand
Looking ahead to 2026, three priorities dominate the NHS landscape, and all three depend on excellent referral management:
Neighbourhood health services rolling out nationally. The 10-Year Health Plan envisions bringing diagnostics, mental health, post-op care, rehabilitation, and nursing to people’s doorsteps. But neighbourhood health only works if referral pathways are optimised first. You can’t digitise chaos or decentralise dysfunction. The foundation must be solid.
Elective recovery targets tightening. NHS England has committed to 65% of patients meeting the 18-week standard for elective treatment by March 2026, with long waits over 52 weeks reduced to less than 1% of the total waiting list. These aren’t aspirational targets – they’re hard commitments that require systematic efficiency gains.
Digital transformation accelerating. From remote monitoring to NHS Online, from the expanded NHS App to integrated care records, 2026 will see digital technologies deployed at scale. But digital tools only deliver value when they’re built on high-quality, structured data. That data originates at the referral point.
None of these priorities can be delivered without referral processes that consistently capture the right information, validate clinical appropriateness, and ensure equitable access.
The fundamentals still matter most
Amid all the headlines about AI, remote monitoring, and digital innovation, it’s worth remembering that the NHS’s most pressing challenges often have surprisingly straightforward solutions. Getting the referral right first time isn’t sexy or cutting-edge, but it’s foundational to everything else the system is trying to achieve.
Looking forward with confidence
2025 was challenging for the NHS. Budget pressures, workforce constraints, rising demand, and political turbulence created headwinds that affected every organisation. Yet amid these challenges, some clear strategic priorities emerged that will shape healthcare for years to come.
What gives me confidence about 2026 isn’t just the policy commitments or the funding announcements – though both are welcome. It’s the growing recognition across the system that sustainable improvement requires getting the fundamentals right. Standardisation over variation. Evidence over assumptions. Equity over postcode lottery.
Referral management exemplifies these principles. When done well, it creates ripple effects throughout the system: shorter waiting times, better use of specialist capacity, reduced administrative burden, improved patient experience, and more equitable access. When done poorly, it undermines every other improvement effort.
As we look ahead to 2026, the organisations that will thrive are those that recognise this reality and invest accordingly. Not in flashy innovations that make good press releases, but in the foundational capabilities that enable sustainable excellence.
That’s our focus at DXS, and it will remain so throughout 2026 and beyond. While others chase the next big thing, we’ll continue perfecting the referral process – because we’ve seen firsthand how getting that right unlocks improvements everywhere else.
A personal note
Before signing off for the year, I want to say thank you to everyone who’s engaged with these newsletters throughout 2025. If they have helped frame the challenges or sparked useful conversations in your organisation, then they’ve served their purpose.
Here’s to a successful 2026. May your referrals be appropriate, your waiting lists manageable, and your mince pie consumption entirely justified.
David & the DXS Team
Want to discuss how SMART referrals can support equitable access in your organisation? Get in touch – hello@dxs-systems.co.uk
