Referrals
No Appointments Available on NHS e-Referral: What Happens Next
You tried to book your first hospital appointment through the NHS App, the Manage Your Referral website or your GP surgery, and were told there were no appointments available. This is known in the NHS e-Referral Service (e-RS) as an appointment slot issue. It does not mean your referral has been refused.
What 'no appointments available' means
e-RS lets you choose and book a first appointment for many hospital services. It can only show slots the hospital has made available to it. NHS England Digital explains that the usual reason no slots appear is that the provider has not made enough appointment slots available in e-RS; in rare cases a technical problem stops a slot being shown or booked.
It is a capacity or booking-system state. It is not a clinical decision about your referral.
Forwarded or deferred: what happens next
When no slot is available, the referral can be forwarded (by you, through Manage Your Referral or the NHS App) or deferred (by your GP practice) to the provider you chose. It then appears on that provider's appointment slot issues worklist, and the provider books the appointment.
NHS England Digital's e-RS guidance says patients in this situation are told the chosen provider will contact them within a set number of days, based on clinical priority. That is an e-RS process expectation for being contacted to book, not a guarantee of when you will be seen. The period is shown in the message you received; we do not quote a national figure because it depends on priority and local arrangements.
Who owns the next action
Once the referral is on the provider's worklist, the hospital is responsible for arranging your appointment. Your GP practice usually cannot book it for you at that point.
- Keep the message or letter showing your booking reference (UBRN) and the date you were told there were no slots.
- Check the NHS App or Manage Your Referral for any change of status.
- If the contact period you were given has passed, ring the hospital's appointments or booking team, quote your reference, and ask whether the referral is on their appointment slot issues list.
- If you are told the referral has been returned or redirected, read why that happens.
Does this affect my waiting time?
NHS guidance says your waiting time starts when the hospital or service receives your referral letter, or when you book your first appointment through e-RS. NHS England's October 2026 RTT guidance FAQ includes specific recording guidance for referrals booked after being on the appointment slot issues worklist. If you are unsure how your own clock has been recorded, ask the hospital booking team.
This guide explains administrative processes only. If your symptoms change or get worse while you wait, contact your GP, NHS 111, or the clinical team named on your letter.
Frequently asked questions
Short answers first. Tap a question to read more.
Does 'no appointments available' mean my referral was rejected?
No. It means no bookable slot was showing in e-RS. The referral can be sent on to the hospital you chose so that it books you.
What is an appointment slot issue (ASI)?
NHS England Digital's term for when a patient cannot be booked into a slot for a directly bookable service in e-RS. The referral goes onto the provider's appointment slot issues worklist for the provider to book.
How long until the hospital contacts me?
You should be told a contact period based on clinical priority when the referral is forwarded or deferred. If it passes with no contact, ring the hospital booking team and quote your booking reference.
Can I choose a different hospital instead?
You may be able to. Speak to your GP practice or check Manage Your Referral; whether another provider can be selected depends on the service and how far the referral has progressed.
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Sources & references5
Reviewed against publicly available NHS England RTT guidance and the NHS Constitution.
- NHS England Digital — Appointment slot issues within the NHS e-Referral Service (managing and minimising)
- NHS England Digital — e-RS acronym and terms glossary
- NHS — Manage your referral
- NHS — Guide to NHS waiting times in England
- NHS England — Recording and reporting RTT waiting times: FAQs v1.5 (October 2026)
Editorial transparency
How this guide was put together
- Reviewed against the latest publicly available NHS England RTT statistics and guidance.
- Written and edited by the NHSWaitHelper editorial team.
- Cross-checked against the NHS Constitution and operational guidance.
- Independent — no paid hospital rankings, no hidden sponsorship.
NHSWaitHelper is an independent information platform and is not affiliated with the NHS. We do not provide medical or legal advice. Always speak to your GP, clinician, or a regulated adviser about your individual circumstances.