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18 weeks

18 weeks

18Weeks ClockWhat is 18 weeks?

The James Paget University Hospitals works to ensure that all patients are seen and treated as quickly as possible. The longest you will wait from being referred by your GP and starting your treatment will be 18 weeks.

Wherever possible you will wait less than this. Any hospital appointments, tests, scans or other procedures that you may need before being treated will all happen within this maximum time limit.

However, there may be times when you cannot begin treatment within 18 weeks, such as:

  • When you choose a later appointment for your treatment, perhaps because of work commitments or a holiday.
  • When you are not medically fit to be treated for surgery to be carried out safely.
  • When your condition requires an extended period of testing and observation before a diagnosis can be made. This will only happen occasionally. This is called watchful waiting or active monitoring.

What does this mean for me?

  • Earlier relief of symptoms, pain or discomfort
  • Coordinated tests and treatments, meaning fewer hospital visits. 
  • Reduced anxiety due to earlier diagnosis and treatment.

Terms that have been used with the ‘18 week wait’ and which you may hear:

Clock starts: An 18-Week clock starts when any care professional such as your GP or Allied Health Professional or service, makes a referral to a consultant led service or to a referral management service.

Clock pause: This occurs if the patient decides to defer their inpatient treatment until a later date after being offered two dates.

Clock stops: Examples of clock stops are: when a patient receives their first definitive treatment, when a clinical decision is made to start a period of active monitoring, if the patient declines offered treatment, a clinical decision is made not to treat or if a patient does not attend (DNA) their first outpatient appointment.

Pathway: A pathway is your journey through hospital, which starts on receipt of your referral and ends when you receive your treatment.


Frequently asked questions

  • Yes. The hospital needs to be alerted as soon as possible so an alternative appointment can be arranged.  

  • Appointments missed are known in the NHS as ‘did-not-attends’ (DNAs). Missing appointments is sometimes unavoidable for patients. An appointment missed without reasonable notice is one not available to another patient, particularly if the appointment has been booked at a time of a patient’s choosing through Choose and Book.

    Any patient who DNAs their first appointment after initial referral is likely to have their clock stopped and be asked to return to their GP (or other referrer) as long as the hospital can demonstrate that the appointment offered was reasonable and clearly communicated to the patient. This means you will have to return to your GP for a re-referral.

    A new clock starts on the date on which the provider of treatment receives notice of any subsequent re-referral.

  • Patients who cancel their first appointments in advance will not have their clock stopped unless their rebooked appointment entails a delay that makes it unreasonable or impossible for 18 weeks to be achieved for that patient.

  • Much like other Trusts around the country, the JPUH experienced a challenging start to the winter period with an increase in ambulances and admissions:

    •  A 9.12% year on year increase in demand within A&E
    • ·A 14% year on year increase in ambulance arrivals.


    We currently have around 100 patients within the hospital that are medically stable and fit for discharge; many of these patients are awaiting their first choice of Nursing or Residential placement.

    To ensure we have the capacity to care for our emergency patients safely and to ensure elective patients are not cancelled the Trust is implementing its Direction of Choice policy. Patients who no longer require acute care, and are therefore ready for discharge, are required to transfer to an available non-acute placement whilst they await their first choice to become available. Our priority is our patients’ safety, and we need to ensure that their discharge is safe and care is in place, but we also need to ensure that we have the capacity for those patients that urgently need our care.

    We have escalated our current situation to the health and social care system via various forums. We have agreed a way forward to expedite discharge and to increase the availability of nursing/residential/community beds and social/health care teams.


Please inform us if you cannot attend

Help us treat you without delay – what you can do to make sure you get treated quickly

Talk to your GP about your treatment so that you understand what to expect, and when.

  • Keep the appointments you have chosen, or let the hospital or clinic know as early as possible if you cannot attend or need to rearrange your appointment.
  • Think about how you might improve your lifestyle, for example stopping smoking or losing weight, so that you will be fit for treatment.