General practice plays a central role in ensuring patients receive a timely and accurate diagnosis, either directly from a GP or from an appropriate specialist as a consequence of a GP referral. Failure, or delay, in correctly identifying and referring patients who need secondary care can have profound clinical consequences. ... and This paper was commissioned by The King’s Fund to inform the panel of the Inquiry into the Quality of General Practice in England. The views expressed are those of the authors and not of the panel.