Patient choice

Patient choice

Everyone who is cared for by the NHS in England has formal rights to make choices about the service they receive.  These include the right to choose a GP surgery, to state which GP you’d like to see, to choose which hospital you’re treated at, and to receive information to support your choices.

These rights form part of the NHS Constitution, some are explained below. This page also contains links to pages on the NHS website, which will explain how to exercise these rights and make the best choices for you.

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Choice of GP practice and particular GP or nurse

NHS England buys GP practice services on your behalf.  You have a legal right to choose which GP practice you want to register with, and which doctor or nurse you see there. Your practice must try to make sure this happens.

While this is your right, there may be times when a practice might have reasonable grounds for not doing so.  This might be because you live outside the GP practice boundary or because the GP practice has approval by NHS England to close their list to new patients. In rare circumstances, the GP practice may not accept you if there has been a breakdown in the doctor-patient relationship or because you have behaved violently at the practice. The practice has a duty to tell you why you have not been accepted onto its list.

Who is responsible for offering me this choice?

You are responsible for registering with the GP practice.  First, contact the GP practice where you want to register.  If you have difficulty registering with a GP practice, contact NHS England or your local Healthwatch office who can give advice and support.  Healthwatch is an independent champion for patients in England.

You can find information on the NHS Website. This includes GP practices close to your home accepting new patients.  NHS.uk is a national website for patients. If you cannot register with your preferred GP practice, NHS England will help you find another.

Choice of where to go for your first outpatient appointment (physical or mental health)

If you need to see a hospital consultant or specialist, this will be at an outpatient appointment. You have a legal right to choose the hospital or clinic you go to for your first appointment. However, you can only choose a hospital or clinic that is in England and offers the right NHS treatment and care for your condition.

If you are going to a hospital for an appointment, you can also choose which consultant you would like to see. You will be able to choose a consultant from a published list.

There might be times where you cannot choose the hospital or clinic. These include where you need urgent or emergency treatment and also if you are:

  • A prisoner
  • A serving member of the Armed Forces
  • Detained under the Mental Health Act 1983
  • Using mental health services

When you are being seen as an outpatient for one condition and you need treatment for a second condition, it will be your right to choose where you are seen for the second condition. You might feel it is more convenient to be treated at the same location, but it is your right to choose and you can ask for this offer of choice.

Who is responsible for offering me this choice?

Firstly, speak to the GP, dentist or optometrist who is referring you.  If you are already having the first outpatient appointment, then ask the doctor there for this choice.

You can find out more information about the hospitals and clinics you can choose from on the NHS Website.  This is a national website for patients.

Patients waiting longer than maximum waiting times

If you need to see a consultant, you will be given an appointment to see one.  If your treatment is not urgent and you are due to waiting more than 18 weeks before starting treatment, you can ask to go to a different hospital.  If your GP thinks it is possible you have cancer and you have to wait more than two weeks to see a specialist, you can ask to go to a different hospital. These are legal rights.

You do not have these rights if:

  • You choose to wait longer for your treatment to start
  • You choose to wait longer for your appointment with a specialist after being urgently referred with suspected cancer
  • Delaying the start of your treatment is in your best interests. For example, if you need to lose weight or stop smoking before starting treatment
  • There are medical reasons which means it is better for you to wait
  • You fail to go to appointments which you had chosen from a set of reasonable choices
  • You are on the national transplant list
  • You are using maternity services
  • You are using services not led by a consultant or a member of their team
  • You refuse treatment
  • A doctor has decided that it is right to monitor you without treatment
  • You cannot start treatment for reasons not related to the hospital (for example, you are a reservist posted abroad while waiting to start treatment)
  • Your treatment is no longer necessary

How will I know I have been waiting for 18 weeks or two weeks?

Ask your GP or the hospital to confirm this to you.  There are specific rules about how the time is worked out.

Who is responsible for offering me this choice?
NHS Blackpool and NHS Fylde and Wyre CCG are responsible for offering this choice.  If you have been referred to a specialist service it may be NHS England.  The CCGs will take all reasonable steps to offer you a choice of other hospitals that can see or treat you more quickly.

Choosing who carries out a specialist test

If your GP decides you need a specialist test, you can choose to have this done by anyone providing that NHS service in England. This is your legal right if:

  • The test has been ordered by your GP
  • It is your first appointment as an outpatient with a consultant or a doctor in the consultant’s team.

It is not your right if:

  • The test is not part of a first appointment as an outpatient with a consultant or a doctor in the consultant’s team
  • You are already at your first appointment as an outpatient, your doctor may decide you need a test.  You may be offered a choice about who carries out that test. But you do not have a legal right to choose once you are being seen as an outpatient.

