Understanding your 'Right to Choose'

What the right to choose actually means

If your GP decides that you would benefit from seeing a specialist, you may have the legal right to choose the hospital, clinic, or NHS-funded provider that delivers that appointment. This right mainly applies to planned, non-urgent outpatient appointments, where more than one provider is available through the NHS e-referral system.

It is important to understand that the right to choose begins after your GP has decided a referral is clinically appropriate. You cannot choose whether to be referred, nor can you use the policy to access treatment that is not appropriate or available through the NHS. The right applies to where you are seen, not what treatment you receive.

When the right to choose is appropriate

There are many situations where choosing a provider is not only allowed but can genuinely benefit patients.

It may be appropriate when:

• Waiting times differ significantly between services and you want to be seen sooner.

• A provider further away offers a specialist clinic or expertise that aligns with your needs.

• Travel to an alternative provider is easier, for example because it is closer to work or the home of someone who can support you.

• You prefer a particular setting, such as a quieter clinic, a service with strong accessibility support, or a provider you have had good experiences with in the past.

In these cases, choosing a different provider can lead to faster access, more personalised care, and a more positive experience overall.

When the right to choose does not apply

There are also circumstances where the right to choose is not available, and where the NHS must prioritise safety and clinical urgency over preference.

Choice is not available when:

• The situation is urgent or an emergency, such as suspected stroke, heart attack, or severe acute illness.

• You are on a cancer pathway following an abnormal screening result.

• You need urgent mental health support or care relating to a crisis.

• Services are temporarily paused, at full capacity or undergoing safety review.

• You are already under active treatment with a specialist for the same condition.

In these cases, care must go ahead through the safest and most appropriate clinical route, often without the option to choose a different provider.

Even in non-urgent situations, your GP may need to follow local NHS commissioning or safety rules that limit which services can be used.

How shared care fits into the picture

For some conditions, the referral itself is only the beginning. Many treatments - particularly those involving long-term medication or monitoring - rely on a partnership between the specialist service and your GP. This arrangement is known as shared care, and it sets out clearly what each party is responsible for.

In a shared-care agreement:

• The specialist usually diagnoses, stabilises treatment, and provides the initial prescriptions.

• The GP may take over the ongoing prescribing and routine checks once the treatment plan is established.

• Both teams remain involved, with the specialist available for advice or escalation if needed.

Shared care is common in ADHD medication, rheumatology, dermatology, gastroenterology, and some mental health conditions. It allows patients to receive regular support close to home while still benefiting from specialist oversight.

Why GPs cannot always agree to shared care

Patients are often surprised - and sometimes distressed - when their GP declines a shared-care request. This does not mean the GP doubts the diagnosis or is refusing treatment. Instead, GPs have a legal and professional duty to prescribe safely, and there are situations where taking on shared care simply isn’t possible.

A GP may decline shared care when:

• The medication is unfamiliar or rarely used in general practice. GPs must only prescribe medicines they can manage safely.

• Monitoring requirements are too intensive, for example, needing frequent blood tests, ECGs, or health checks that the practice does not currently have capacity to provide.

• The shared-care protocol is incomplete or unclear, making it difficult for the GP to know exactly what they are responsible for.

• The specialist provider is outside the local NHS system, making communication and support harder to guarantee.

• Local NHS policies (ICB guidance) restrict shared care for certain medicines or conditions.

• The patient’s condition is not yet stable, meaning prescribing should remain with the specialist.

These decisions are based on safety, clarity, and local capacity - not on judgement about the patient or the value of their treatment.

When shared care works well

Shared care can be extremely beneficial when the treatment is stable, the specialist provides clear information, and the GP practice has the resources to offer monitoring. In these situations, patients receive convenient long-term care near home, with confidence that their GP and specialist are working in partnership. Good communication makes a huge difference, and many shared-care arrangements are straightforward, safe and supportive.

When shared care may not be appropriate

Shared care may be unsuitable when treatment is new or unstable, when the patient has complex health needs that require specialist oversight, or when the provider is unable to supply timely clinical advice to the GP. It may also be inappropriate if the monitoring required is beyond what the GP practice can reliably deliver. In these cases, prescribing must remain with the specialist service.

What this means for patients choosing a provider

When exercising your right to choose, it’s helpful to understand how your long-term treatment will be managed. Some providers expect to pass prescribing responsibility back to the GP relatively quickly. If your GP is unable to take on shared care, the specialist may need to continue prescribing, but this may not always be possible long term.

Before choosing a provider, you may wish to ask:

• How will follow-up and monitoring work be carried out?

• When might shared care be requested?

• What information will be sent to your GP?

• What happens if your GP cannot take on shared care?

Understanding this in advance can avoid delays or uncertainty later on.

Alles unter einen Hut bringen

The right to choose gives patients more control over where and how they access non-urgent NHS care. It can lead to shorter waits and more personalised treatment, but it works best when patients also understand the realities of shared care and the responsibilities placed on GPs. GPs must prescribe safely, follow local NHS policies and ensure they have the capacity to manage long-term treatment. Their decisions are made with safety and practicality in mind, not to restrict your choices.

By understanding both the benefits and the limits of these policies, patients can make informed decisions, ask constructive questions, and work alongside their GP and specialist team to ensure they receive safe, effective, and appropriate care throughout their treatment.