If you’re unwell or have symptoms which you believe need investigation, you should see a member of the Practice Team first (usually a Dr or Nurse Practitioner), who will decide whether you need treatment. They will decide whether they can treat you, or if you need to be referred to a specialist for further investigation.
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. 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.
If you want to pay for investigation privately, the GP can write a letter of referral to a private consultant or specialist explaining your condition and your medical history.
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.
What if I have private medical insurance?
Insurance companies usually require a letter of referral from a GP. 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 GP. In most cases, the GP who provides your treatment will be the best person to complete the form because they will have the information required. However, they do not have to do this and if they do complete the form, they’re entitled to charge for this service.
How do I get an update on my referral?
To receive an update on your referral, it is important that you contact the Health Board/Hospitals booking department on the numbers below. The Practice will not have information on your appointment and cannot access updates any easier than the patient:
Cardiff and Vale University Health Board – 029 20 748181
Bridgend (Cwm Taf Morgannwg Health Board) – 01656 754393
Latest Referrals waiting times data:
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 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.
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.
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:
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.
How do I get an update on my referral?
To receive an update on your referral it is important that you contact the Hospitals booking department on the numbers below. The Practice will not have information on your appointment and cannot access updates any easier than the patient:
-Cardiff and Vale University Health Board – 029 20 748181
-Bridgend (Cwm Taf Health Board) – 01656 754393
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 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 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
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.