Referral to treatment

In England, under the NHS Constitution, patients ‘have the right to access certain services commissioned by NHS bodies within maximum waiting times, or for the NHS to take all reasonable steps to offer a range of suitable alternative providers if this is not possible’. The NHS Constitution sets out that patients should wait no longer than 18 weeks from GP referral to treatment.

Rules and guidance

Patient’s rights and the guide to NHS waiting times

Read the guide to NHS waiting times for patients which aims to provide patients with a guide to NHS waiting times including rights and choice in relation to waiting times.

RTT rules suite – published by the Department of Health

The RTT Rules Suite aims to set out clearly and succinctly the rules and definitions for referral to treatment consultant-led waiting times to ensure that each patient’s waiting time clock starts and stops fairly and consistently.

The October 2015 Referral to treatment consultant-led waiting times Rules Suite is the current version of this document. 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 2015 Rules Suite reflects this change.

Although the NHS will wish 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 – they will not affect a patient’s RTT ‘clock’, and there is no provision to report pauses or suspensions in RTT waiting time clocks in monthly RTT returns to NHS England under any circumstances.

Recording and reporting guidance

The guidance aims to provide information to support the process of accurate recording and reporting of referral to treatment waiting times.

Take a look at our current recording and reporting RTT guidance and FAQs.

Non-reporting guidance and template

NHS England, TDA and Monitor have published mandatory guidelines setting out the responsibilities of providers of NHS services who want to suspend the reporting of mandatory data including RTT.

Guidance for reviewing patient pathways over 18 weeks

As set out in the NHS Operating Framework and NHS Constitution patients have a right to start consultant-led treatment within a maximum of 18 weeks. This guidance, published by the Department of Health, sets out the benefits of reviewing the pathways of patients who have waited longer than 18 weeks before starting their treatment. It also suggests methods for reviewing and reporting waits longer than 18 weeks in order to understand the causes and drive further improvements in patient experience.

Maximum waiting time guidance for commissioners

NHS England guidance has been published to inform commissioners of their legal duties around waiting times, provide a brief overview of the maximum waiting times rights and supply resources to support implementation.

IMAS elective care guide

The NHS Intensive Support Team (NHS IST) have produced a guide to the management of elective care pathways designed to explain the essential elements of a Referral to Treatment (RTT) pathway; from pre-referral advice and outpatients, all the way through diagnostics to patient admissions. The guide also covers a number of key areas which support the operational delivery of a good RTT pathway, including demand and capacity planning, elective access policies, performance management and reporting.

Good practice and other information

Demand Management Good Practice Guide

The Demand Management Good Practice Guide is intended to provide a list of initiatives and actions that CCGs should consider implementing locally, in collaboration with providers and other organisations to effectively manage the increasing demand for elective care services (particularly to reduce unnecessary outpatient appointments). Effective implementation of these initiatives and actions will help ensure that those patients who do need to be referred for treatment to hospitals are seen as quickly as possible and in line with their right under the NHS Constitution. The guide is supplemented by case studies and links to further help and advice.

This guide was published on 16 August 2016 and updated on 19 December 2016.

Elective Care – summary of some actions CCGs can take

The traditional pathway for elective surgery is complex and disjointed, with considerable variation in surgical operation rates. This quick guide contains ideas and examples that will help commissioners and providers effectively manage the increasing demand for elective care services. It will also help ensure that those patients who need surgical treatment are seen as quickly as possible and in line with their right under the NHS Constitution.

Capacity and demand models and tools (NHS IST)

Through its experience of working with NHS Trusts and commissioners, the NHS IST has developed a series of demand and capacity models designed to help organisations achieve an appropriate balance between demand and capacity, and to ensure that waiting lists are of an appropriate size. These models can act as a helpful starting point for organisations to better understand demand and plan capacity accordingly.

The demand and capacity models are freely available via the NHS IMAS website.

Information sheets (NHS IST)

The NHS IST has created a series of good practice information sheets to assist organisations:

Writing a Local Access Policy (NHS IST)

NHS IST presentation aimed at individuals supporting Trusts in the development of the review and sign-off of a Local Access Policy: writing an access policy

Guide for developing and implementing an elective care training strategy (NHS IST)

Training programmes for all staff groups, including clinicians, are beneficial in supporting a general understanding of the RTT rules and the value of their application in both administrative and clinical settings. The purpose of this guide is to provide a framework for Trusts to use when making the transition to a contextual elective care training strategy comprising training, awareness, engagement, competency and compliance.

Developing and Implementing an RTT Training Strategy – Guide

Changes to the RTT operational standards and reporting arrangements

RTT data

The monthly RTT data is published routinely each month. These statistics are used to inform debate, decision-making and research both within government and by the wider community. The published data set includes data for all providers and commissioners and can be found at: Consultant-led Referral to Treatment (RTT) Waiting Times