NHS Radiology Crisis Requires Fresh Approach to Patient Referrals, Experts Warn

The relentless increase in radiology workloads threatening patient care across the NHS cannot be solved by radiologists alone, according to a stark assessment from senior specialists in the field. Instead, sustainable solutions require a fundamental shift in how general practitioners, hospital consultants and emergency department doctors refer patients for imaging scans, experts argue.

Writing in the British Medical Journal, consultant radiologist Giles Maskell from Truro highlights a troubling historical pattern. Nearly half a century ago, in August 1978, radiologist MJ Brindle published an article in the same journal describing exactly the same crisis facing radiology departments. The fact that the problem remains largely unresolved decades later suggests that the current approach to managing demand is fundamentally flawed.

The scale of the current crisis is stark. In 2024 alone, almost one million patients in England—976,000 to be precise—waited longer than one month for their scan results, representing a 28% increase on the previous year. This staggering figure represents a complete failure against the NHS target of zero patients waiting more than a month for imaging results. The delays come despite the NHS spending a record £216 million outsourcing radiology reporting to private companies—more than five times the figure spent in 2016.

The Royal College of Radiologists reports that demand for computed tomography (CT) and magnetic resonance imaging (MRI) scans grew by 8% in 2024 alone. This explosive growth in demand, combined with a severe shortage of qualified radiologists, has created a perfect storm threatening the sustainability of imaging services across the country. The college’s 2024 census identified 470 whole-time-equivalent consultant vacancies, representing a 9% national vacancy rate, with smaller departments facing gaps of up to 20%.

Maskell’s analysis, drawing on Brindle’s decades-old insights, identifies a fundamental issue often overlooked in policy discussions: potential demand for imaging is almost limitless. Unlike surgical procedures—where a patient can typically only have one knee replacement or hip operation—imaging can be performed repeatedly using different scanning modalities and techniques. This creates an ever-expanding appetite for scans that no amount of additional equipment or staffing can fully satisfy.

When faced with soaring demand, healthcare systems have traditionally attempted two approaches, neither of which has proven effective. The first strategy involves simply increasing capacity by purchasing more scanning machines and training additional radiologists. However, this “reflex approach” consistently fails because newly available capacity is rapidly consumed by ever-growing demand, creating a perpetual shortfall.

The second strategy attempts to reduce “unnecessary and unrewarding examinations”—scans that may not be clinically justified or likely to change patient treatment. Yet this approach proves equally ineffective. Determining which scans are truly unnecessary requires sustained effort, diligence and persistence from the medical community, and often generates conflict between referring doctors and radiologists about clinical decision-making.

The solution lies not in trying to solve the problem within radiology departments, but in engaging those who refer patients for imaging—general practitioners, hospital specialists and emergency medicine doctors. These clinicians control the volume and appropriateness of referrals and therefore hold the key to making imaging services sustainable.

Maskell advocates for a system-wide conversation involving representatives from all medical specialties to collectively decide how limited imaging capacity should be allocated. Rather than attempting to meet infinite demand, the approach recognises that imaging is a scarce resource requiring careful prioritisation. Decisions need to be taken about what proportion of available appointments should be allocated to outpatients, inpatients, and emergency department referrals.

This approach requires agreement on the reasonable capacity of radiology services and the discipline to maintain those limits, ensuring imaging is directed only to patients most likely to benefit. Whilst this may sound straightforward in principle, implementing it requires agreement and cooperation across multiple medical disciplines—something that has proved challenging to sustain over decades.

The financial cost of current approaches is becoming increasingly unsustainable. NHS trusts across the UK spent £325 million managing excess radiology demand in 2024, with 95% of trusts and health boards outsourcing at least some of their radiology reporting to private companies. If current trends continue unchecked, the NHS will be spending more than £400 million annually by 2028—enough to cover the salaries of 3,389 full-time consultant radiologists that could be employed within the NHS itself.

Workforce projections paint an increasingly concerning picture. The Royal College of Radiologists forecasts that consultant radiologist shortages could reach 39% by 2029 unless urgent action is taken to expand training numbers. This would make the current crisis considerably worse.

Key Takeaways

• Almost one million patients waited longer than one month for scan results in 2024, a 28% increase on 2023, as NHS radiology services face unsustainable demand
• The crisis cannot be solved by radiology departments alone; solutions require those referring patients—GPs, consultants and emergency medicine doctors—to fundamentally rethink imaging referral patterns
• Healthcare spending on outsourcing radiology reporting has reached record levels at £216 million annually, yet continues to fail to meet patient demand, indicating the need for system-wide change rather than piecemeal fixes

What This Means for Kent Residents

For patients across Kent and Medway, the radiology crisis translates directly into delayed diagnoses and longer waits for essential imaging. Those referred for CT or MRI scans by their GP or hospital consultant face the prospect of waiting beyond the NHS target timeframe for results. Healthcare professionals across Kent and Medway NHS Trust and GP practices must now engage in difficult conversations about how imaging capacity can be allocated most effectively. Rather than accepting ever-longer waiting lists, the solution requires collaboration between radiologists and all referring physicians to prioritise scans for patients most likely to benefit. If you have been referred for imaging, contacting your referring healthcare provider to discuss your specific circumstances may help clarify timeframes, whilst remembering that urgent referrals from emergency departments are appropriately prioritised within the system.