How to access a UK specialist

The United Kingdom runs specialist access through three distinct routes. An NHS referral from your general practitioner (GP) is the default. NHS Right to Choose allows the patient to steer the destination of an NHS referral, and for specific conditions to request referral to an independent provider contracted to the NHS. Private self-pay or private medical insurance allows direct booking outside the NHS entirely.

This article sets out how each route works, what it costs, how long it takes, and how to decide which fits your situation. Sources are at the end.

Route 1: NHS GP referral

The default route for specialist access in the UK is a referral from your NHS GP to an NHS specialist. The GP makes the clinical assessment, writes the referral letter, and sends it through the NHS electronic referral system (eRS). The patient then receives a letter or an NHS App notification with the hospital and clinic appointment offered.

### When to use it

This is the right route for:

• Any problem that clearly needs specialist assessment.

• Any situation where cost is a significant concern.

• Any condition where ongoing NHS follow-up and prescribing will be needed (most long-term conditions).

• Anything that might turn out to require complex, urgent, or specialised hospital care.

### What to expect on timing

NHS specialist waits vary substantially by specialty and by region. Urgent referrals (including all suspected-cancer two-week-wait referrals) are seen quickly. Routine referrals can take months for high-demand specialties such as neurology, dermatology, gynaecology, orthopaedics, and mental health. The NHS England waiting times dashboard publishes current figures.

### The referral letter matters

A clearly written referral letter that states the clinical question, the relevant history, and the specific outcome the GP is looking for usually produces a faster and better-focused specialist appointment. If you are asking for a referral, help the GP by being specific about what has happened, what you are worried about, and what you would like the specialist to address.

Route 2: NHS Right to Choose

NHS patients in England have a legal right to choose the hospital or clinic their GP refers them to. This is written into the NHS Constitution for England. You can choose any NHS provider that offers the relevant service.

In practice this means three useful things.

• You can choose a hospital with shorter waits if you are prepared to travel. The NHS e-Referral Service shows the expected waiting time at each provider that offers your referral.

• You can choose a hospital with a particular specialism if your condition would benefit from concentrated expertise.

• You can choose a named consultant where the provider permits this (some providers do, some do not).

### The specific ADHD and some-other-conditions route

For a defined set of conditions, NHS Right to Choose extends beyond NHS trust hospitals to include any NHS-funded provider in England, including some independent-sector providers contracted to the NHS. The most visible example is adult attention-deficit/hyperactivity disorder (ADHD) assessment, where patients with long NHS waits in their home area have used Right to Choose to access independent NHS-funded providers with shorter waits.

The route requires the GP's referral, the patient's choice of provider, and the NHS's agreement (which is legally required if the criteria are met). ICB-by-ICB variation exists in how readily the route is processed, but the legal entitlement is national.

### How to use Right to Choose

• When your GP offers you a referral, ask which providers offer the service and what the waiting times are.

• Use the NHS e-Referral Service (accessible through the NHS App or through your referral letter) to see the provider list and waiting times.

• If you want a specific provider not on the default list, ask your GP to add it. The GP can usually accommodate this unless there is a clinical reason against.

• For ADHD specifically, ask your GP about Right to Choose by name. The route is well established.

Route 3: Private specialist consultation

Private specialist consultations are self-referred in most cases. A patient can book a private consultant appointment directly, without going through a GP, provided they can pay the consultation fee either through private medical insurance (PMI) or self-pay.

### When private might fit

Private specialist access fits well when:

• You want a faster consultation than the NHS is currently offering for your condition.

• Your need is a defined one-off question rather than ongoing specialist care.

• You have private medical insurance that covers the specialty.

• You want to see a specific named consultant whose NHS clinic is not easily accessible to you.

• You are a short-term visitor to the UK and registering with a GP is not practical.

• You want to combine a private diagnostic pathway with ongoing NHS treatment (a mixed pathway, discussed in the shared care article).

### How to book

• Private specialists maintain their own bookings. Most operate through private hospital booking lines, their own practice websites, or secretarial services at Harley Street or equivalent consulting rooms.

