When the NHS pays for private treatment

The NHS will, in some circumstances, fund treatment for an NHS patient at a private provider. This is not the same as a patient paying for private healthcare alongside an NHS pathway. Four routes lead to NHS-funded private treatment:

1. NHS contracts with the independent sector

NHS England routinely contracts with private providers and Independent Sector Treatment Centres (ISTCs) to deliver NHS-funded elective care — particularly orthopaedics, ophthalmology, and diagnostics. From the patient's point of view this is identical to being treated at an NHS Trust: no payment is taken, the e-Referral Service (e-RS) shows the provider as a Choose & Book option, and care follows the same NHS pathway and outcome standards.

2. Patient choice for shorter waits

Under the NHS Choose & Book entitlement, at the point of GP referral you can select any provider (including private hospitals with an NHS contract) that is e-RS-listed for your specialty. If a private provider can offer a shorter wait than your local NHS Trust, you can choose it — the NHS pays.

3. Individual Funding Requests (IFR)

If you need a treatment your local Integrated Care Board (ICB) does not routinely commission — for instance, a drug not yet recommended by NICE, or a treatment outside the standard clinical pathway — your clinician can submit an Individual Funding Request. The ICB's panel reviews evidence of clinical exceptionality and may approve funding for the specific case. IFR decisions are appealable to the same ICB's appeal panel; ultimately to the NHS Ombudsman.

4. Continuing Healthcare (CHC) and personal health budgets

Patients eligible for NHS Continuing Healthcare can spend their personal health budget at private providers if the ICB agrees the spend meets the agreed care plan.

What the NHS does NOT pay for

You cannot use the NHS to subsidise a private pathway you have chosen for convenience. Specifically: the NHS will not pay for private follow-up of an NHS surgery, will not fund private consultations to expedite an NHS referral, and will not reimburse out-of-pocket private payments retrospectively (with the very narrow exception of CHC assessment errors).

How to apply or appeal

For IFRs, ask your treating clinician to submit the request to your ICB. For Choose & Book private-NHS providers, ask at the GP appointment to be shown the full e-RS list of providers in your specialty. If a request is refused, the written decision letter must include the appeal route — usually within 28 days.

Sources

• NHS England, Specialised commissioning.
• NHS England, Personalised care and personal health budgets.
• NICE, Technology appraisals and clinical guidelines.

Common questions

Where can I find the official documentation? Each numbered source link above takes you to the canonical NHS England, NHS Digital, NICE, or CQC publication. PlainNHS does not paraphrase these documents at length — we point you to them and explain the practical implication for patients.

How often does the underlying guidance change? NHS operational standards (RTT, A&E, cancer) have been stable for several years but performance against them is published monthly. NICE guidelines are revised every 2-3 years on a published schedule. CQC's inspection methodology was last updated in 2024 and the new framework is now in force for all inspections.

What if my situation differs from what is described here? Always speak to your GP, NHS 111, or PALS at the treating Trust. The guidance on this page covers the standard pathway; individual cases can vary on clinical grounds, locality of services, and patient preference.

How PlainNHS uses this guidance

When we present operational performance data on a Trust profile (e.g. “a Trust achieved 76% on the 18-week RTT standard”), we are referring to the same standard described on this page. Reading this guide gives you the context to interpret the numbers correctly. The PlainNHS methodology describes how we compute and verify the figures.

Related guides on PlainNHS

• The NHS 18-week RTT pathway
• The cancer 2-week-wait pathway
• How to interpret CQC ratings
• Choose & Book — your right to choose your hospital
• The A&E 4-hour target
• NHS Continuing Healthcare eligibility
• When the NHS pays for private treatment
• How to make an NHS complaint

Glossary of terms used in this guide

• NHS Trust — a statutory NHS body that runs hospitals or other healthcare services for a defined catchment.
• Integrated Care Board (ICB) — the local NHS body that commissions (purchases) healthcare for a region; succeeded Clinical Commissioning Groups in 2022.
• Multidisciplinary team (MDT) — a clinical team combining specialists from different disciplines to plan an individual patient's care.
• e-RS (e-Referral Service) — the NHS digital booking system that replaces paper referrals.
• PALS — Patient Advice and Liaison Service. Every NHS Trust has one; first point of contact for non-formal questions and complaints.

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