What does the 18 week duty actually require?

Where the conditions in regulation 47 are met, regulation 48 requires the responsible body to take all reasonable steps to ensure you are offered an appointment with a consultant, or a member of a consultant's team, at a suitable provider other than the one you are waiting on, and that appointment must commence treatment earlier than you would have commenced it by continuing to wait. If more than one suitable provider exists you must be offered a choice. It is a duty to take reasonable steps to offer, not a guarantee of an assessment, a switch or a date.

Who has to set it off?

You do. Regulation 47(4) and (5) say the duty arises once the provider or the integrated care board has been notified, by the person referred or someone lawfully acting on their behalf, that appropriate treatment has not commenced or will not commence within eighteen weeks of the start date. Nobody does that for you and it does not happen automatically.

Is a complaint the same as notifying them?

No. A complaint goes into the complaints process. The notification in regulation 47(4) is a statement to the provider or the integrated care board that you have not commenced, or will not commence, appropriate treatment within eighteen weeks of the start date. You can do both, but a complaint on its own is not that notification.

Does it apply if my assessment is not with a consultant?

Regulation 47(3) limits it to a referral for assessment or treatment by a consultant, a member of a consultant's team, or an interface service that can refer you on to a consultant or a consultant-led team. If none of those applies, regulations 47 to 49 do not apply to your referral. The separate choice right in regulation 39(2)(b) covers an elective referral for mental health services where the first outpatient appointment is not with a consultant or a member of a consultant's team.

Do you store my answers?

No. The four questions are answered and worked out in your browser. Nothing is written to a database, no answer is sent anywhere, and you are not asked for an email address.

Is this legal advice?

No. We are not lawyers and this is not legal advice. Every legal statement on the page carries its regulation number and links to the regulations on legislation.gov.uk so you can read the wording yourself.

Free check

The 18 week check: regulations 47 to 49

We are not lawyers and this is not legal advice. Every legal statement on this page carries its regulation number and links to The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 (S.I. 2012/2996) so you can read the wording yourself. The four questions are answered in your browser: nothing is stored and no answer is sent anywhere.

What the regulations say

Where the conditions in regulation 47 are met, regulation 48 requires the responsible body to take all reasonable steps to ensure you are offered an appointment at a different provider that commences treatment earlier than continuing to wait would, and to offer you a choice if more than one suitable provider exists. That is a duty to take reasonable steps to offer. It is not a promise that an assessment, a switch or a date will follow.

Regulation 47(3)
The referral is for assessment or treatment in the course of the provision of health care services by (a) a consultant; (b) a member of a consultant's team; or (c) persons providing interface services where a person who has been referred may be referred on from those services to a consultant or consultant-led team.
Regulation 47(4)
The relevant health service provider, or the relevant body which has responsibility for the person referred, has been notified that the person referred (a) has not commenced appropriate treatment; or (b) will not have commenced appropriate treatment, within eighteen weeks, beginning with the start date.
Regulation 47(5)(a)
The notification referred to in paragraph (4) was given by, in the case of the relevant health service provider or an integrated care board, the person referred or a person lawfully acting on their behalf.
Regulation 48(1) to (4)
The relevant body which has responsibility for the person referred must take all reasonable steps to ensure that that person is offered an appointment. The appointment offered must be with a consultant, or a member of a consultant's team, at a suitable health service provider other than the relevant health service provider. The appointment must be an appointment to commence treatment earlier than the person referred would have commenced treatment if they had continued to wait for treatment at the relevant health service provider. If there is more than one suitable health service provider, the person referred must be offered a choice of appointment with more than one suitable health service provider.
Regulation 44(1)
“start date” means the date on which the person's referral request was received by the health service provider to whom that person has been referred.

Regulation 49 sets out when regulation 48 does not apply. That list is closed: regulation 49 says regulation 48 does not apply in the circumstances described in paragraphs (2) to (10), and a commissioner deciding to limit what it will fund is not one of them.