When making a choice you can only choose from organisations that carry out the test you need in a proper and safe way.  You cannot choose who carries out the test if you need a test urgently or you have been admitted to hospital.

If you need information and support in making your choice, speak to your GP or the doctor who has asked for your test.  You can find out more information about the hospitals and clinics you can choose from the website.

Maternity services

You can expect a range of choices over maternity services, although these depend on what is best for you and your baby, and what is available locally.  When you find out you are pregnant you can:

  • Go to your GP and ask them to refer you to a midwifery service of your choice
  • Go directly to a midwifery service of your choice. You do not have to ask your GP to refer you first.

While you are pregnant, you can choose to receive ‘antenatal’ care from:

  • A midwife
  • A team of maternity health professionals, including midwives and obstetricians. This will be safer for some women and their babies.

When you give birth you can choose to give birth:

  • At home, with the support of a midwife
  • In a local midwifery facility (for example, a local midwifery unit or birth centre), with the support of a midwife
  • In any available hospital in England, with the support of a maternity team. This type of care will be the safest option for some women and their babies. If this is the case for you, you should still have a choice of hospital.

After going home, you can choose to get postnatal care:

  • At home
  • In a community setting, such as a Sure Start Children’s Centre.

Depending on where you live, you may have other choices about your maternity care.  Contact your midwife or the CCG for information.

Is this a legal right?

No. It depends what is best for you and your baby, and what is available locally. Every pregnancy is different.

When am I not able to make a choice?

You can choose where to give birth, but this may mean you cannot have some kinds of pain relief during the birth.  Some kinds of pain relief are only available in hospitals. If you need urgent or emergency treatment, you cannot choose who you see and may not be able to choose where you give birth.

Who is responsible for offering me this choice?

Your midwife will tell you about the choices available locally.

Where can I get information and support to help me choose?

Your midwife will be able to give you information, advice and support to help you decide. A number of charitable and voluntary organisations can also help you decide what to do.

These are listed below.

Community services

What choices do I have?

You may be able to choose who you see for services provided in the community.  In Blackpool, Fylde and Wyre you have choices for:

  • Adult hearing assessment services
  • Psychological therapies such as counselling.

In some cases, there may not be a choice of service.  However, you may be able to choose from a choice of different locations in order to access an appointment which is more convenient and closer to home. These services include:

  • Community eye health (ophthalmology)
  • Musculoskeletal (bones, muscles, joints) services.

Different choices are available in different areas. In future, the number of services and locations available is expected to increase.

No.

When am I not able to make a choice?

Your choice of services will depend on what your CCG, GP practices and patients think are priorities for your community.

Who is responsible for offering me this choice?

The GP or the health professional that referred you to the service.

Where can I get information and support to help me choose?

You can find out which services there is a choice for in your area by asking your GP practice.

Health research

What choices do I have?

You can take part in approved health research (for example, clinical trials of medicines) about your circumstances or care. You are free to choose whether you take part in any research. You do not have to take part if you do not want to.

When am I not able to make a choice?

You cannot take part in research if:

  • There is no research about your circumstances or care
  • You do not meet the requirements for a particular study.

Who is responsible for giving me choice?

The health professional who is providing your care, for example, your hospital doctor, GP or nurse.

Where can I get information and support to help me choose?

Below are various websites with information to help you decide whether to take part in research.

NHS Choices explains why the NHS carries out research and the different types of research there are. Visit  www.nhs.uk and search for ‘getting involved in research’.

Treatment in another European economic area

You have the right to choose, keeping within certain rules, to receive treatment that is normally available to you on the NHS in other countries within the European Economic Area (EEA).[1]

This is a legal right set out in the NHS Constitution and in EU law.

You can access any healthcare service in another member state that is the same as (or equivalent to) a service that would have been given to you in the circumstances of your case. This means that your treatment must be one that is available through the NHS.

You then have a right to claim money back up to the amount the treatment would have cost under the NHS – or the actual amount if this is lower. This means that you will normally have to pay for the full cost of your treatment upfront (though other arrangements may be available via the CCG or NHS England).  The EU directive covers treatment delivered in state-run hospitals and services given by private clinics and clinicians.

When is choice not available?

The directive does not cover:

  • Long-term (i.e. social) care
  • Access to and allocation of organs (for transplantation)
  • Public vaccination programmes against infectious diseases.

In some cases, prior authorisation may be needed before you get treatment in another EEA country. This will allow you to confirm that you are entitled to the treatment, as well as the level of reimbursement that will apply.  This process will also make sure that you are aware of all of the possible treatment choices within the NHS, which may be more convenient to you than going abroad. If you are unable to access treatment on the NHS without undue delay in your particular case, you must be given authorisation.

Who is responsible for giving me choice?

If you wish to have your treatment in another EEA country, your GP, dentist or CCG will outline the choices that are available to you.

