Referral System
A referral system requires you to see a GP first before accessing a specialist or hospital department.
A referral system requires you to see a GP first before accessing a specialist or hospital department.
Also known as
GP gatekeeping, Specialist referral, Letter of referral, Verwijsbrief (Netherlands)
Why travellers need to know
Some countries require a GP referral before you can see a specialist; others let you self-refer directly. Knowing which system your destination uses avoids wasted appointments and delays. Countries with referral requirements (UK, Netherlands, Denmark) will simply turn you away at the specialist's door without one. Countries without (France, Japan, Thailand, most of Asia) let you book directly.
Real-world example
You have a recurring knee problem and want to see an orthopaedic specialist in Amsterdam. You go directly to a specialist clinic but they won't see you without a verwijsbrief (referral letter) from a GP. You have to book a GP appointment first, explain your problem, get the referral, then rebook with the specialist. In Bangkok, by contrast, you walk directly into a specialist's office without any referral.
Country-specific notes
🇬🇧 United Kingdom
GP referral required for all NHS specialist access
The NHS requires a GP referral for virtually all specialist and hospital outpatient care. The only exceptions are A&E, sexual health clinics, and some mental health services. Private specialists in the UK also typically want a referral letter, though it's not legally required.
🇫🇷 France
Referral optional but financially incentivised
France uses a soft referral system. You can see any specialist directly, but if you go through your médecin traitant (nominated GP) first, you receive a higher reimbursement rate. Visitors without a French GP can self-refer with lower reimbursement.
🇩🇪 Germany
German GKV patients need a GP referral (Überweisung) for most specialist consultations
Private patients and visitors to Germany can often self-refer to specialists, but fees are higher and some specialists only accept referred patients. Some specialties (ophthalmology, gynaecology) allow direct access for all patients.
At German private clinics, call ahead to confirm self-referral is accepted — it saves a GP visit but some specialists have referral-only policies.
Frequently asked questions
Can I see a specialist abroad without a referral?
It depends on the country. In Japan, Thailand, France, Spain, Germany (private), and most of Asia, yes. In the UK (NHS), Netherlands, Denmark, and Norway, no — you need a GP referral first. Private practitioners in referral-required countries sometimes accept patients without one.
What if a specialist abroad refers me to another specialist — will my insurer cover it?
Generally yes, if the original specialist consultation was covered. The chain of referrals is typically covered provided the original consultation was pre-authorised (if required) and all providers are within your insurer's network (if applicable). Confirm with your insurer before each onward referral.
Your Nomedic record includes your diagnosis history, making a GP referral appointment faster when the doctor can see what they’re referring you for.