What is NHS Right to Choose and how does it work?

NHS England believes that people are experts in their own health, meaning involving them in decisions about their treatment and which healthcare provider to use will improve outcomes. Studies have shown that outcomes tend to improve when patients can speak freely with their doctors and understand the information given to them. It also lowers the stress associated with being ill. Being able to choose a healthcare professional you get on with can be a positive first step.

NHS England aims to allow patients to discuss their needs with their GP and choose an appropriate healthcare provider. It also wants to ensure that GPs give patients enough information to make an informed choice.

Within reason, you have the right to choose a healthcare provider for any aspect of your care. For example, you can choose which GP surgery you register with, but your location and other factors often limit this. It can become a priority if your existing GP surgery closes.

You have the right to choose a healthcare provider or switch to a new healthcare professional. Here are your main options.

1. Who to see for your first consultant appointment

If your GP refers you to a consultant or for mental health treatment, you have the right to choose who you see. This applies to out-patient care; you can choose an organisation and team. For example, you might go to a particular hospital with several consultants, each leading a team of healthcare professionals. You can decide which one you want to see for your first out-patient appointment. If you need treatment for a mental health condition, you can choose a mental healthcare team offering treatment in your area.

2. Switching to a different consultant or hospital

NHS waiting times remain a challenge. However, waiting lists are still measured against NHS England standards for maximum waiting times. You have a legal right to switch to a new healthcare provider if your current one can't see you within those guidelines. You should expect to see a consultant for cancer treatment within two weeks. Otherwise, your first appointment should be within 18 weeks. If you've waited more than 40 weeks, your current provider should contact you to ask if you'd like to change, but you can ask to move before this. NHS England calculates waiting times based on when your GP made your referral.

3. You can choose a private hospital

It's worth remembering that you have the right to choose a private healthcare professional if you want to. Many consultants practice privately and in the NHS. However, NHS England also has contracts with private hospitals where consultants can carry out treatment. You have the right to choose private treatment as long as the costs don't exceed NHS costs for the same care. Your chosen hospital must also already provide services to the NHS.

If you've already seen a consultant for your first out-patient appointment and need surgery, they may offer you the opportunity to go to a private hospital for your operation. Colin received treatment from an ENT consultant and said this about his care:

"I saw my consultant at an NHS hospital, and then they contacted me to offer me an appointment for surgery at a local private hospital much closer to home."

4. How Right to Choose applies to mental health services

Right to choose applies to mental health services just as to physical treatment. You can decide where to be treated and which team provides your care. You can also use private services as long as they don't cost more than NHS care.

The right to choose also applies to treatments for conditions such as ADHD. Earlier this year, a court ruled that patients had the right to select ADHD assessments from private providers and have them paid for by the NHS. Any service offering ADHD assessments that meet NHS standards can take a GP referral if a patient requests it. It's worth remembering that even private services face increased demand, meaning you may still need to wait for treatment.

How much demand is there on mental health services?

This guide looks at the increasing demand for mental health services.

There are some circumstances where the right to choose doesn't apply, so you must understand your legal rights.

Generally, prisoners or anyone detained in young offender institutions, immigration removal centres, secure training centres or living in a secure children's home don't have the right to choose. This also applies to members of the armed forces or anyone sectioned under the Mental Health Act. Other restrictions also apply depending on your situation.

First appointment

You have a legal right to choose who you see for your first out-patient appointment, but there are exceptions. If you've already seen a consultant for treatment and they refer you to another healthcare professional for additional care, you don't have the right to choose who that is.

There can also be some restrictions on maternity services. While you can book with a hospital of your choice and make decisions about who looks after you and the type of birth you have, these aren't a legal right, as your care will vary depending on your risk profile.

Changing consultant/hospital

The right to choose scheme lets you switch to a new provider if you must wait for more than the maximum time for treatment. You don't have a legal right to a second opinion, but you can ask for one.

However, the right to switch doesn't apply if no one else can see you within the time limit, if a consultant doesn't lead the care you need, or if you choose to wait longer. In some circumstances, a delay might give you a better outcome. For example, some treatments have a better chance of success if you lose weight or give up smoking before you start.

