Referrals to treatment

Patient visit, their rights and responsibilities

In order to give our patients the best care possible, it is important that they attend their appointments with us. If they are not able to do so or no longer require your appointment, it is important that they let us know as soon as possible. This way we can ensure that the appointment can be offered to another patient in need of care.


18 weeks referral to treatment (RTT) rules – your rights

We are committed to treating all our patients within 18 weeks. This is part of the NHS Constitution and your legal right.

The NHS Constitution gives you the right to access consultant led services within a maximum of 18 weeks from referral or, if this is not possible, for the NHS to take all reasonable steps to offer you a range of suitable providers.

The waiting time is calculated from the date we receive your referral, to the date you either receive treatment or a decision is made that you do not require treatment. This timescale is referred to as 'referral to treatment' (RTT). Our patient access policy outlines how we manage the process between referral to our services and the first treatment or discharge. The maximum waiting times are detailed in the NHS Constitution handbook which covers the whole of the NHS in England. 

The only services not covered by the 18 weeks rule at Moorfields are those that are not consultant led. If you are referred into a service where your care is not overseen by a consultant, the 18 week target does not apply.


18 weeks RTT rules – your responsibilities

We want to use our clinics, theatres and staff efficiently and effectively, and we do everything we can to ensure that all of our patients are seen within 18 weeks. The following are a few things that our patients can do that help us and in turn help other patients.

  • When you are being referred to us please make sure that, as far as is reasonably possible, you are available within the next 18 weeks.
  • If you are unable to attend your appointment please tell us with as much notice as possible. The more notice you give, the easier it is for us to offer that appointment to another patient who needs our help.
  • Arrive on time for your appointment. We do our best to see all our patients on time and while situations can occur that cause clinics to run behind, if our patients arrive on time for appointments this helps ensure clinics run smoothly.
  • Tell us and your GP if you move house or change your contact details.

If you feel that you have waited too long for your appointment without being contacted by us, please get in touch to see how we can help you.


18 weeks RTT rules – missing and cancelling appointments

Our patient access policy outlines the rules we have regarding cancelling or missing your appointment. These rules are in place so that we are able to use our resources as efficiently as possible and ensure that your safety is maintained.

You are allowed to cancel and rebook an appointment once, however if you cancel a second time it is likely that you will be discharged back to the care of your GP.

If you do not attend (DNA) your first appointment (this means not attending your appointment and not contacting us at least 24 hours before your appointment to tell us that you won't be attending), you will be offered another appointment. If you DNA your second first appointment or any follow up appointment, it is likely that you will be discharged back to your GP.

In the event of multiple DNAs or cancellations, your condition will be assessed by a consultant and providing there is no clinical reason otherwise, you will be discharged back to your GP.


18 weeks RTT rules – stopping the clock

While you are waiting for your treatment you are on an 'active 18 week clock'. This is how we measure how long you have been waiting. There are several circumstances that can stop that clock:

  • It is medically necessary to wait for your treatment to begin. For example, if your blood pressure needs to improve before we can consider surgery.
  • You do not require any treatment.
  • There is a more pressing medical condition that requires treatment before the condition you are being considered for can be completed. For example, if you require cataract surgery but need to have a heart bypass before that.
  • You have not attended appointments and have been discharged.
  • You are offered treatment but choose to refuse that treatment.
  • It is not necessary for you to have treatment at this time but you will be followed up by the hospital. For example, you have very mild glaucoma that does not require any treatment but need to have another appointment in six months’ time.

If you have your clock stopped because of treatment or because it was not appropriate to start treatment at the time, your clock can restart at a later date. If your doctor decides to try a new treatment or that it is now appropriate to start treatment and you have to wait for that treatment, your clock will start from that date. For example, if you have mild cataracts that have not needed treatment but at a follow up appointment the consultant decides that treatment is needed, you would go on the waiting list that day and your clock would restart from zero.

If you have any questions about your appointment, your rights or your responsibilities, please contact us using the number on your letter.



Last updated: May 2019