Referral to Treatment (RTT)

Previous Department of Health targets have focused on stages of treatment; the length of wait for a first outpatient appointment and the wait for admission to theatre. In 2007 the Department of Health introduced a new waiting time standard which allows a maximum of 18 weeks ref initial referral to hospital treatment, which includes all diagnostic tests. This is called the Referral To Treatment (RTT) pathway. The start and stop times on this pathway are referred to as “clocks”.

We are dedicated to seeing and treating your patients as quickly as possible, from the moment they are referred to the conclusion of any post-operative care.

Forming part of the NHS constitution, the entitlement to receive treatment within 18 weeks became a legal right in April 2010. This means that a patient may exercise the right to request alternative providers if their chosen provider is unable to meet this standard. The only exclusions to this is where the RTT pathway is clinically complex or where the patient chooses to wait more than 18 weeks.


Preparing the Patient

  • Explain to the patient how NHS waiting times have changed. This is no longer about getting onto a long waiting list, but a moving process that will start immediately they are referred
  • Make sure that patients are ready for this, both practically and mentally
  • Patients need to make their appointments promptly, ideally within seven days
  • Encourage patients to consider whether they are personally willing and prepared for appointments, tests and treatment, including surgery where appropriate, over the next 18 weeks, typically with the first appointment between 3 – 6 weeks. If they are undecided, give them the option to advise the practice when they are ready, and only then send the referral.
  • Explain to patients that if they do not attend for their appointments their referral may be returned to you, their GP, which will delay their treatment as well as wasting NHS resources.
  • Do not refer patients if you know they will not be suitable or will be unavailable for surgery in an 18 week timeframe (unless you are referring for an opinion only).
  • Only refer patients for surgical assessment that meet minimum fitness criteria (Fast Steady Stop/fitness for general anaesthetic)


Pre-Operative Assessment

All patients added to the waiting list need to attend the pre-operative assessment unit. Patients should allow up to half a day to see the surgeon and attend the pre-operative assessment unit.

At the POA Units situated at Ashford and St Peter’s Hospitals patients will have a pre-operative assessment to ensure their suitability and fitness for surgery and be screened for MRSA.

All patients will have a physical assessment by a trained pre-operative assessment nurse with a selection of patients being required to return for a full anaesthetic review by an anaesthetist.

Cancer cases will be treated as a priority and every effort will be made to investigate and treat co-morbidities.