Right to Choose vs going private: a doctor's comparison

If you're stuck on a long NHS waiting list, you have three main options. Most patients are aware of two of them — wait, or pay privately. Far fewer know about the third, which is often the most powerful.

This piece walks through all three honestly, in the order I'd usually consider them, from a medically-trained perspective.

Option 1: Choose a different NHS hospital using Right to Choose

In England, when your GP, dentist or optometrist refers you for a first outpatient appointment with a consultant-led service, you have a legal right to choose which provider you go to, from those with an NHS contract for the service you need. The government's NHS Choice Framework sets this out, and the law behind it is regulation 39 of the NHS Standing Rules Regulations 2012. The NHS website also explains it on nhs.uk.

Two limits matter. The choice is made "at the point of referral", in the Choice Framework's words, and there are exceptions, including urgent care, suspected cancer and an onward referral for a condition you are already receiving care and treatment for. And your GP decides whether a referral is clinically appropriate: NHS England's guidance says the referrer "is not required to make a referral to a provider or team if they do not believe this would be clinically appropriate". If you are already on a list, a different right applies: you can ask to be referred elsewhere once you have waited, or will wait, more than 18 weeks (section 4 of the same framework).

Why this is so powerful:

• It is free. You stay within the NHS, and the NHS pays the provider in the normal way.
• The wait at a different hospital can be dramatically shorter. On HospitalWaits, you can compare median waits across hundreds of trusts for the same specialty — differences of 20+ weeks between neighbouring trusts are common.
• It works for outpatient referrals, which covers most elective conditions (joint surgery, ENT, dermatology, gynaecology, urology, cataract surgery, and many more).

Why most patients don't use it:

Healthwatch England says few people exercise this right. Part of the reason is information: the data needed to make a confident choice has historically been hard to find.

(That last bit is one of the reasons HospitalWaits exists.)

How to use it:

1. Look up the wait at your local trust + specialty (use HospitalWaits or the NHS RTT data).
2. Compare with other trusts in your travel range.
3. Take a printable letter (HospitalWaits has a generator) to your next GP appointment, naming the specific trust you'd like.
4. If you think you were not offered a choice you were entitled to, the Choice Framework says to speak to your GP first; after that you can complain to your local integrated care board (ICB) and raise it with NHS England (0300 311 22 33). What to do if you are not offered a choice.

Option 2: Insurance-funded private treatment

If you (or your partner, or your employer) have private medical insurance — Bupa, AXA Health, Vitality, WPA — your insurer will likely cover the consultation and treatment privately, often with the same consultant who would have seen you on the NHS. The NHS waiting list isn't a barrier; private insurance pathways usually skip it.

The under-recognised question: do you have private medical insurance and not realise it?

Many UK households do. PMI is often bundled with:

• Employer benefits (especially in finance, tech, professional services)
• Spouse/partner family policies
• Health-cash-plan add-ons (Simply Health, HSF) — these aren't full PMI but cover some procedures
• Older policies you took out years ago and forgot about
• Ex-employer continuation coverage that auto-renewed

Five minutes spent checking your benefits portal, your partner's policy, or your last few payslips is worth it. If there's any cover, the wait drops dramatically.

How to check:

1. Search your email inbox for "policy schedule" / "Bupa" / "AXA" / "Vitality" / "private medical".
2. Ask your HR / benefits team in writing: "Am I covered under any private medical insurance, and what's the procedure for using it?"
3. Ask your partner the same question.
4. If you find a policy, call the insurer first — they'll guide you through their authorisation route.

If you don't have cover and are considering buying it now: be aware that pre-existing condition exclusions usually apply, so a policy bought after symptoms appear may not cover the condition you actually need treated. Talk to a Defaqto-rated independent broker before deciding.

Option 3: Self-pay private

Self-pay means you pay out of pocket for private treatment. For some procedures this is genuinely affordable; for others it's a significant financial decision.

Realistic UK price ranges (2026 data, indicative):

• Hip replacement: £14,000 – £18,000
• Knee replacement: £12,000 – £16,000
• Cataract surgery: £2,500 – £5,000 per eye
• Inguinal hernia repair: £3,500 – £6,000
• Tonsillectomy: £3,000 – £5,000
• Diagnostic MRI: £200 – £500

Note these are floors. Real bills often run 10–30% higher because of consultant fees on top of theatre fees, anaesthetist fees, and length of stay. Always get a written all-in quote before you commit.

When self-pay makes sense:

• Your wait is exceptionally long (52+ weeks) and your quality of life is materially affected.
• Right to Choose has been exhausted (no shorter NHS option available within your travel range).
• The procedure is one with predictable costs (e.g., cataract surgery, where private prices are well-established).
• You can comfortably afford it without compromising other essentials.

When self-pay does not make sense:

• You haven't yet exhausted the NHS Right to Choose path.
• The procedure has high complication risk (which can compound costs).
• You don't have a written, all-in quote.
• You haven't checked CQC ratings + complication rates for the specific provider.

My honest order of preference

If I were weighing this up myself, my order would usually be:

1. Choose a shorter-waiting NHS provider first: Right to Choose when you are referred, or the 18-week right if you are already waiting. Free, and often a much shorter wait.
2. Check insurance cover. Five-minute audit; potentially huge upside.
3. Self-pay only if 1 and 2 don't help and you can comfortably afford it.

The exception: a small number of procedures where private prices are very stable and the NHS is clearly not going to deliver in your timeframe. Cataract surgery is the clearest example — £2,500 for an eye that affects your work or driving is often a defensible decision even with short waits available elsewhere.

What this isn't

This is general information, not medical advice. I'm medically trained but not currently in clinical practice and not GMC-registered — I'm not your doctor or anyone's doctor. Every individual case has factors I don't see — your medical history, your specific condition, your insurer's policy fine print, your financial situation. Talk to your GP or specialist nurse for advice on your specific situation.

I also have no commercial relationship with any private hospital or insurer mentioned. Where HospitalWaits eventually runs sponsored placements (from late 2026), they will be loudly disclosed and never modify the analysis you read in articles like this. The full sponsorship policy is at /sponsorship-policy.

If you found this useful, the homepage has the NHS data + a postcode search to compare your local trusts. Right to Choose is the most underused power patients have. Use it.