The following information is applicable to patients living in England, and being treated in England. No information provided should be taken as formal legal or medical advice.

Right to choice

Under the “NHS Choice Framework”, patients have the right to choice in the NHS.¹ The right to choice applies to consultant-led services. This includes being seen by a cardiologist to talk about managing your heart problems, or seeing an orthopaedic surgeon for a knee replacement.

Using this right, you may be able to be seen by a provider with shorter waiting times or a location more convenient for you. Often your local hospital will not have the shortest waiting times, and you can more than halve your waiting time by travelling less than 15 miles away.² This guide outlines the NHS right to choice, when it applies and how you can use it.

Referrals and at the GP

Acting as a first point of contact in the NHS, GPs play an important role in helping patients exercise their right to choice. Generally, if you have a non-emergency health concern you will visit your GP. If they feel it is appropriate, they will then refer you to a specialist clinician/team.

If they decide to refer you to a specialist, you have the right to choose where you are referred. Your GP will likely have an idea about where to refer you, but some important questions you can ask are:

• What are my options for where I can be referred?
• Are there providers further away but with shorter waiting times?

Using what is called the NHS e-Referral Service, the GP will either refer you then and there - during your appointment - or they will provide you with a booking reference number and password. Using these details, once home, you can log into the NHS e-Referral Service and choose where you are referred.

It can be hard to find all the information to choose where to be referred. To help choose, you can use our comparison service to find and compare NHS services near you. This helps you to be referred to the service which is best for you. Important things to consider are: waiting times, care quality and distance from your home.

On the NHS waiting list

Once referred for a particular treatment, if you expect to wait for longer than a certain length of time, you are entitled to change provider, just as you would’ve been at the point of referral. In many cases this is not advisable though. By switching to a different service, you will be “moved” to the back of their waiting list, as so may be seen even later depending on the waiting times.

“You have the legal right to ask for your appointment to be moved to a different provider if you're likely to wait longer than the maximum waiting time specified for your treatment.”³

For non-urgent, consultant-led treatments the maximum waiting time is 18 weeks. Therefore, if you have to (or expect to) wait longer than 18 weeks, you’re entitled to change provider – albeit with some exceptions. If cancer is suspected, you will be referred to the ‘2 week wait’ pathway, where you should be seen within two weeks.⁴

For operations, if treatment is cancelled after you are admitted for ‘non-clinical reasons’ (e.g. no clinician is available due to an emergency), then you’re entitled to be seen within 28 days or to have private treatment funded at a hospital of your choice.

Exceptions

Your right to choose your provider may not hold if any of the following are the case:

• The service is not commissioned by NHS England (e.g. maternity services or services commissioned by your local authority).
• It is in your medical interest to wait longer or no longer receive treatment.
• You are in the armed forces.
• You are being held under the Mental Health Act 1983.

A full list of exceptions can be found on the NHS website.

Next steps

First, you should check that none of the exceptions apply to you. If they do, you may not have the right to choice.

Using HealthSay’s comparison service, you can search for the best services near you. With this knowledge, you can then have a discussion with your GP or healthcare team to see how you can be referred to your desired service.

If you feel you are wrongly refused the right to choice by a clinician or healthcare team, you should discuss your concerns with the clinician/team. Using their expertise, their decisions are designed to be in your best interests, and so it is important you have an open and honest conversation with them. If you feel you are still being treated unfairly, you can make a complaint.

Sources:

1. NHS Choice Framework. Link: https://www.gov.uk/government/publications/the-nhs-choice-framework/the-nhs-choice-framework-what-choices-are-available-to-me-in-the-nhs
2. Time to choose: How patients exercising their right to choose can help clear the NHS elective backlog. By IHPN and The Patients Association, Link: https://www.patients-association.org.uk/Handlers/Download.ashx?IDMF=5bf7f02f-56aa-4c5a-a28b-9cb99bafd033.
3. Your choices in the NHS. By NHS England. Link: https://www.nhs.uk/using-the-nhs/about-the-nhs/your-choices-in-the-nhs/.
4. Handbook to the NHS Constitution. Link: https://www.gov.uk/government/publications/supplements-to-the-nhs-constitution-for-england/the-handbook-to-the-nhs-constitution-for-england