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18 weeks

A round clock face showing five past eightWhat 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 the NHS e-Referral Service.

    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.

  • Our Trust, like many others around the country, continues to be busy.

    To ensure we have the capacity to care for our emergency patients safely and to ensure elective operations are not cancelled we have to maintain patient flow through the hospital. This can be challenging and there may be times when procedures are rescheduled. We will work to keep you informed through the process.

    When you are admitted to hospital we will work to try and ensure you are mobile again as soon as it  is safe.

    Our priority is our patients’ safety, and we need to ensure that 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.

    With this in mind we work closely with healthcare partners to facilitate safe admission, treatment and discharge. 


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.


If you would like to find out more about what you can expect from the NHS, please see the NHS Constitution section of our website here.

To read our Referral to Treatment Pathway (RTT) Access Policy and Procedure please click here and scroll down to the documents at the bottom of the page. 

There is also a patient information leaflet 'Access Policy Guidance - 18 week wait' that can be found under the 'Corporate' section here.