A little known rule could save months of time and hundreds of pounds by letting people skip NHS waiting lists - for free.
The NHS aims for 92% of patients to start specialist treatment within 18 weeks of a GP referral, but with staff shortages, backlogs of cases and a lack of equipment and bed capacity, it's not always possible for the NHS to deliver this itself.
Patients referred to an ear, nose and throat specialist at Liverpool University Hospitals Foundation Trust - which runs the Royal Liverpool, Aintree and Broadgreen hospitals - wait an average of 30 weeks just for their first outpatient appointment, according to data provided by the trust to My Planned Care, an NHS website.
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That's the longest average waiting time at any NHS trust in Merseyside, according to the latest data shared with My Planned Care, which is updated weekly, but the picture is similar across hospitals. Less than half the 85,542 patients on waiting lists for treatment at Liverpool University Hospitals in November had been waiting under 18 weeks.
At St Helens and Knowsley Teaching Hospitals, this was 66%, while at Wirral University Teaching Hospital, it was 62%, and at Southport and Ormskirk Hospital it was 66%. Under the NHS Constitution, patients have a 'right to choose' where they are treated. This covers other NHS hospitals and private providers, which can be a crucial mechanism for patients waiting months for treatment, and for hospitals overwhelmed by demand.
What treatments are covered?
The 'Right to Choose' covers physical and mental health conditions for which treatment would take longer than 18 weeks to start. It does not include emergency services or urgent treatment. For maternity services, your range of choices - including home births and hospital births - are not legal rights and are limited by the services clinical commissioning groups have put in place in your local area.
For cancer care there is a separate two-week target for being seen by a specialist. You can only choose other NHS providers - not private ones - if it would take more than two weeks to be seen at your local hospital.
Who is eligible?
Most people in England have a legal right to choose their care provider. This legal right does not apply to members of the armed forces, prisoners, people on temporary release from prison, or people detained in "prescribed accommodation, which includes, courts, secure children's homes, secure training centres, immigration removal centres, or young offenders' institutions.
It also does not apply to people held in hospital under the Mental Health Act 1983, or to people already receiving care and treatment for the condition they're being referred for, according to the Department of Health and Social Care (DHSC) website.
Where can I get treatment?
Under 'Right to Choose', you can pick which general practice (GP) you register with and the doctor or nurse you see at your GP. You can pick the hospital or clinic you go to for your first outpatient appointment following a referral, and you can choose the clinical team in charge of your care.
You can even switch to a different NHS provider if you'd have to wait more than 18 weeks to start treatment at your current one. For suspected cancer, you have this choice if you'd wait more than two weeks before seeing a specialist.
If you can't access specialist care from the NHS within 18 weeks, you can also choose to be treated by a private provider. You can only choose another NHS provider, not a private one, for urgent cancer care, according to NHS Cheshire and Merseyside.
The NHS contracts private healthcare providers to act like a pressure valve for waiting lists when they extend beyond the maximum length promised to patients. Private providers - referred to by the Department of Health and Social Care (DHSC) as the 'independent sector' - delivered 450,000 appointments in October, roughly 6% of NHS care, according to the DHSC.
Among these private providers are Psychiatry UK, which offers diagnosis and treatment for conditions like ADHD and autism. Adults can wait years for an initial assessment through the NHS, while private assessments can cost £600.
Thanks to a contract with the NHS, Psychiatry UK is able to offer appointments through 'Right to Choose' within six months of a referral. At one point last year, demand was so high it stopped taking new referrals, but as of December, it is taking referrals again.
Neither DHSC nor NHS Cheshire and Merseyside has a list of private qualified providers - providers commissioned to provide services to NHS patients - either in this region or nationally. Some of these private providers are only commissioned locally, while others are commissioned nationally, meaning people in different parts of England have different choices depending on where they're registered with a GP.
NHS Cheshire and Merseyside said: "If a private provider service outside of the Cheshire and Merseyside region is listed on the national NHS e-referral system to a patient registered with an NHS Cheshire and Merseyside Integrated Care Board GP Practice, then they will be able to access that service."
Will it cost me anything?
Staying true to its founding principles, patients do not have to pay for care accessed through 'Right to Choose'. It is paid for from existing NHS budgets, regardless of whether the provider is another NHS trust or a private company. The NHS said private providers are included "if it does not cost the NHS any more than a referral to a standard NHS hospital".
However, private providers factor profits into their prices, potentially driving it higher than it would cost a standard NHS hospital to deliver a service. The ECHO put this point to the DHSC and NHS Cheshire and Merseyside, both of which said prices could be set either nationally or locally, giving flexibility with pricing arrangements.
Patients can also get help with transport and accommodation costs incurred by travelling to appointments away from their local hospital, according to the DHSC, which said such patients "will be offered a comprehensive support package".
How do I access my 'Right to Choose'?
Your GP should discuss your 'Right to Choose' at the point of referral, offering you the option of picking another NHS trust or a private provider if you would otherwise be waiting more than 18 weeks. Where there is a legal right to choice, patients referred to an outpatient appointment by primary care can use the NHS electronic referral system to choose from available providers.
The 'Right to Choose' is not always offered to or discussed with patients even when it does apply. In these cases, patients can contact their local integrated care system - in our area this is NHS Cheshire and Merseyside - which is responsible for implementing the choice framework.
A spokesperson for NHS Cheshire and Merseyside said: "Under NHS Right to Choose, patient choice should be discussed and offered in line with the NHS Choice Framework at the point of a referral being made. If a patient feels they have not been offered a choice at the point of referral they can speak to their GP Practice or contact NHS Cheshire and Merseyside."
They can also contact NHS England, which responds to and investigates complaints about patient choice, as well as giving advice and guidance to patients, NHS commissioners, and providers on their choices under the NHS constitution.
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