Right to Choose (RTC) Referral Guide

Right to Choose (RTC) Referral Guide

• The Department of Health & Social Care’s NHS Choice Framework
• Patient Choice Guidance
• The NHS Constitution; and
• Patient advice pages such as ‘Your choices in the NHS’.

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Patient Choice Guidance

• All referrers should ensure they shortlist on average five choices for the patient, where this is practicable, clinically appropriate, and preferred by the patient
• Where they have access to appropriate technology, patients should be encouraged to use ‘Manage Your Referral’ or the NHS App – However, a patient may choose a provider not listed on eRS, or listed as ‘indirectly bookable’ on eRS, where a provider has made reasonable endeavours to list their services in an accessible
• The legal rights do not extend to self-referrals or any referral other than from or on behalf of a GP (NHS Right to Choose referrals are not ‘self-referrals’ which are a common misconception, they are often however, patient initiated in terms of selecting a provider)
• 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 (please see ‘ADHD 360’s specific responsibilities under Patient Choice Guidance’ and ‘Summary’ sections)
• Contracts for most services to which the legal right to choice of provider and team apply will specify specific locations at which services must be delivered. Some services which are delivered remotely (e.g., ASD and ADHD assessments) may also be subject to the legal right to choice of provider and team
• Referrers are responsible for determining the clinical appropriateness of a referral. Determining clinical appropriateness involves a clinical judgement about what is in the best clinical interests of the patient, working within the published National Institute for Health and Care Excellence (NICE) guidelines and other relevant guidelines and specifications (ADHD 360 referral documents contain an age-appropriate screening help aid primary care providers with the judgement of clinical appropriateness)
• Referrers may seek support from other clinicians and intelligence from commissioners when deciding on the clinical appropriateness of a referral
• The commissioner’s prior approval for the referral is not required where a patient has exercised their legal right to choice
• Where initiatives such as Clinical Assessment Services (CAS), Single Point of Access (SPAs) and Referral Management Centres (RMCs) are put in place, these should not obstruct the patient’s legal rights
• It will usually be the case that the same provider and team will treat the patient for their entire episode of care, prior to discharge back to the GP (where applicable), unless the patient’s diagnosis changes significantly or there are other clinical reasons to change provider and team
• Prior to making a referral, referrers should consider ongoing care which may be required following an elective referral and explain how this will affect the patient e.g. how a service interacts with local pathways and requests for GPs to enter Shared Care Protocols for certain prescribed medications and how these will be handled (please see the ‘Summary’ section)

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NHS Patient Choice Framework

• They are already in receipt of care and treatment for ADHD, and you are making an onward referral
• They are a prisoner, on temporary release from prison, or detained in ‘other prescribed accommodation’ (such as a court, secure children’s home, secure training centre, an immigration removal centre or a young offender’s institution)
• They are currently held in a hospital setting under the Mental Health Act 1983
• They are a serving member of the armed forces (this does not apply to dependants)

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ADHD 360’s specific responsibilities under Patient Choice Guidance:

• Although not bookable via eRS, our service may be listed on here as ‘indirectly bookable,’ this means we are required under our NHS Standard Contract to make ‘reasonable endeavours’ to list our services which you can find on our dedicated Right to Choose webpage
• We are required to give advice to GPs on potential referrals, and the care of services users
• We are required to accept any and all clinically appropriate referrals, where the legal rights of choice apply. This includes those from primary care providers of patients whose ICB is not a direct commissioning ICB (or signatory on) via an NHS Standard Contract with ADHD 360
• We are expected to oversee a patients care until their episode of care ends, and they are discharged back to their GP, unless their diagnosis changes or there are other clinical reasons for not doing so
• For legal rights of choice of provider and team to apply, the referrer must deem the service to be clinically appropriate. In which the referral can contact the service directly to confirm details, or the service can contact the referral to confirm suitability of the referral

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Summary

• An eligible service does not have to be local, nor commissioned by a GPs commissioning ICB for the GP to refer a patient to them as their provider of choice
• A GP does not have to seek funding from their ICB to refer a patient under patient choice
• Referrals do not have to be sent via eRS to be eligible and funded
• A Right to Choose referral is an NHS, primary care-initiated referral, and not a self-referral process
• ADHD360 is happy to discuss and support local shared care protocols and facilitate these when and wherever possible to ensure the best treatment outcomes ongoing for patients
• ADHD360 is happy to support GPs with the referral and ongoing care processes, and any queries professionals (and patients) may have along the way
• ADHD360 are contracted via an NHS Standard Contract for the provision of ADHD assessment, diagnosis, and medical treatment for both paediatric and adult patients by NHS Devon ICB & NHS Sussex ICB. Our sister service, Autism 360 is contracted by NHS Devon ICB for the non-medical assessment, diagnosis, and treatment of paediatric and adult patients for ASD. We are happy to provide copies of any supporting documentation to commissioners and other professionals where appropriate to do so.