Step 1 — The referral is sent
Your GP sends the referral electronically via the NHS e-Referral Service or by letter. The hospital's referral management team receives it, logs it, and assigns it to the appropriate clinical team. Your RTT clock starts at this point.
Step 2 — Acknowledgement
You should receive an acknowledgement from the hospital within three weeks of a routine referral. If you hear nothing, contact your GP to confirm the referral was sent and received.
Step 3 — Appointment letter
Once the hospital has a slot, they will send you an appointment letter with the date, time, location, and the name of the consultant or clinical team. If the date does not work, contact the hospital as soon as possible — do not simply not attend.
Step 4 — First appointment
Your first appointment is usually a consultation. The specialist will review your history, examine you, and decide on next steps. This appointment is your RTT clock stop — your 18-week entitlement is fulfilled once you've had this consultation.
Step 5 — Outpatient letter
After the appointment, the specialist will write to your GP and usually to you with a summary of what was discussed. This is called an outpatient clinic letter — it may contain clinical language. NHS Decoder can help you understand it in plain English.
If you are waiting for your first appointment and have not heard anything, read our guide on how to chase your NHS referral for the exact steps to take.