The regulation 49 exceptions, paragraph by paragraph

49(2) You did not attend an appointment the provider made, where the date was reasonable, you had been told the consequences of not attending, and you had not asked in advance to rearrange it.
49(3) You did not attend an appointment you had already rearranged, where the original date was reasonable and you had been told the consequences of not attending.
49(4) You chose to start treatment after the 18 weeks, having been offered a reasonable date inside the period, or you decided you did not want any date inside it.
49(5) You decided that you did not want to commence treatment.
49(6) You could not start treatment inside the 18 weeks for reasons unrelated to the provider or the commissioner, having been offered a reasonable date or being unable to make yourself available for any.
49(7) A consultant, a member of a consultant's team or an interface service has assessed you and decided that it is in your best clinical interests to start later, that you do not need treatment, or to refer you back to primary care.
49(8) One of those clinicians has assessed you and decided you need a period of monitoring with reassessment at intervals inside the 18 weeks.
49(9) You are on the national transplant waiting list.
49(10) You were referred for maternity services.

Four questions

1. Which integrated care board covers your GP practice?

The commissioner is the responsible body that the duty in regulation 48 falls on, and it is the body you can notify under regulation 47(5)(a).

2. What date did the provider receive your referral?

Regulation 44(1) defines the start date as the date on which your referral request was received by the provider you were referred to. It is not the date you saw your GP, and it is not the date of any appointment you were given. If you do not know it, ask the provider.

3. Who is carrying out your assessment?

Regulation 47(3) turns on this, and it cannot be worked out from the provider's name: the assessing clinician varies between services and inside the same service. Only the provider can tell you.

4. Have you already told the integrated care board, in writing, that you have not started treatment within 18 weeks?

A complaint is not that notification. The notification in regulation 47(4) is a statement to the provider or the integrated care board that appropriate treatment has not commenced, or will not commence, within eighteen weeks of the start date.

Answer all four questions to see what the regulations say about your referral.

Common questions

What does the 18 week duty actually require?: Where the conditions in regulation 47 are met, regulation 48 requires the responsible body to take all reasonable steps to ensure you are offered an appointment with a consultant, or a member of a consultant's team, at a suitable provider other than the one you are waiting on, and that appointment must commence treatment earlier than you would have commenced it by continuing to wait. If more than one suitable provider exists you must be offered a choice. It is a duty to take reasonable steps to offer, not a guarantee of an assessment, a switch or a date.
Who has to set it off?: You do. Regulation 47(4) and (5) say the duty arises once the provider or the integrated care board has been notified, by the person referred or someone lawfully acting on their behalf, that appropriate treatment has not commenced or will not commence within eighteen weeks of the start date. Nobody does that for you and it does not happen automatically.
When does the 18 weeks start?: Regulation 44(1) defines the start date as the date on which your referral request was received by the provider you were referred to. It is not the date you saw your GP and it is not the date you were given an appointment.
Is a complaint the same as notifying them?: No. A complaint goes into the complaints process. The notification in regulation 47(4) is a statement to the provider or the integrated care board that you have not commenced, or will not commence, appropriate treatment within eighteen weeks of the start date. You can do both, but a complaint on its own is not that notification.
Does it apply if my assessment is not with a consultant?: Regulation 47(3) limits it to a referral for assessment or treatment by a consultant, a member of a consultant's team, or an interface service that can refer you on to a consultant or a consultant-led team. If none of those applies, regulations 47 to 49 do not apply to your referral. The separate choice right in regulation 39(2)(b) covers an elective referral for mental health services where the first outpatient appointment is not with a consultant or a member of a consultant's team.
Do you store my answers?: No. The four questions are answered and worked out in your browser. Nothing is written to a database, no answer is sent anywhere, and you are not asked for an email address.
Is this legal advice?: No. We are not lawyers and this is not legal advice. Every legal statement on the page carries its regulation number and links to the regulations on legislation.gov.uk so you can read the wording yourself.

Source for every legal statement on this page: The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 (S.I. 2012/2996), regulations 39, 44, 47, 48 and 49. We are not lawyers and this is not legal advice.