Understanding Your Healthcare Access Options in England

Explore key NHS referral routes and how they work – so you can make confident, informed decisions about your care.

When it comes to accessing healthcare in England, there are several NHS pathways available depending on your needs and circumstances. While these systems are designed to ensure fair and timely access to care, they can sometimes feel complex or unclear.

This guide introduces some of the key referral and access systems in place today – including the e-Referral Service (e-RS), PIDMAS, the Right to Choose, and traditional GP referrals. Some of these schemes are designed to give patients more control — allowing them to choose where and when they receive treatment — while others focus on reducing long waits by offering appointments with alternative NHS-approved providers, sometimes in different locations.

At Self-Pay Health, we believe in supporting informed choice. For some people, paying privately for healthcare may be the right decision — but before making any decisions, it’s important to understand the NHS options available to you. That’s exactly what this page is here to support.

(Previously known as Choose and Book)

The e-Referral Service (e-RS) is the NHS’s main digital system for booking specialist appointments following a referral from your GP. It replaced the earlier "Choose and Book" system and is now widely used across England to make referrals more transparent and accessible.

If your referral goes through e-RS, your GP may:
- Book your appointment directly during the consultation
- Or give you a booking reference number and password so you can choose and book your appointment online or by phone

This gives many patients the ability to view available hospitals or clinics, and in some cases, see estimated waiting times.

Who is it for:

• NHS patients in England referred for non-urgent outpatient care
• People whose condition requires further investigation or treatment beyond what a GP can provide

Things to Consider:

• eRS is the standard route for most non-urgent outpatient referrals in England
• Choice: You may be able to select from different hospitals or clinics, depending on availability
• Visibility: Some listings show estimated waiting times, helping you compare options
• Limitations: Not all services are always listed — this depends on local capacity and provider participation
• Support: If you're unsure how to proceed, GP practice staff can usually assist with booking or advice

Visit: https://www.nhs.uk/nhs-services/hospitals/book-an-appointment/

A system to help reduce NHS diagnostic waiting times by offering earlier appointments through alternative providers

PIDMAS is a national NHS system aimed at reducing long waits for diagnostic tests, such as MRI scans, ultrasounds, and endoscopies. It identifies patients who have been waiting longer than clinically appropriate and gives them the option to be seen sooner by a different provider, which may include private hospitals delivering NHS care.

The system is called “mutual aid” because it allows different NHS trusts and approved independent sector providers to help relieve pressure in areas with longer waits

Who is it for:

• Patients waiting longer than expected for diagnostic tests
• Specialties include imaging, endoscopy, cardiology, neurophysiology

How Are Patients Identified?

• Patients are flagged automatically within NHS systems if their wait exceeds nationally agreed thresholds
• NHS clinical teams review the lists to check whether the patient is clinically suitableto be offered an earlier appointment through PIDMAS
• If you meet the criteria, you may be contacted via text message, phone call, letter or email.

How to Access It:

You can’t request a PIDMAS referral directly, but if you know you’vebeen waiting a long time (e.g. longer than 6 weeks for a diagnostic scan), you can

• Contact your GP or referring clinician to ask if mutual aid options like PIDMAS might be available
• Check NHS letters or messages — PIDMAS invitations often include specific instructions to respond quickly.

Things to Consider:

• Faster Access: PIDMAS may help you receive essential tests more quickly than staying on your original waitlist
• Different Location: You may need to travel further — the alternative provider could be outside your usual area
• Your Choice: Taking the earlier appointment is optional. You can decline and stay on the original list if preferred
• Safe and Suitable: You’ll only be offered this if the care is appropriate and safe for your clinical needs
• Still NHS: Even if you attend a private hospital, you won’t pay — the service remains part of your NHS care

A legal right that gives NHS patients more control over where they receive consultant-led care.

Under the NHS Constitution for England, you have the Right to Choose which hospital or service provider you are referred to for mostnon-urgent, consultant-led care. This applies to yourfirst outpatient appointment for a new condition.

You don’t have to be referred to the nearest hospital. In many cases, you can choose from a list of NHS-approved providers across England, including some private hospitals that deliver care on behalf of the NHS.

Despite being a legal entitlement under the NHS Constitution, Right to Choose is not widely known among patients, often because it isn’t routinely highlighted during GP consultations, and many people are unaware that they must actively ask for it.

Who is it for:

• NHS patients in England needing non-urgent specialist care
• Common areasinclude, elective surgery, dermatology or gastroenterology
• Mental health referrals

How to Use It:

• When your GP recommends a referral, ask: “Can I use my Right to Choose for this?”
• Your GP will need to confirm that the provider is NHS-approved, and process the referral through the appropriate route (often via e-RS)
  

Things to Consider:

• Applies only to the first outpatient appointment for a condition, not follow-up care
• You can choose the provider (hospital or clinic), but not a specific consultant
• Some services are excluded, such as emergency care, maternity, and certain community services
• You may be able to access care faster by choosing a provider with shorter waiting times
• Care remainsfree to you, it’s still NHS-funded

Learn more:

https://www.nhs.uk/nhs-services/hospitals/choosing-a-hospital/

https://www.england.nhs.uk/mental-health/cyp/trailblazers/right-to-choose/

The starting point for most NHS specialist care

Most NHS care begins with a GP referral. GPs assess your symptoms and decide whether a specialist referral or further testing is needed. They also determine the most appropriate referral route (e.g. e-RS, urgent referral, or community service).

Who is it for:

• Any NHS patient needing specialist input, testing, or treatment

How It Works:

• Your GP will assess your condition and either book directly or give you booking details
  

Things to Consider:

• You can ask questions about where you're being referred, what your options are, and how long the wait might be.
• You can request to use your Right to Choose a different provider
• Your GP may suggest monitoring or alternative care if referral isn’timmediately needed
• In some regions, services like physiotherapy or mental health support can be accessed without GP referral, check your local NHS site

Navigating the healthcare system can feel overwhelming, especially if you're facing a long wait or exploring self-pay care. But understanding the different NHS referral pathways — including e-Referral, PIDMAS, Right to Choose, and GP referrals — empowers you to make informed decisions that suit your needs.

At Self-Pay Health, we believe that clarity and choice go hand-in-hand. Whether you'recontinuing on an NHS pathway or considering private options, it’s important to know what’s available, how it works, and where you can take control.