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In April 2014, the then coalition government established legislation for people with mental health conditions to have the same legal right as those with physical health conditions to choose their health care provider.
The NHS stated that patients in England have the legal right to choose any clinically appropriate mental health provider that has a contract with any Clinical Commissioning Group (CCG) or NHS England for the service required.
Partly because of the way the NHS England guidance was interpreted by many different health professionals and NHS services, the legislation is not something that has been widely publicised or is known about.
As we first reported to OCD-UK members in the last member’s magazine, we have been speaking with NHS England's 'Patient Choice' team to clarify the legislation and how people seeking treatment for OCD or BDD can implement it.
At the moment when a patient requires treatment they are automatically referred (or they can sometimes self-refer) to their local service within the same CCG area that they are registered with a GP. For the majority of people that will be fine, and travel restrictions may mean they can only access local services anyway. However, for others where travel is not restrictive, there may be occasions where they may wish to be referred to a different NHS service for their treatment.
Why is this important?
As you will have read in our previous magazine, there is significant difference in OCD recovery rates being reported from region to region. So, with your ‘Right to choose’, if a neighbouring and commutable region seems to offer a better IAPT service, or you wish to access a service with a better reputation, you can now choose to do that.
The other main reason people generally ask about accessing alternative services where they may wish to implement their right to choose are to access treatment services out of their home CCG area, but close to their work location.
The reality is that many of you reading this may not even be aware that you do actually have a right to choose your treatment provider, including IAPT services.
In April (2016) NHS Improvement published updated information about your right to choose, and within that they state that:
If a GP refers you to a consultant or specialist in mental health, you have the right to choose the provider of your care.
This means you can exercise your right to choose without having to explore local therapeutic services first, and do not have to go through the timely process of seeking funding from your local Clinical Commissioning Group (CCG) to be referred to your treatment provider of choice.
There are some caveats to your right to choose and we will try and clarify those within this article.
The NHS Improvement document goes on to state:
Choice should be offered at a point in your treatment where you can make a meaningful decision about who will provide your care. The decision will often be made with your GP on referral to a specialist. In some areas an assessment service will help to decide what type of treatment is best. If this is the case, you can choose a provider once the assessment has recommended a type of treatment. If you’ve already been seen by a provider and discharged, you can choose a different one if your GP thinks you need further treatment.
What this means in terms of IAPT referral, if you identify a better IAPT service out of area that meets your need, i.e. one with a better record, or a service that is nearer your place of work, then you now have a right to choose that treatment provider.
If you have a preference for a particular provider, your GP can discuss the pros and cons of that preferred choice so you can make the right decision.
You cannot self-refer to the IAPT service of choice; you must speak to your GP and discuss your choice and options with them, and it is they who need to make the referral for you.
What the NHS Improvement advice above is also stating is that if you have a telephone assessment with your local IAPT service and they then recommend a course of CBT treatment, then at that point if you wish to choose an alternative treatment provider for the therapy you can ask they advise your GP of the recommendation and you can then go back to your GP and ask them to implement the assessment recommendation at the IAPT provider of choice.
In addition, while you cannot choose a new IAPT provider midway through a course of treatment, if you are discharged back to your GP after 6/10 sessions and the OCD is still problematic (impacting on you) at that point, you can exercise your ‘right to choose’ should you wish to. Simply have that conversation with your GP.
However, the GP needs to be satisfied that the treatment referral meets your needs and is clinically appropriate.
When you are referred to one of the types of services made available by your commissioner, you can choose to go anywhere in England for it as long as the provider chosen works with the NHS and fits with your care needs. This means you can choose providers known for specialist care or tertiary care if they offer the type of service required.
However, the right to choice doesn’t mean that you can choose different types of service that aren’t suitable for your needs. For example, if referred for a consultant outpatient appointment you can’t choose inpatient therapy, or if sent to an Improving Access to Psychological Therapies (IAPT) service you can’t choose a consultant outpatient appointment.
To be clear, your right to choose is only about your right to choose the NHS provider of that treatment, not the treatment itself. Equally your right to choose can only be for a treatment provider offering the same ‘level’ of treatment. So if your GP tells you that you need to be referred to secondary care mental health services, if you live in Derbyshire for example, you can discuss your right to choose with the GP and if you work in Nottingham you can ask your GP to make the referral to Nottinghamshire Healthcare mental health services. But, you cannot step yourself up from primary care IAPT services to secondary care services. Your right to choose is only applicable for the same level of service.
But, because they state “you can choose providers known for specialist care or tertiary care if they offer the type of service required”, you can also choose to be referred to an out-patient service that is also a national treatment clinic like the Centre for Anxiety Disorders and Trauma (CADAT), provided they offer the level of service you need to be referred to. For example, CADAT already offers different levels of care for the treatment of anxiety disorders for patients in their locality, a local IAPT and Secondary Care service. Both of which would eligible for patient choice.
If you would like guidance on your Right to Choose your treatment for OCD or BDD before you speak to your GP then please do get in touch with OCD-UK or you can contact NHS Improvement for advice at: https://improvement.nhs.uk/.
The NHS Improvement advice published in April can be found at: https://improvement.nhs.uk/resources/choice-mental-health/