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Guidance

Consultant-led treatment: right to start within 18 weeks

The rules for ensuring patients’ referral to treatment (RTT) waiting time, for consultant-led treatment, is fair and consistent within an 18-week period.

Updates to this page

From:
Department of Health and Social Care
Published:
31 January 2012
Last updated:
27 October 2022
Show all updates

  1. The referral to treatment (RTT) guidance suite has changed to reflect NHS England’s revised guidance on patient choice. The changes mean providers can better manage patients who wish to delay treatment at their current or alternative provider. If these patients wish to delay treatment, and have rejected 2 offers of reasonable treatment dates, providers can place them into a period of active monitoring. This would only happen following a clinical conversation and agreement with the patient. When these patients are then ready to accept an offer of treatment, they will re-join the waiting list and will be offered treatment. There will be flexibility in clinical decision-making, with the changes being suggestions rather than requirements, so providers can make decisions in the best interests of their patients. The overall aim of the changes is to support providers to manage their waiting lists and resources more accurately and efficiently, by focusing on arranging treatment for patients who have been waiting long times and who are available, while still protecting patients’ rights to choice.

  2. Updated to reflect that the October 2015 Referral to Treatment consultant-led waiting times Rules Suite is now the current version.

  3. April 2014 rules suite added.

  4. First published.

Applies to England

Documents

Referral to treatment consultant-led waiting times: rules suite (October 2022)

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Details

Patients have a right to start consultant-led treatment within 18 weeks of referral or request an offer of alternative providers that can start their treatment sooner. The NHS must take all reasonable steps to meet patients’ requests.

The maximum waiting times legislation requires commissioners to consider the ‘Referral to treatment consultant-led waiting times rules suite’. The rules suite includes:

  • national waiting time rules
  • definitions for RTT waiting times
  • guidance on applying the national rules locally
  • guidance on reviewing the pathways of patients who have waited longer than 18 weeks before starting their treatment
  • guidance on clinical exceptions to the NHS Constitution right to access services within maximum waiting times

On 1 October 2015, the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) (No.2) Regulations 2015 came into effect, removing the provision for a patient pause. The October 2022 rules suite reflects this change.

The NHS will want to maintain a local record of delays resulting from patient choice, to aid good waiting list management and to ensure patients are treated in order of clinical priority. However, it will not affect a patient’s RTT ‘clock’.

Monthly referral to treatment data, guidance and practical tools for waiting list management are available from NHS England.

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