Right to Choose · Escalation
What to do if your GP refuses a Right to Choose referral
Where the legal right to choose applies, you choose between providers that the person referring you judges clinically appropriate, and some situations are excluded from the right. If you think you have not been offered a choice you were entitled to, there is a clear route to take it further.
Written and reviewed by Mustafa Ghafouri (MBChB, MSc) ·
What NHS England actually says
NHS England's Patient Choice guidance says that, for an elective referral from a GP, dentist or optometrist to a first outpatient appointment with a consultant-led service (or, for mental health, a named professional), the patient can choose “Any clinically appropriate provider that holds a qualifying NHS Standard Contract with any ICB or NHS England, for the service which the patient needs as a result of the referral”.
What it says about the GP's role, quoted directly:
- “The referrer is not required to make a referral to a provider or team if they do not believe this would be clinically appropriate.”
- “Patients can be referred to services outside of their local ICB geography when exercising their legal right to choice of provider and team if the service meets the criteria to be a choice for patients”.
- “The commissioner’s prior approval for the referral is not required where a patient has exercised their legal right to choice”.
- “Primary care referrers should then help to facilitate any preferences the patient may express in relation to the legal rights to choice which apply.”
The right does not apply in some situations, for example urgent care, suspected cancer, an onward referral for a condition you are already being treated for, or a referral you make yourself. See the full list.
Step 1 — Ask the practice to record the refusal
Politely ask the GP or practice manager to write the refusal into your medical notes, including the reason. A written reason tells you whether the practice is relying on a clinical judgement or on one of the exceptions, and it is the record anyone you escalate to will ask for.
If the refusal is on clinical grounds, ask them to explain which specific clinical reason applies. A genuine clinical objection should be discussable.
Step 2 — Contact your ICB or NHS England
The NHS Choice Framework says that if you still feel you have not been offered choice, you may wish to complain to your local integrated care board (ICB) “as they must ensure that choice is offered to you”, and that you can also raise concerns with NHS England, which “can give advice about matters relating to patient choice and may be able to resolve individual issues”. NHS England's contact centre:
- Phone: 0300 311 22 33 (9am to 5pm Monday to Friday, opening at 9.30am on Wednesdays; closed on bank holidays)
- Email: england.contactus@nhs.net, or the address the gov.uk NHS Choice Framework gives for patient choice: england.choice@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.
Step 3 — Raise it with local Healthwatch
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. The NHS Choice Framework says Healthwatch “can help you to make a complaint about NHS health and social care services”.
Find your local Healthwatch at healthwatch.co.uk. Healthwatch has its own Right to Choose advice page that mirrors NHS England's position.
Step 4 — Submit a formal NHS complaint
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, or to your ICB. Under the NHS complaints regulations, the body must acknowledge your complaint within 3 working days and send you a written response; if it has not responded within 6 months (or a longer period you agreed), it must write to you explaining why. 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.
A note on tone
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 NHS Choice Framework sets out the official order: your GP first, then your ICB or NHS England, then the Ombudsman.
Before you escalate
Try the letter template first
A written Right-to-Choose letter, citing the NHS Choice Framework, sets out your request clearly before you escalate.
Open the letter templateRead next
- The full Right to Choose explainer — covers the legal basis, when it applies, and when it doesn't.
- Right to Choose for adult ADHD assessment.
- Right to Choose for adult autism assessment.
This page gives general information about escalating NHS patient-choice disputes. It is not legal advice. For questions about your own referral, speak to your GP or contact NHS England.