Post by vagueandrandom on May 23, 2020 18:12:43 GMT
There’s been a lot going on in the Adult ADHD UK Facebook Group about NHS Right to Choose (England only) and there have been some success stories despite GPs and CCGs insisting that it doesn’t apply.
In a nutshell: If your GP thinks it is clinically appropriate for you to be referred for assessment and/or treatment for ADHD, YOU HAVE THE RIGHT TO CHOOSE provider. This can be a private specialist or company if they are commissioned by ANY NHS CCG in England and they don’t charge more than their NHS work.
IMPORTANT: your GP should make the referral DIRECTLY to your chosen provider and NOT to the CCG for an Individual Funding Request which is likely to be turned down. You are NOT REQUESTING, you are exercising your RIGHT to Choose. The provider will then invoice the CCG.
1. It doesn't have to be a locally commissioned provider.
2. Mental health is covered under this legal right.
3. ADHD does count as a mental health condition in this context, so the right applies to ADHD treatment as it would any other mental health condition.
4. It's not 'just' for the first outpatients appointment, but funding is expected to be provided for the entire episode of care.
5. If you've been diagnosed and you're on medication, and have been discharged from your previous specialist but need to be referred for a review, you can still use your right to choose, as a new referral would count as a new episode of case.
6. It doesn't matter if the CCG doesn't commission a specialist mental health service, as ADHD is still supposed to be part of the remit of mental health services.
7. Even though you wouldn't normally be able to use your right to choose if you are on a waiting list, if you've never actually been offered a choice the CCG is supposed to make arrangements for you to be able to make the choice even if you're already on a treatment pathway.
If you are referred for consultant-led treatment (in the case of mental health referral, this can be a referral to a named mental health professional rather than a consultant), you have the right to choose which provider (and the team within that provider) you are referred to from all those who have a contract to provide the service. There are certain exceptions including for:
persons detained under the Mental Health Act 1983
serving members of the armed forces
persons detained in, or on temporary release from, prison or detained in other prescribed accommodation (for example, a court, secure children's home, secure training centre, an immigration removal centre and a young offender institution)
Source of the right:
Part 8 of the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2013.
Pledge: ‘The NHS commits to provide convenient, easy access to services within the waiting times set out in the handbook to the NHS Constitution.’
All patients should receive high-quality care without any unnecessary delay.
patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral
Right: ‘You have the right to access certain services commissioned by NHS bodies within maximum waiting times, or for the NHS to take all reasonable steps to offer you a range of suitable alternative providers if this is not possible. The waiting times are described in the handbook to the NHS Constitution.’
You have the right to:
start your consultant-led treatment within a maximum of 18 weeks from referral for non-urgent conditions
Your right to start treatment within 18 weeks from referral will include treatments where a consultant retains overall clinical responsibility for the service or team, or for your treatment. This means the consultant will not necessarily be physically present for each appointment, but will take overall responsibility for your care. The setting of your consultant-led treatment, for example whether hospital based or in a GP-based clinic, will not affect your right to start treatment within 18 weeks.
3. Choosing where to go for your first appointment as an outpatient
Your choices:You can:
decide which NHS organisation you would like to receive care from as an outpatient
choose the clinical team who will be in charge of your care within an organisation
Are these legal rights?
Yes, but there are circumstances in which you may not choose.
You do not have legal rights to choose if you are:
already receiving care and treatment for the condition for which you are being referred and this is an onward referral
someone who is held in a hospital setting under the Mental Health Act 1983
a serving member of the armed forces
Information and support to help you choose
You can talk to your GP, or who is referring you for more information. You can also find out more information on the NHS website about the organisations you can choose from. This is a national website for patients.
You can search for services near you by using the ‘NHS services’ tool on the home page, or you can use the search function to find information on specific hospitals and clinics.
What you can do if you’re not offered these choices
If you feel that you have not been offered these choices you should first speak to your GP.
If you still feel that you have not been offered choice, you may wish to complain to your local Clinical Commissioning Group (CCG) as they must ensure that choice is offered to you.
CCGs are the organisations responsible for organising the delivery of the majority of NHS services in England. Each CCG is responsible for a specific geographical area.
If you feel you have been denied your legal entitlement to choose where to go for your first outpatient appointment, you may also wish to raise concerns with NHS Improvement. NHS Improvement can provide advice about choice issues and may be able to resolve individual issues. This could involve directing you to the appropriate place to make your concerns known or could involve NHS Improvement directly engaging with relevant parties.
You are also entitled to take your complaint to the independent Parliamentary and Health Service Ombudsman. The ombudsman is the final stage of the complaints system.
In a nutshell: If your GP thinks it is clinically appropriate for you to be referred for assessment and/or treatment for ADHD, YOU HAVE THE RIGHT TO CHOOSE provider. This can be a private specialist or company if they are commissioned by ANY NHS CCG in England and they don’t charge more than their NHS work.
IMPORTANT: your GP should make the referral DIRECTLY to your chosen provider and NOT to the CCG for an Individual Funding Request which is likely to be turned down. You are NOT REQUESTING, you are exercising your RIGHT to Choose. The provider will then invoice the CCG.
1. It doesn't have to be a locally commissioned provider.
2. Mental health is covered under this legal right.
3. ADHD does count as a mental health condition in this context, so the right applies to ADHD treatment as it would any other mental health condition.
4. It's not 'just' for the first outpatients appointment, but funding is expected to be provided for the entire episode of care.
