How referrals to specialists and hospitals work in Spain

Key rules

• GP referral: Your family doctor or paediatrician must refer you to a specialist in the public system, except in emergencies and a few direct-access specialties that vary by region.
• Reference hospital: Your home address decides which hospital you are sent to, unless your region allows free choice.
• Free choice: Choosing your hospital is possible only in some regions, and normally only within your own region.
• Private care: Private care needs no referral, though your insurer may ask for one.

The short version

In the public system, your family doctor (or your child's paediatrician) decides whether you see a specialist. You do not book a specialist yourself. The doctor refers you, and the hospital then gives you an appointment. Emergencies and a few direct-access specialties are the exceptions. Private care needs no referral, though some insurers ask for one.

Your reference hospital

You are assigned to a health centre and a GP based on where you live. Your area has a reference hospital for specialist care, and referrals go there by default. Your health card already links you to it, so you do not register separately. To find out which hospital it is, check your regional health portal or ask at the admissions desk of your health centre.

How a referral works

1. Your GP examines you and sends an electronic referral to the specialty, with a priority level.
2. The hospital reviews it and gives you a date. You may hear by letter, SMS, phone, email or your regional health app.
3. You go to the appointment with your health card and ID. The specialist may order tests or treatment, or send you back to your GP.

You can usually change or cancel an appointment by phone or through the app. The checklist below covers what to do if nothing arrives.

Priority levels

Your GP proposes a level, and the hospital can change it.

• Ordinary: a routine wait.
• Preferente: for suspected serious illness, such as possible cancer. You are seen within days or a few weeks.
• Urgent: the same day, or through emergency services.

Names and time targets vary by region.

The volante

The volante is the referral document from your GP. In many places it is electronic and goes straight into the hospital system, so you carry nothing. Some regions still give a paper volante that you hand in at the hospital. Ask your GP which applies to you.

When you can skip the GP

Emergency care (urgencias) needs no referral. Other direct access depends on your region. It often covers:

• gynaecology and obstetrics, through a midwife or family planning centre
• mental health or addiction units, in some places
• eye care, child dental programmes, and sexual health clinics, in some regions

Most other specialties, such as dermatology, traumatology and cardiology, need a referral. Ask your health centre what your region allows.

Choosing a different hospital

Free choice of hospital and specialist exists only in some regions. Madrid is the best-known case, and others offer it in varying forms. Where it exists, you ask when your GP refers you, at the health centre or through the regional portal or app. The choice is normally within your own region. Elsewhere you go to your assigned hospital. Check your regional health service for the rules where you live.

Choosing between options

Which route do you use to reach a specialist?

• Go through your GP to your reference hospital: Fits most cases. Your address sets your health area, which has a designated reference hospital. Your GP refers you there, and it shows on your health card, the regional patient portal or the health centre's admissions office.

• Choose another hospital or specialist: Fits only if your region has free choice (libre elección), for example Madrid, and the hospital is in your own region. Ask when your GP refers you.

• Go direct without a referral: Fits emergencies everywhere, and in some regions services such as gynaecology, mental health or sexual health clinics. Ask your regional health service what is open to direct access.

If it is an emergency or a direct-access service in your region, go directly. Otherwise ask your GP for a referral, and if your region has free choice, ask for another hospital at that visit.

Documents you need

• A volante: the referral document your GP or paediatrician issues to authorise a visit to a specialist, a test or a hospital service. In many places it is electronic and goes straight into the hospital system. Where it is still on paper, you hand it in at the hospital.

Following up a referral, test or hospital appointment

• Check the referral letter or message for how to confirm or cancel the appointment, and confirm the date that way.

• Look up your appointment in your regional health app or web portal, or call the regional appointment line, using your Cl@ve, digital certificate or health card.

• Ask at the admissions desk (admisión) of the health centre or hospital if you have no date or message after your referral.

• Check your regional patient portal for reports and test results, and ask the doctor at your next visit if a result is not there yet.

• Ask in writing for a copy of your medical record (historia clínica) at the records or admissions office, with your ID, if you need reports for another doctor.

• Raise a stalled referral or appointment at the patient service desk (Servicio de Atención al Paciente) of your health centre or hospital.

• File a formal complaint (reclamación) at the centre or on your regional health service's website if the desk does not fix it, and keep the stamped copy.

• Take the problem to your regional ombudsman or the national Defensor del Pueblo if you get no reply or an unsatisfactory one.

Frequently asked questions

What do ordinary, preferente and urgent referrals mean?

An ordinary referral is a normal appointment, a preferente one is for suspected serious illness such as possible cancer, and an urgent one means the same day or via emergency services. Your GP proposes the level with a clinical reason, and the hospital specialist or triage unit can change it. Time targets are set by each region.

Is the volante on paper or electronic?

It depends on your region and centre, but the volante is increasingly electronic and sent straight into the hospital system. Some regions still give a paper volante that you hand in at the hospital. Ask your GP which kind you will get.

Can I choose a different hospital from my reference hospital?

Yes, but only in regions with free choice of hospital, such as Madrid, and only within your own region. You usually ask at the health centre or on the regional portal or app when your GP refers you. Choosing a hospital in another region needs a specific agreement.

Which specialties can I see without a GP referral?

Emergency care needs no referral anywhere, and some regions also allow direct access to gynaecology, mental health units or sexual health clinics. Dermatology, traumatology and cardiology usually need a GP referral. Ask your regional health service for its list.