You also won't have a right to choose a new provider if you've declined treatment or haven't attended appointments.

Emergencies

If you need urgent or emergency treatment, such as at A&E, you won't have the right to choose who treats you. This can apply if you need an urgent appointment, for example, for suspected cancer. However, your GP will usually offer you a choice if it's practical.

Clinical reasons for not offering a choice

There may be medical reasons that mean you don't have a right to choose who treats you. For example, you may need treatment only available at a specialist centre or from one consultant-led clinical team in your area. You won't have a right to choose in those circumstances, as your GP will make your referral based on clinical need.

What are your options if you're stuck on a waiting list?

What is a GP referral and how can you get one?

What's happening with NHS waiting lists?

You can book an appointment with your chosen consultant by completing the NHS e-Referral service online form or asking your GP to book the appointment. You'll need a GP referral, and your GP will include a shortlist of providers for you to choose from. It's a good idea to discuss your options with your GP before they make the referral so they know what your priorities are or if you have a particular consultant in mind.

If you must wait longer than 18 weeks for treatment, you can contact your chosen provider directly and ask to switch. They can send information on an alternative provider and arrange a transfer if necessary.

If your GP has referred you for treatment but has not offered a choice, you should contact them initially to discuss this. If that doesn't resolve things, you can complain to your local Integrated Care Board (ICB). ICBs are responsible for commissioning and managing healthcare services in your area, including ensuring GPs offer patients their right to choose. You can take it further if necessary; there's guidance in the NHS Framework document on the next steps and other organisations that can help you.

Reasonable adjustments are separate from your right to choose and are a legal right under the Disability Discrimination Act. However, you may need to consider any reasonable adjustments and discuss these with your GP when they make your referral. Your chosen provider doesn't have to make adjustments but must take reasonable steps to accommodate your needs.

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Reasonable adjustment

A reasonable adjustment is a change or adjustment to services to support patients with a disability or impairment that affects their ability to access services.

Having the right to choose is great, but how can you make an informed choice?

Check your priorities

When you need medical care, your first priority is likely to be to feel better. However, think about the type of care you need. Do you want a hospital close to home? Is there a consultant or clinical team specialising in the treatment you need? You might need a larger hospital offering a broad range of support services.

Talk to your GP

Your GP can offer helpful insights during the conversation about your referral.

GP insights

In many cases, GPs coordinate follow-up care after surgery and receive updates on how consultant-led treatment is going. These updates let them offer insights into the standard of care each consultant provides.

Private consultants

Many consultants work privately and in the NHS, meaning you may be able to see a consultant at a private hospital and have it funded by the NHS. Ask your GP whether this is a possibility.

Friends and family

If your friends or relatives have had similar treatment, ask them for recommendations. NHS England also collects reviews based on the 'friends and family' test and adds them to treatment provider listings.

Private Healthcare Information Network (PHIN)

PHIN publishes reviews and information on private healthcare services. However, as many consultants also practice in the NHS, their website can be a valuable source of information.

What is PHIN?

PHIN is a government-mandated, independent organisation that helps patients make informed choices about private treatment.

What does PHIN do?

They collect and publish reviews and information about healthcare professionals and work with various agencies, including the NHS, to improve standards.

Using PHIN to find a consultant

PHIN's website has a search facility where you can find providers by name, type of service, or postcode.

Google individual practitioners

Many consultants have websites advertising their private services and including details about their background and patient reviews. If you have a consultant in mind, Google can provide links to these and other review sites.

Patient review sites

There are many patient review sites where you can discover the positives and negatives of different consultants and services. Always check whether reviews are verified to ensure you hear from actual patients. You can find out more here.

Search the GMC register

Every doctor in the UK must register with the General Medical Council (GMC). The GMC records training and is responsible for investigating complaints. You can search for your chosen consultant on their website to find out about their training and whether there have been any issues in the past.

Check the Care Quality Commission website

The Care Quality Commission (CQCs) inspects hospitals in England and produces regular reports detailing evidence of good clinical practice and areas of concern. You can search their website to help you decide which hospital to choose.

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