5. If you've been diagnosed and you're on medication, and have been discharged from your previous specialist but need to be referred for a review, you can still use your right to choose, as a new referral would count as a new episode of case.
6. It doesn't matter if the CCG doesn't commission a specialist mental health service, as ADHD is still supposed to be part of the remit of mental health services.
7. Even though you wouldn't normally be able to use your right to choose if you are on a waiting list, if you've never actually been offered a choice the CCG is supposed to make arrangements for you to be able to make the choice even if you're already on a treatment pathway.
8. If you are on a waiting list longer than 18 weeks and an alternative provider can see you sooner the CCG must take all reasonable steps to offer a suitable alternative provider.
There is a private supplier who is commissioned to provide ADHD services to several NHS CCGs and is actively encouraging Right to Choose and chasing up CCGs. Go to Facebook or DM me as I don't want to get in trouble for advertising.
Boring Legal Stuff edited with links to originals:
NHS Improvement: Making Choice Work in Mental Health 27th April 2016
NHS ImprovementSection 4 page 3:
4. Your commissioners and healthcare professionals need to be proactive in facilitating choice Commissioners need to make arrangements so that you are able to choose and go to the provider you think best meets your needs. At NHS Improvement, many of the queries and complaints we receive are because a person has been told they can’t choose a provider because the provider doesn’t have a contract with the person’s local commissioner. This is an example of choice not working properly, and isn’t a reason for a commissioner to refuse a person their choice. Where we have seen commissioners making choice work well, there is a clear process in place for supporting the referral of a person, even to providers the commissioner doesn’t have existing arrangements with. Whatever process commissioners use shouldn’t unnecessarily delay access to care. Some commissioners hold meetings or panels to assess the needs of a small number of people who have complex conditions and make sure that they are able to choose the best care. Commissioners using these panels effectively tell us that people’s interests are put first and local finance and contract arrangements aren’t relevant to the decision-making. We’re aware of some commissioner policies that require the use of local providers either exclusively or for first appointments with consultants. These policies may prevent people from choosing the provider of care that is best for them, and are against the NHS Constitution. Handbook to the NHS Constitution for England Updated 28 October 2019
Right: ‘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.’
persons detained under the Mental Health Act 1983
serving members of the armed forces
persons detained in, or on temporary release from, prison or detained in other prescribed accommodation (for example, a court, secure children's home, secure training centre, an immigration removal centre and a young offender institution)
You have a right to be provided with information wherever there is a legal right to choice. Currently, this includes information to support you in choosing your provider when you are referred for your first outpatient appointment with a service led by a consultant. In the case of mental health referrals, a right to information applies if you are referred to a service led by a named healthcare professional and/or consultant.
Information to help you make your choice can be found on the NHS website. CCGs are expected to promote this information and make it more accessible to patients.
Part 8 of the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2013.
Pledge: ‘The NHS commits to provide convenient, easy access to services within the waiting times set out in the handbook to the NHS Constitution.’
All patients should receive high-quality care without any unnecessary delay.
patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral
Right: ‘You have the right to access certain services commissioned by NHS bodies within maximum waiting times, or for the NHS to take all reasonable steps to offer you a range of suitable alternative providers if this is not possible. The waiting times are described in the handbook to the NHS Constitution.’
You have the right to:
start your consultant-led treatment within a maximum of 18 weeks from referral for non-urgent conditions
If this is not possible, the CCG or NHS England, which commissions and funds your treatment, must take all reasonable steps to offer a suitable alternative provider, or if there is more than one, a range of suitable alternative providers, that would be able to see or treat you more quickly than the provider to which you were referred. A suitable alternative provider is one that can provide clinically appropriate treatment and is commissioned by a CCG or NHS England. You will need to contact either the provider you have been referred to or your local CCG before alternatives can be investigated for you. Your CCG or NHS England must take all reasonable steps to meet your request.
NHS Choices Framework updated 14th January 2020
Your choices:You can:
decide which NHS organisation you would like to receive care from as an outpatient
choose the clinical team who will be in charge of your care within an organisation
These choices only apply at the point of referral.
Yes, but there are circumstances in which you may not choose.
You do not have legal rights to choose if you are:
already receiving care and treatment for the condition for which you are being referred and this is an onward referral
someone who is held in a hospital setting under the Mental Health Act 1983
a serving member of the armed forces
Information and support to help you choose
You can talk to your GP, or who is referring you for more information. You can also find out more information on the NHS website about the organisations you can choose from. This is a national website for patients.
You can search for services near you by using the ‘NHS services’ tool on the home page, or you can use the search function to find information on specific hospitals and clinics.
If you need help choosing where to go for your first appointment because you have a disability, a mental health condition, or any other impairment, talk to the healthcare professional that referred you. This will make sure that your additional needs are considered.
If you feel that you have not been offered these choices you should first speak to your GP.
If you still feel that you have not been offered choice, you may wish to complain to your local Clinical Commissioning Group (CCG) as they must ensure that choice is offered to you.
CCGs are the organisations responsible for organising the delivery of the majority of NHS services in England. Each CCG is responsible for a specific geographical area.
If you feel you have been denied your legal entitlement to choose where to go for your first outpatient appointment, you may also wish to raise concerns with NHS Improvement. NHS Improvement can provide advice about choice issues and may be able to resolve individual issues. This could involve directing you to the appropriate place to make your concerns known or could involve NHS Improvement directly engaging with relevant parties.
You are also entitled to take your complaint to the independent Parliamentary and Health Service Ombudsman. The ombudsman is the final stage of the complaints system.