NHS Wales is committed to ensuring that patients are seen as quickly as possible according to their clinical need.
The main focus is on Referral to Treatment times. This is the total time from referral by a GP or other medical practitioner for hospital treatment in the NHS in Wales and includes time spent waiting for outpatient appointments, diagnostic tests, therapy services and inpatient or day-case admissions.
The key objectives are to ensure that:
•95% of patients referred by will start their treatment within 26 weeks;
•All patients whose care is too complex to be undertaken within 26 weeks or those who choose to wait longer receive their definitive treatment within maximum of 36 weeks;
•Patients who are not on a referral to treatment pathway but require specified diagnostic and therapy services are seen in accordance with the operational standards.
If it is not possible to be seen within the maximum waiting time, the local health board that commissions your treatment can investigate and may be able to offer you suitable alternative hospitals or community clinics that may be able to see or treat you more quickly.
However, you will need to contact the original hospital, clinic or health board first before alternatives can be investigated for you. Your health board can take reasonable steps to meet your request.
See the Welsh Government website for more information on NHS waiting times.
Note: Referrals for investigations of breast symptoms where cancer is not initially suspected are not urgent referrals for suspected cancer, therefore, they fall outside the scope of this.
Referral Guidelines for Suspected Cancer
The Welsh Government aim is to ensure that all those patients with suspected cancer undertake diagnostic tests as quickly as possible to minimise any anxiety that they may be feeling.
There are two pathways that a patient may follow:
•Patients who are referred by the GP as urgent suspected cancer, which is confirmed by a cancer specialist, should wait no more than 62 days for their treatment to commence;
•Patients who have been newly diagnosed as having cancer, not through a GP referral should start their treatment within 31 days of a decision to treat.
How does it work
If a GP, Dentist, Optician or other clinician refers you for hospital treatment, the clock starts when your referral letter is received by the hospital. In other words, measurement of the time you wait starts from this point.
When you see a clinician at your chosen hospital or clinic you may:
•Undergo tests, scans or other procedures to help ensure that your treatment is tailored appropriately to your condition;
•Have medication or therapy to manage your symptoms until you start treatment;
•Be referred to another consultant or department.
The clock will stop (your waiting time ends) if no treatment is necessary or when your treatment begins. This could include:
- Being admitted to hospital for an operation or treatment;
- Starting treatment, such as taking medication, that doesn’t require you to stay in hospital;
- Beginning your fitting of a medical device, such as leg braces;
- Agreeing to your condition being monitored for a time to see whether you need further treatment;
- Receiving advice from hospital staff to manage your condition.
If you want to delay your hospital admission, for example because of a planned holiday, the NHS may temporarily pause the clock.
How do I get a referral to an NHS specialist?
You are entitled to ask for a referral for specialist treatment on the NHS. You will need to see your GP if you wish to be referred to a specialist in a particular field, such as a surgeon, or a gynaecologist (a specialist in the female reproductive system).
All your medical records are held by your GP who understands your health history and treatments better than anyone. Therefore, your GP can decide whether a specialist referral is necessary and, if so, can recommend what hospitals, or clinics, would be appropriate to visit.
If you ask your GP to refer you to a specialist, it is likely that they will first suggest that you try various tests, or treatment options, to see whether your condition improves. Generally, you cannot self-refer to a specialist within the NHS, except when accessing sexual health clinics or accident or emergency (A&E) treatment.
A specialist will only see you with a letter of referral from your GP. The letter will give the specialist essential background information, such as your medical history, and it will also contain details for the specialist to pay particular attention to.
If you wish to see a private specialist, you are still advised to get a letter of referral from your GP. However, if you see a private specialist without a GP referral, your GP is not obliged to accept the specialist’s recommendations.
Can I demand a specific treatment?
Your GP doesn’t have to prescribe a particular medication or treatment for you if they think it’s not the right option. You’re entitled to ask for their reasons for the decision.
You’re also entitled to make a suggestion and explain to your GP why you believe that a medication or treatment is a good option.
- some types of treatment aren’t available on the NHS, and
- you need a referral from your GP to have some types of treatment on the NHS, such as cosmetic surgery.
Seeing a consultant
Your GP might refer to you to see a specialist consultant if they think you need to.
If you want to see a particular doctor or consultant, you can ask for this. However you don’t have a right to see the person you ask for, and your GP can’t insist that you see a particular doctor or consultant.
But you do have the right to see a doctor who is capable of dealing with your situation.
If you have special reasons for wanting to see a particular consultant, for example, if your child is the consultant’s patient, you could ask for an appointment, explaining your reasons for wanting to see them. If you still have difficulty in seeing the consultant, you could write to the hospital administrator asking for their help.
If you want to get a second opinion you will need to ask the consultant, who may arrange for you to see someone else. If the consultant doesn’t agree, you could ask your GP to help.
If you’re not satisfied with your GP’s advice, you may want to consider getting a second opinion. Although you’re not legally entitled to a second opinion, a healthcare professional will rarely refuse to refer you.
You may feel happier with a different GP, but be aware that they may give you the same advice.
NICE and NHS medicines and treatments
The National Institute of Health and Clinical Excellence (NICE) regularly looks at new medication and treatments to assess whether they:
- are safe,
- are more or less effective than other medication or treatments, and
- represent value for money, by assessing how well a medication or treatment works in relation to its cost.