Where can I find information to support my choice?

Please see:

What organisations can I approach for support in making decisions?

Contact NHS Blackpool, NHS Fylde and Wyre CCG or NHS England to talk about the choices available.

[1] The member states of the European Union, plus Iceland, Liechtenstein and Norway.

End of life care

You have the right to be involved in discussions and decisions about your health and care, including your end of life care. You also have the right to the information needed so you, with support from your family or carer, can make decisions about the end of life care you want to receive. This includes your preferred place of care.

What does this right means for you?

Your clinician will talk to you about your choices and circumstances; these will be reflected in the decision that is made.  You will be listened to and treated as an individual.

Where a range of treatments or forms of healthcare are available, you have the right to receive the information you need in order to decide on your preference.  NHS staff will involve you in discussions to decide, with you, on the right choice for you.  If you wish, this can include your family and carers.

Not everyone will wish to take up this right.  Some people may not be able to do so for themselves, for example if they are not conscious or if they have lost mental capacity. The Mental Capacity Act and its code of practice set out how others can make healthcare decisions for you in such circumstances.

Planning your long-term care

If you have a long-term condition, you need to identify how your condition is affecting the things that are important to you. A care planning discussion can help you work out a range of personal goals and how the NHS will help you to achieve them. It can also include your wishes around end of life care if this is relevant or appropriate.

The discussion can also identify the range of support available, how much you are able to do things for yourself, what support groups are available, and the best way for you to get more information.

This gives you more control over the care and support you receive and should help reduce the chance of avoidable hospital admission. The care planning discussion is generally led by your main health or care professional, such as your GP or hospital doctor. It may also be offered by a community pharmacist, e.g. after a medicines use review or a healthy lifestyle discussion.

The NHS has developed a range of patient decision aids to support you and your health professional in discussions about planning your care. Patient decision aids are specially designed information resources that will help you make decisions about difficult healthcare choices. They will help you to think about why one option is better for you than another is. People’s views change over time depending on their experiences and who they talk to. Understanding what is important to you about your decision will help you choose the option that is best for you.  The outcome of the discussion about your care will usually be recorded. This record could be called many things – for example a care plan, a health plan, a support plan, a self-management plan, or an information prescription.

For some people their ‘plan’ will be very detailed; for others it might be something simpler.  It is good practice to offer you a written record of what is agreed. The care planning approach is well established in mental health services and in aspects of social care. The aim is to make this type of practice more generally available. You may not want a written document; you might just want to record what you have agreed in your patient notes. The important thing is that you know you have a plan and that you are happy with what has been agreed in it.

Your right to information

You have a right to information where there is a legal right to choice. This gives you the right to information to support you in choosing your provider.  We are committed to the following:

  • Telling you about the healthcare services available to you, locally and nationally.
  • Giving you easy-to-access, reliable information to help you to make choices about your health and healthcare. This is available on the NHS Choices website and includes information, where available, on the quality of clinical services.
  • Making sure referrers are able to access information on Choose and Book around choice of provider and a choice of named consultant-led team.
  • Giving information to support children and those with learning disabilities make decisions around their healthcare.
  • Promoting choice via our website, practice websites, our annual report, press releases and other forms of regular written communication, and at engagement events.

There are many ways to get general information to help you make the right choice for you:

  • The NHS website has tools and resources to help you look at your choices and make the right decision. Visit www.nhs.uk.
  • The Care Quality Commission checks all hospitals in England to make sure they are meeting national standards. They share their findings with the public. Visit www.cqc.org.uk.
  • The NHS Constitution tells you what you can and should expect when using the NHS. Visit www.nhs.ukand search for ‘NHS Constitution’. The NHS Constitution is also available in an easy read version for download. Audio and Braille versions are available too.
  • Information about how local authorities are performing on improving public health, published by Public Health England. Visit  www.gov.uk/government/organisations/public-health-england.

What can I do if I am not offered these choices?

First, you can speak to your GP or the health professional who is referring you. In the case of maternity services, speak to your GP, midwife or head of midwifery.

If you are still unhappy that you have not been offered a choice, you can make a complaint.

You can complain to the organisation that you have been dealing with or you can make a complaint to the CCG.  If we agree with your complaint, we will make sure that you are offered a choice for that health service.

If your complaint is about not being offered a choice of GP practice or about health research you should complain to NHS England. To contact NHS England visit www.england.nhs.uk.

If you are unhappy with the decision from the CCG or NHS England, you have the right to complain to the independent Parliamentary and Health Service Ombudsman. To contact the Ombudsman:

  • Visit www.ombudsman.org.uk
  • Call the Helpline: 0345 015 4033
  • Use the Textphone (Minicom): 0300 061 4298

Last updated on 17 December 2018 at 16:06 by communications manager