With more than 7.2 million people currently on NHS waiting lists (compared to 4.4 million before the pandemic), the government has announced a revamped patient choice initiative as part of its plan to cut NHS elective surgery waiting times. Research carried out by the Independent Health Providers Network in partnership with the Patients Association shows giving patients choice can cut up to 14 weeks off the time an individual is waiting for surgery, depending on where a person lives.

Patients will be able to choose from an average of 5 providers – depending on various factors, including their medical condition and personal circumstances – at the point of referral. Those who have already been waiting more than 40 weeks, and have not been given a date or started treatment, will also be asked if they wish to switch to an alternative healthcare provider.

Whilst the emphasis of this initiative is on ensuring that patient choice is adequately advertised and enabled, the restated requirement for ICBs to ensure a robust accreditation process for providers (as required by the NHS (Procurement, Patient Choice and Competition) (No 2) Regulations 2013) may see new Independent Sector Healthcare Providers (IHSPs) seeking to enter the market or existing IHSPs looking to expand their offering.


When referring a patient for treatment, GPs will be required to have a conversation with each individual about their most important criteria for selecting a secondary healthcare provider (for consultant led services); this may include current waiting time, distance and provider quality. Following this discussion, the GP will then create a list of, on average, 5 providers for the patient to choose from; this may include both NHS and approved independent sector organisations. Patients should then be able to select their preferred provider through the NHS app.

For patients without access to the NHS app, the GP will either help them select a provider or may advise the patient to call the ‘National Referral Helpline’, who will talk the patient through their shortlist and support them in finalising their choice and onward referral.


Integrated Care Boards (ICBs) will have a key role to play in ensuring patient choice is enabled. They must, among other things:

  • Put a system plan in place which ‘raises the profile’ of patient choice;
  • Identify a system level patient choice SRO;
  • Ensure travel costs are not a prohibitive factor to patients exercising their choice;
  • Seek regularly assurance patients are being offered a choice; and,
  • Have a robust provider accreditation process in place for new providers to enter the NHS market, or for existing providers to deliver additional services.

Will it work?

The reason waiting lists are so long is multifactorial and includes bed capacity issues, a scarcity of operating theatres and staffing shortages. Whilst patient choice is not a new concept (it was introduced in 2012), currently just 1 in 10 patients exercise their right to choose. An awareness campaign to help patients understand their rights, along with the fact millions of people downloaded the NHS App during the pandemic, hopes to increase the numbers of patients exercising their right to choose. However, only around 40% of services are currently on the NHS eRS platform; this will increase over time to allow all patients to book appointments via the NHS App, but it is unclear when full functionality will be achieved. It also remains to be seen whether patients will be prepared to travel further (if required), even if they are given the choice.

There is some scepticism from within the health service, with the NHS Confederation’s opinion being that "choice works well in a system that is well funded, with sufficient workforce and a well-funded relationship with the independent sector. In the current environment, with no new resources, it will be interesting to see how much capacity this new policy actually creates, and how many people are helped off the elective waiting lists.”

Read the full letter from NHS England to trusts, GPs and commissioners here.

If you would like to discuss any issues relating to this article, please contact Anna Davies.


Laura Cook, Trainee

Anna Davies, Partner 

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