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The NHS Constitution

Your rights to choice in the NHS

Everyone who is cared for by the NHS in England has formal rights to make choices about the service that they receive.  These include the right to choose a GP surgery, to state which GP you'd like to see, to choose which hospital you're treated at, and to receive information to support your choices.

These rights form part of the NHS Constitution (PDF, 106kb), some are explained below. This page also contains links to other pages on this site, which will explain how to exercise these rights and make the best choices for you.

Free NHS services

“You have the right to receive NHS services free of charge, apart from certain limited exceptions sanctioned by Parliament.”

NHS services are generally provided free of charge. This includes access to local services like your GP, hospital or clinic, or health improvement services provided by your local authority, so you do not have to worry about payment. However, there are some exceptions which means some people will have to pay for prescription charges and visits to the dentist. Overseas visitors may also have to pay charges.

Rights about GP choice

“You have the right to choose your GP practice, and to be accepted by that practice unless there are reasonable grounds to refuse, in which case you will be informed of those reasons.”

You can choose which GP surgery you'd like to register with. That GP surgery must accept you unless there are good reasons for not doing so, for example, you live outside the boundaries that it has agreed with the locla commissioner (NHS England), or because it has no spaces left. Whatever the reason, the surgery must tell you why. If you can't register with your preferred GP surgery, the NHS will help you find another one.

“You have the right to express a preference for using a particular doctor within your GP practice, and for the practice to try to comply.”

Within your GP surgery, you have the right to say which particular GP you'd like to see. Your GP surgery will try to give you your choice, but there may be good reasons why you can't see your preferred GP.

Right to choose the organisation that provides your NHS care

“You have the right to make choices about the services commissioned by NHS bodies and to information to support these choices. The options available to you will develop over time and depend on your individual needs.”

You have the right to choose the organisation that provides your NHS care when you are referred for your first outpatient appointment with a service led by a consultant. There are certain exceptions including:

Persons excluded

  • persons detained under the Mental Health Act 1983
  • serving members of the Armed Forces
  • prisoners (including those on temporary release)

Services excluded

  • Services are exculded from choice where speed of access to diagnosis and treatment is particularly important. For example, emergency attendances/admissions, attendances at a Rapid Access Chest Pain Clinic under the two-week maximum waiting time and attendance at cancer services under the two-week maximum waiting time
  • maternity services
  • mental health services
  • public health services commissioned by local authorities

Local authorities arranging public health services are not required to offer a choice of service
provider, but can be expected to do so now as a matter of good practice whenever it is

Your right to choose will develop as choice is extended into other areas. You have a right to information where there is a legal right to choice. You can find information about service providers such as hospitals, on this site. Simply use the Services near you search tool. Clinical Commissioning Groups (CCG) are expected to promote this information and make it more accessible to patients.

Right to drugs and treatments that have been recommended by NICE

“You have the right to drugs and treatments that have been recommended by NICE for use in the NHS, if your doctor says they are clinically appropriate for you.”

NICE (the National Institute for Health and Care Excellence) is an independent organisation producing guidance on drugs and treatments. ‘Recommended for use by NICE’ refers to a type of NICE recommendation set out in legislation. The relevant health body is obliged to fund specified NICE recommendations from a date no longer than three months from the publication of the recommendation unless, in certain limited circumstances, a longer period is specified.

In practice, this means that you have a right to receive that drug or treatment if NICE has recommended its use in a technology appraisal or a highly specialised technology assessment and your clinician says it is appropriate for you to receive it.

There may be a few cases where the usual three month period for compliance with the statutory duty to fund a particular recommendation is extended, usually for a limited period in order to allow the NHS to make arrangements for implementation. In those cases, the right applies once the extended period specified in the NICE recommendation has expired.


Consent to treatment

“You have the right to accept or refuse treatment that is offered to you, and not to be given any physical examination or treatment unless you have given valid consent. If you do not have the capacity to do so, consent must be obtained from a person legally able to act on your behalf, or the treatment must be in your best interests.”

No one can carry out any physical examination or give you treatment unless you have given your valid consent. You can therefore accept or refuse any treatment that is offered to you. If you lack capacity to consent yourself, and have given a person legal authority to make treatment decisions for you, then they can consent to or refuse treatment for you (this is called having a lasting power of attorney) where this would be in your best interests.

If there is no such person then doctors will have to act in your best interests in deciding whether or not to carry out a treatment. Doctors must follow the guidance in the Mental Capacity Act when they make decisions in your best interest; they must consult with family members and other interested people where possible. For serious medical treatment decisions, if there is no family available with which to consult, they must consult an independent mental capacity advocate (an IMCA), who will support and represent you if you lack capacity to make a decision. In some difficult cases the courts will be asked to decide what is in a person’s best interests.

Page last reviewed: 19/04/2013

Next review due: 19/04/2015

This consultation closes on March 11 2015 at 11.45pm

Consultation: updating the NHS Constitution

Take part in this consultation on GOV.UK. It proposes amendments to the NHS Constitution

The Choice Framework 2014

The Choice Framework explains when you have a legal right to choice about treatment and care in the NHS. The legal right to choice doesn't apply to all healthcare services, however, where you do not have a legal right to choice you should at least be offered some choices, depending on what’s available locally.

What does patient choice mean to you?

People talk about choices they have made for their health, in their lifestyle, their NHS treatment and of NHS services.

Media last reviewed: 15/09/2014

Next review due: 15/09/2016

The history of patient choice

The history of patient choice

Explore the history of patient choice in the NHS since 1948 with this interactive timeline.