• The Private Healthcare Information Network (PHIN) publishes consultant-level performance, fee, and outcome data for UK private practice. It is the main patient-facing source for comparing consultants.

• Most PMI insurers maintain consultant directories of their recognised network.

• Some private specialists accept direct patient bookings without a GP referral; others require one for clinical reasons. Ask when booking.

### What it costs

A typical first private consultation with a consultant runs £200 to £400 for a non-procedural specialty and can run higher for specific specialties and for longer initial appointments. Follow-up consultations are usually cheaper. Additional costs (imaging, blood tests, procedures) are charged separately. Self-pay patients see the fee upfront; insured patients settle through the insurer's claims process.

### What a private consultation produces

A private specialist consultation produces a letter to the patient, and usually to the patient's NHS GP. That letter can be used to:

• Inform the patient directly of the specialist's opinion.

• Hand back to the NHS GP for onward NHS prescribing, NHS monitoring, or NHS referral onwards.

• Initiate a private follow-up treatment pathway.

• Request a second opinion if clinically useful.

A private consultation does not replace the NHS record. Responsible private providers write to the patient's NHS GP to ensure the NHS record stays complete.

How to choose between the routes

A rough decision framework fits most situations.

• For anything that might be urgent, anything in a child, anything that might need complex or inpatient care, or anything you cannot afford to pay for privately: the NHS GP route is the right first call.

• For a routine referral where the NHS wait is long and you have flexibility in travel: consider Right to Choose and compare provider waiting times before accepting the default.

• For adult ADHD assessment, for some long-wait specialty categories, and for some community-based services: ask your GP about Right to Choose to independent NHS-funded providers.

• For a defined, time-sensitive specialist question where you can afford to pay or have insurance that covers it: consider a private specialist consultation. Hand the letter back to your NHS GP afterwards for any ongoing NHS-side follow-up.

• For a complex condition that is likely to need ongoing specialist care, NHS-funded medication, and hospital facilities: the NHS remains the right main route, with private consultations as occasional add-ons if useful.

None of these routes is a substitute for NHS GP registration. Private specialists, NHS specialists, and Right to Choose providers all benefit from your NHS record being complete, and from your NHS GP being the long-term co-ordinator of your care.

The summary

There are three routes to a UK specialist: NHS GP referral (the default), NHS Right to Choose (which lets you steer an NHS referral and, for specific conditions, access independent NHS-funded providers), and private consultation (self-pay or PMI). Each has its place.

Most UK patients use the NHS GP route for most things, with Right to Choose for situations where provider choice matters, and private consultations for defined one-off specialist questions. The key is to know which route fits which situation and to keep the NHS GP in the loop across whichever routes you use.

Sources and further reading

• NHS, Your right to choose where you have your NHS treatment. The formal NHS Right to Choose explanation.

• gov.uk, NHS Constitution for England. The patient-rights basis for Right to Choose.

• NHS, NHS e-Referral Service. Online referral and provider selection.

• NHS England, Statistics and waiting times. Published NHS specialist waiting-time data.

• Private Healthcare Information Network, phin.org.uk. Consultant-level performance and fee data for UK private practice.

• NHS App, nhs.uk/nhs-app. Patient access to NHS referrals and appointments.

• Right to Choose (Adult ADHD), adhduk.co.uk/right-to-choose/. A patient-support resource frequently cited for the ADHD-specific Right to Choose pathway.

About the author

Dr Seth Rankin qualified in medicine at Auckland School of Medicine in New Zealand in 1990 and worked as a junior doctor across New Zealand, Australia, and the UK before qualifying as a Member of the Royal College of General Practitioners (MRCGP) through the London Deanery in 2004. He was Managing Partner of Wandsworth Medical Centre from 2006 to 2016 and served as a Board Member of Wandsworth Clinical Commissioning Group for nine years. He is the founder of London Travel Clinic, London Doctors Clinic, London Medical Laboratory, and LoveMyLife.

Read more about Dr Seth Rankin.

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