Giving people the care that is best suited to their needs can improve quality of care and health outcomes. We also know that people value being involved in conversations and decisions about their and their families’ care.
Choice plays an important role in making sure that people can access the provider of care that best suits their individual needs and preferences. The right to choose is enshrined in the NHS Constitution, so it’s a legal right everyone has.
Choice can also help to improve health services by showing which providers of care people value most, and where there are gaps in care. For example, if lots of people are choosing to travel some distance for a particular clinic, there may be a case for setting up a similar clinic locally or improving local services.
If a GP refers you to a consultant or specialist in mental health, you have the right to choose the provider of your care.
Choice should be offered at a point in your treatment where you can make a meaningful decision about who will provide your care. The decision will often be made with your GP on referral to a specialist. In some areas an assessment service will help to decide what type of treatment is best. If this is the case, you can choose a provider once the assessment has recommended a type of treatment. If you’ve already been seen by a provider and discharged, you can choose a different one if your GP thinks you need further treatment.
The best provider for you will depend on your individual needs and preferences. You may need information about your options before you can make a decision. Your GP can help you to decide what the best choice is for you and give you advice on the two different choices available. There is also information online about quality of care, waiting times and transport links:
The NHS website is a good place to start for information on mental health conditions and providers.
If you don’t mind which provider you see, your GP can suggest one that meets your needs. If you have a preference for a particular provider, your GP can discuss the pros and cons of that preferred choice so you can make the right decision.
If you need crisis or acute mental healthcare, you don’t usually choose your provider. Once the acute phase is over, you can choose who provides your non-acute followup care.
Local healthcare commissioners determine the types of services that are available for their local population. Each commissioner is responsible for people who are registered with a GP in its area.
When you are referred to one of the types of services made available by your commissioner, you can choose to go anywhere in England for it as long as the provider chosen works with the NHS and fits with your care needs. This means you can choose providers known for specialist care or tertiary care if they offer the type of service required.
However, the right to choice doesn’t mean that you can choose different types of service that aren’t suitable for your needs. For example, if referred for a consultant outpatient appointment you can’t choose inpatient therapy, or if sent to an Improving Access to Psychological Therapies (IAPT) service you can’t choose a consultant outpatient appointment.
Sometimes you may want to see a provider that isn’t appropriate for your clinical or care needs. When this happens the care professional or team responsible needs to explain clearly and document why the preferred choice isn’t appropriate, and support you in choosing a more appropriate provider.
Commissioners need to make arrangements so that you are able to choose and go to the provider you think best meets your needs.
At NHS Improvement, many of the queries and complaints we receive are because a person has been told they can’t choose a provider because the provider doesn’t have a contract with the person’s local commissioner. This is an example of choice not working properly, and isn’t a reason for a commissioner to refuse a person their choice.
Where we have seen commissioners making choice work well, there is a clear process in place for supporting the referral of a person, even to providers the commissioner doesn’t have existing arrangements with. Whatever process commissioners use shouldn’t unnecessarily delay access to care.
Some commissioners hold meetings or panels to assess the needs of a small number of people who have complex conditions and make sure that they are able to choose the best care. Commissioners using these panels effectively tell us that people’s interests are put first and local finance and contract arrangements aren’t relevant to the decision-making.
We’re aware of some commissioner policies that require the use of local providers either exclusively or for first appointments with consultants. These policies may prevent people from choosing the provider of care that is best for them, and are against the NHS Constitution.
In most cases you should first speak to the healthcare professional responsible for your treatment, usually your GP. However, if you don’t feel comfortable doing this or if you are dissatisfied with the outcome, you may wish to complain to another organisation. Details of how to contact these organisations are set out below.
Contacting your local commissioner
Commissioners (NHS England and your local clinical commissioning group, or CCG) are responsible for organising the delivery of NHS services in England. Each commissioner is responsible for a specific geographical area. They must publish their complaints procedure. If they agree with your complaint, the CCG must make sure that you are offered a choice for that health service.
To contact your local commissioner:
visit the NHS website at www.nhs.uk, click on the ‘health services near you’ section on the home page. You can search for your CCG by the location of your GP practice.
ask your GP practice as they can tell you how to contact your commissioner.
you can also visit www.england.nhs.uk/ccg-details
Contacting NHS Improvement
If after speaking with your local CCG you are still concerned that you are being prevented from exercising your right to choice, you may want to contact NHS Improvement. NHS Improvement can provide advice about choice issues and may be able to resolve individual concerns. This could involve directing you to the appropriate place to make your concerns known, or could involve NHS Improvement directly engaging with relevant parties.
For more information on raising concerns with NHS Improvement:
visit the NHS Improvement website
call the enquiries team: 020 3747 0000
Contacting NHS England
You can also contact NHS England:
call the customer contact centre: 0300 311 22 33 (Monday to Friday, 8.00am to 6.00pm)
Contacting the Parliamentary and Health Service Ombudsman
If you are unhappy with the decision from your CCG, NHS England or NHS Improvement, you have the right to complain to the independent Parliamentary and Health Service Ombudsman. The Ombudsman is the final stage in the complaints system. To contact the Ombudsman:
call the helpline: 0345 015 4033
use the textphone (minicom): 0300 061 4298
text ‘call back’ with your name and your mobile number to 07624813005; you will be called back within one working day during office hours (Monday to Friday, 8.30am to 5.30pm).
Contacting your local advocacy service
In addition to the above, you can contact an NHS complaints advocacy service if you have concerns regarding your right to choose. Contact your local Healthwatch to find your local advocacy service by visiting www.healthwatch.co.uk/find-local-healthwatch