What to do if your GP refuses a Right to Choose referral

NHS England's Patient Choice guidance states that patients have a legal right to choose the provider for a first outpatient appointment from any provider that holds a valid NHS Standard Contract for that service. The guidance is explicit: the practice should support the choice and the practice cannot decline on grounds of cost, geography, or preference for the local trust. The only valid clinical grounds for declining are that the service is not clinically appropriate or that an emergency route is needed instead.

Politely ask the GP or practice manager to write the refusal into your medical notes, including the reason. This step alone resolves most cases. Most refusals stem from administrative friction rather than a clinical position. Once the practice realises they would have to put the refusal in writing, the referral usually goes through.

If the refusal is on clinical grounds, ask them to explain which specific clinical reason applies. A genuine clinical objection should be discussable.

NHS England's Customer Contact Centre handles patient choice escalations directly:

• Phone: 0300 311 22 33 (Monday to Friday, 8am to 6pm)
• Email: england.contactus@nhs.net
• Post: NHS England, PO Box 16738, Redditch, B97 9PT

When you contact them, name the practice, the date you asked for the referral, the provider you asked to be referred to, and the reason given for the refusal. Quote the NHS Constitution and Patient Choice guidance explicitly.

Healthwatch is the statutory consumer champion for the NHS in England. Your local Healthwatch can advocate on your behalf, route your case to the right NHS commissioner (your Integrated Care Board), and apply public pressure if needed. They handle this kind of escalation routinely.

Find your local Healthwatch at healthwatch.co.uk. Healthwatch has its own Right to Choose advice page that mirrors NHS England's position.

If the practice still refuses after the first three steps, you have two formal routes:

• Local resolution: Submit a formal complaint in writing to the practice, addressed to the practice manager. They are required to respond within set NHS timeframes (acknowledgement within 3 working days, substantive response within 6 months). PALS — the Patient Advice and Liaison Service — at your nearest NHS trust can help you draft and submit it.
• Parliamentary and Health Service Ombudsman: Once local resolution is exhausted, the Parliamentary and Health Service Ombudsman is the final independent escalation route for NHS complaints in England.

Most GPs and practice managers want to do the right thing. The escalation ladder works because each step adds formality, not because each step adds confrontation. Lead with the NHS England guidance, ask for the refusal to be recorded, and keep the conversation factual. The four-step path above is the route NHS England itself signposts.

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