Patient referral choice

NCL Wide
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If a GP refers their patients for a physical or mental health condition, in most cases patients have the legal right to choose the hospital or service they would like to go to. 

The choices currently available to NHS patients can be found in the NHS Choice Framework.

Consultant led Services

When referring a patient for consultant-led treatment, the patient should be able to:

  • decide which provider they would like to receive care from as an outpatient
  • choose the clinical team who will be in charge of their care within that provider organisation

These choices apply only at the point of referral (from their GP, dentist, or optometrist) to providers that have an NHS contract to provide the service needed. 

For a service to be available for the patient to choose, for physical health referrals, the service must be led by a consultant who has overall responsibility. Normally the same provider the patient has chosen for their first outpatient appointment will also go on to provide the rest of their treatment. For a community service it is usually it is the same Acute Trust where the Consultant leading the community service works in.

Community Services

Please follow the ‘Community first’ ethos with referrals where available and have suitable service inclusion and exclusion criteria. This means where there is an appropriate community service available, it should be highly considered.

Please note: where there is a community-based service in place, the minimum standard of five patient choices does not apply. 

As service provision across NCL varies, GP practices are advised to check their local borough community provision. A full directory of Community Services available can be found in Community Clinical Service Topics page.

For outpatient referrals in a secondary care setting, NHSE are asking referrers to ensure they shortlist on average five choices from which the patient may choose, where this is practicable, clinically appropriate, and preferred by the patient.

Please note: if you are referring to a local community service provider, then offering five choices does not apply. 

The patient and their referrer agree a shortlist of suitable providers at the point of referral and depending on who books the referral (the GP or the patient), then further information is available at the point of referral. 

Patients can view providers’ details such as waiting times and CQC ratings through ‘Manage your referral’ on the online e-Referral Service (e-RS): Book an appointment using the NHS e-Referral Service - NHS (www.nhs.uk)  This includes independent sector providers who are providing services for the NHS.

There is no requirement that any of the five choices must include independent sector providers.

The maximum waiting time to begin a treatment or assessment is usually 18 weeks, or two weeks to see a specialist for cancer.

A patient can ask to be referred to a different provider of NHS services if:

  • they have to wait, or have already waited, more than 18 weeks before starting treatment or assessment for a physical or mental health condition, as long as their referral is not urgent and the service they require is led by a consultant
  • they have to wait, or have already waited, more than two weeks to see a specialist for suspected cancer

From October 2023, anyone waiting over 40 weeks who has not attended their first outpatient appointment will automatically be asked by their current provider if they would like to change their healthcare provider. There may be exceptions in some circumstances – for example, if their first outpatient appointment is very soon.

Waiting times can vary between services and a patient has the right to ask to be referred to another provider that may be able to start their treatment sooner.

Patients can request to be sent to an independent sector provider if they have waited longer than their waiting time standard right of 18 weeks.

  • If a patient has to wait for more than 18 weeks for non-urgent treatment to start, they do not have a legal entitlement to ask to be referred to a different provider if:
  • there is no service available for the treatment they need that can start treatment sooner
  • the services they need are not led by a medical consultant
  • they chose to wait longer for their treatment to start
  • delaying the start of their treatment is in their best interests –for example, if they need to lose weight or stop smoking, or for other personal medical reasons, before treatment can start
  • they fail to attend appointments which they had chosen from a set of reasonable options
  • they decide not to start, or they decline, treatment
  • a doctor has decided that it’s appropriate to monitor they for a time without treatment
  • they cannot start treatment for reasons not related to the provider – for example, they’re a reservist posted abroad while waiting to start treatment
  • their treatment is no longer necessary
  • they are on the national transplant list
  • they are using maternity services (see section 5, ‘Choosing maternity services’)

If a patient has to wait for more than two weeks for an appointment to a cancer specialist, they do not have a legal right to ask to be referred to a different hospital if:

  • they did not go to an appointment that they agreed to go to
  • they have declined treatment

NHSE recommends that a patient talks to the referring healthcare professional if they need help choosing where to go for their first appointment because they have a disability or any other impairment.

The referrer must ensure that these additional needs are taken into account when a patient is making their choices. The patient should be provided with the information and support needed to choose to receive their care in a setting that is best for their individual health and wellbeing needs. 

If a patient requires reasonable adjustment and is booking via e-RS, then in addition the GP can prompt the patient to request reasonable adjustments through this process as well.  

Full details: NHS Choice Framework – what choices are available to you in your NHS care