NICE will not automatically reject a medication or treatment because it’s expensive. NICE recognises that something can be both expensive and represent good value for money.
The NHS in England and Wales is legally obliged to fund medicines and treatments that NICE recommends. This means that when NICE recommends a medicine or treatment, the NHS must ensure it’s available to those people it could help, normally within three months of the guidance being issued. So, if your doctor thinks a medicine or treatment recommended by NICE is right for you, you should be able to get it on the NHS.
Medicines and treatments not recommended or assessed by NICE
The NHS is not legally obliged to fund a medicine or treatment not recommended by NICE, even if your GP thinks it would benefit you.
In fact, most NHS medicines and treatments have never been looked at by NICE. The Department of Health (DH) only asks NICE to provide guidance when there’s uncertainty over the use of a treatment.
All medicines must be licensed by the Medicines and Healthcare products Regulatory Agency (MHRA). There is no ban on prescribing licensed medicines that NICE has not yet assessed or where a NICE appraisal is in progress.
The DH has issued clear guidance to local organisations, such as Health Boards and NHS Trusts, on what to do when NICE has not issued guidance on a new medicine. In these circumstances, Health Boards are expected to take into account all the evidence available when deciding whether to fund treatments.
Do I need a GP referral for private treatment?
It’s possible to seek private treatment from a consultant or specialist without being referred by your GP. However, the British Medical Association (BMA) believes that, in most cases, it’s best practice for patients to be referred for specialist treatment by their GP.
If you’re unwell or have symptoms, you should see your GP first who will decide whether you need treatment. If you do, they will decide whether they can treat you or if you need to be referred to a specialist.
If your GP thinks you need specialist treatment and you want to pay for it privately, they can write a letter of referral to a private consultant or specialist explaining your condition and your medical history.
Your GP will only refer you to a specialist if they believe that specialist assessment or treatment is clinically necessary. If they don’t think it is necessary, they do not have to refer you.
Whilst a patient may request to be seen in a certain hospital, patients registered with a GP in Wales do not have a statutory right to choose at which hospital they receive treatment. However patients on the border who are registered with a GP in England are entitled to exercise Patient Choice.
If you’ve had a private consultation for tests and diagnosis, you can still have treatment on the NHS. You will join the NHS waiting list as a new referral. Paying for a private appointment will not gain you an advantage over others referred direct to the NHS.
Treatment without a GP referral
If your GP doesn’t think you need specialist treatment, it’s possible for you to seek treatment without a referral. However, the BMA believes that it’s usually best if patients are referred by their GP for specialist treatment.
What if I have private medical insurance?
Insurance companies usually require a letter of referral from a doctor. Some companies will accept GPs’ referrals to consultants, while others have their own lists of consultants.
If you have private medical or health insurance and you need specialist treatment, check your policy to find out:
- if your policy covers the treatment that you need
- whether your insurance company accepts consultant referrals from GPs or if it has its own list of consultants
- when you need to contact your insurance company to tell them that you’ve been referred for treatment
If your insurance company accepts GP referrals, arrange to see your GP as soon as possible.
If you make a claim for treatment under your private medical insurance, some sections of the claim form will probably need to be completed by a doctor. In most cases, the doctor who provides your treatment will be the best person to complete the form because they will have the information required.
You can also ask a GP or a NHS hospital doctor if they will complete the form. However, they do not have to do this and if they do complete the form, they’re entitled to charge for this service.
Is choose and book available in Wales?
Choose and book is not available to patients in Wales. In Wales a GP makes a referral to a local hospital in your health board area. Patients are normally only referred outside the area if the treatment they require is not available where they live. If this is the case then funding for treatment outside the local area has to be agreed with the health board.
The Welsh Government introduced waiting times for assessment and treatment by local primary mental health support services in 2012.
These stated that people referred for a mental health assessment should be seen within 28 days of receipt of referral. Following assessment, those who need treatment should start to receive it within 56 days.
The 56-day assessment to treatment target was changed in November 2015 to become a 28-day target to ensure people have timely access to treatment following the assessment outcome
Waiting time exceptions
The right to be seen within maximum waiting times does not apply:
- If you choose to wait longer.
- If delaying the start of your treatment is in your best clinical interests, for example where stopping smoking or losing weight is likely to improve the outcome of the treatment.
- If it is clinically appropriate for your condition to be actively monitored in secondary care without clinical intervention or diagnostic procedures at that stage.
- If you fail to attend appointments that you had chosen from a set of reasonable options, or
- If the treatment is no longer necessary.
The following services are not covered by the right:
- Maternity services;
- Palliative care;
- Level 3 fertility services.
What if you have waited longer than 26 weeks?
If you have already waited longer than 26 weeks from the start of your referral, or you think that your treatment will not start within 26 weeks, you should contact either the Waiting times department in the hospital you have been referred to or the health board.
If you are not happy with the outcome, you also have the option of taking the complaint further using the NHS raising a concern procedure.
What if the hospital postpones your operation?
If your operation is postponed by the hospital on more than one occasion with less than eight days notice for a reason that has nothing to do with your medical condition, then you should receive your operation within 14 days, or at your earliest convenience.
Latest Referrals waiting times data: