referraltotreatment

Referral to treatment (RTT) refers to the period between a patient's referral by a clinician and the start of the first definitive treatment for an elective condition. RTT is used as a performance metric in health systems to assess access to planned care.

In the National Health Service (NHS) in England, RTT has historically been defined as the time from a GP referral to the start of treatment for elective care. A national target, commonly described as 18 weeks from referral to treatment, has guided planning and reporting, though actual targets and reporting practices may vary by specialty and region.

Process: Patients are referred by a primary-care clinician to a hospital or specialist service. Referrals may be triaged or screened to determine urgency. The patient is placed on an RTT pathway and awaits a first treatment date, with the clock starting on the referral and stopping on the start of the first definitive treatment (or, in some cases, a patient-initiated hold).

Interpretation and use: RTT data are used by hospital providers, commissioners, and health authorities to monitor performance, forecast demand, and allocate capacity. The measure informs decisions on service provision, elective surgery lists, and initiatives to reduce wait times. It is also used to inform patients about expected wait times.

Challenges: RTT systems face backlog pressures from aging populations, rising demand, and disruptions such as the COVID-19 pandemic. Waiting time performance is subject to variation by specialty, region, and patient factors, leading to ongoing quality improvement efforts.