Guides

RTT pathway June 2026 Registry guide

18 week pathway NHS: how RTT works

The NHS 18 week pathway, Referral-to-Treatment (RTT) - aims to start consultant-led treatment within 18 weeks of a GP referral for non-urgent elective care. Below: what the rule measures, then how incomplete pathways on file actually sit against it.

Check a live wait against the rule

Open a tracked procedure median or a profiled trust page to place the 18-week operational standard next to the incomplete-pathway figures on file.

The 18-week picture on file

On the incomplete RTT pathways in PlainNHS's 537 England provider rows (June 2026), 65.8% sit within the 18-week operational standard - while large treatment functions stretch from Elderly Medicine at 83.1% within 18 weeks to Oral Surgery at 55%.

65.8%
Incomplete pathways within 18 weeks (all provider rows)
7.2m
Incomplete pathways summed across those rows
2.5m
Incomplete pathways past 18 weeks
106,621
Incomplete pathways past 52 weeks

Descriptive registry totals from NHS England RTT monthly statistics (June 2026). Not a prediction of any individual wait.

Lowest within-18-week shares by treatment function

Large treatment functions (more than 20,000 incomplete pathways on file), ordered by share already inside the 18-week standard. Lower bars mean a larger share of the incomplete list is past 18 weeks.

Oral Surgery: 55%Oral Surgery55%Ear Nose and Throat: 59%Ear Nose and Throat59%Plastic Surgery: 59.3%Plastic Surgery59.3%Trauma and Orthopaedic: 60.6%Trauma and Orthopaedic60.6%Gynaecology: 61%Gynaecology61%Neurology: 61.7%Neurology61.7%Neurosurgical: 62.8%Neurosurgical62.8%General Surgery: 63%General Surgery63%
Share of incomplete RTT pathways within 18 weeks (lowest large treatment functions; June 2026)

Source: NHS England RTT provider-specialty returns aggregated on PlainNHS. Browse procedure pages for median waits by tracked procedure.

Median wait weeks on tracked procedures

PlainNHS tracks a fixed procedure set with published median wait weeks. The 18-week standard is a pathway operational target (92% within 18 weeks on incomplete lists), not a per-procedure median guarantee - these medians show how long published procedure waits currently sit relative to that clock.

Tonsillectomy: 15 wksTonsillectomy15 wksHip Replacement: 14 wksHip Replacement14 wksKnee Replacement: 14 wksKnee Replacement14 wksHernia Repair: 14 wksHernia Repair14 wksVaricose Vein Treatment: 14 wksVaricose Vein Treatment14 wksGallbladder Removal (Cholecystectomy): 14 wksGallbladder Removal(Cholecystectomy)14 wksCataract Surgery: 10 wksCataract Surgery10 wksMRI Scan (Outpatient): 4 wksMRI Scan (Outpatient)4 wksColonoscopy: 4 wksColonoscopy4 wksCT Scan (Outpatient): 3 wksCT Scan (Outpatient)3 wks
Median wait weeks for tracked procedures (longest first)

Open the procedure index to sort trusts by median wait for a named procedure.

What the 18-week standard measures

The 18-week Referral-to-Treatment (RTT) standard is NHS England's operational target for starting consultant-led treatment within 18 weeks of a GP referral for non-urgent elective care. The published incomplete-pathway measure asks trusts to keep at least 92% of patients on an incomplete pathway inside that window. It was introduced in 2008 and remains the headline elective performance metric in the monthly statistical release PlainNHS ingests.

When the clock starts

The RTT clock starts on the day the NHS receives the referral - not when the GP signs it. For an e-Referral System (e-RS) referral this is the day the appointment is booked; for a paper or letter referral it is the day the receiving trust's administration team records it. The start date sits on the patient trust record and is what NHS England audits.

What counts as treatment

The clock stops on the earliest of: first definitive treatment begins (for example an operation date), an active monitoring decision is recorded, the patient is added to a planned-care list, the patient does not attend (DNA) and is discharged, or the clinician decides no treatment is appropriate. The clock does not stop for a diagnostic appointment, an outpatient consultation, or pre-op assessment.

Cancer pathways are tracked separately

Patients referred under the urgent 2-week-wait suspected-cancer pathway are tracked against different standards (including the 28-day Faster Diagnosis Standard and the 62-day treatment target) - not 18-week RTT. PlainNHS does not currently ingest the cancer waiting-time statistical series; see the cancer 2-week-wait guide for the published rule set, and use this page's RTT charts only for elective incomplete pathways.

Published options when a wait exceeds 18 weeks

The 18-week figure is an operational target for NHS England, not an absolute legal entitlement. NHS guidance documents several administrative routes that already exist on the pathway: contacting the trust's Patient Advice and Liaison Service (PALS) for an updated estimate; asking the GP about a re-referral elsewhere under Choose and Book / e-RS choice; and reviewing procedure-specific median waits at alternative trusts before any re-referral. Some pathways may also use Independent Sector Treatment Centres under NHS contract. This page does not advise which route fits a clinical case.

Sources

What to do with this guide

Turn the pathway rules into a concrete next step on the live registry.

  • On the latest return, 65.8% of incomplete pathways were within 18 weeks (7,178,718 pathways across 537 providers). Open a trust profile
  • Side-by-side compare two trusts on the same monthly RTT statistics. Compare trusts
  • Lowest within-18-week share among large specialties on file: Oral Surgery (55%). Browse procedures

Pathway rules and registry statistics are separate from your individual referral clock, contact your GP or NHS 111 for case-specific advice.

Important: This guide is general information about published NHS operational standards and registry statistics. It is not medical advice. Always consult your GP, NHS 111, or a qualified healthcare professional for clinical decisions about your own care.

Source: NHS England Referral to Treatment (RTT) waiting times · September 2026 Live incomplete-pathway shares on this guide come from the provider return; pathway-rule prose cites NHS England RTT rules and the NHS Constitution.

Spotted a figure that looks wrong? Report a correction.

This guide explains the published NHS 18 week pathway (RTT) rules and joins them to live incomplete-pathway shares from NHS England’s monthly provider return. Rule and entitlement prose is editorial; the distribution figures are rendered from the return on file. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error on this page. Data current as of September 2026. Figures here are for context and comparison; clinical pathway decisions belong with your GP, NHS 111, or the treating Trust.