Overview

• In this information ‘your doctor’ means your GP or psychiatrist.
• Doctors can have different opinions, particularly in mental health. Second opinions can help you feel more certain about the right diagnosis and treatment for you.
• If you disagree with your doctor about your diagnosis or treatment, you can tell them why. You can give your doctor more information to see if they will change their mind.
• You can ask for a second opinion, but you have no legal right to one.
• If your doctor agrees that a second opinion will help, they will try to arrange one for you.
• Your doctor might think you need a second opinion in a different part of the country. If they do so, your local integrated care board (ICB) will decide if they should pay for this.
• There are some specialist NHS services that are experts in particular mental illnesses. You might be able to get a second opinion from this sort of service.
• If you ask for a second opinion but get turned down, you can challenge this.

About 

What is a second opinion?

A second opinion is when you:

• don’t agree with your current treatment or diagnosis, and
• ask for another doctor to look at it again.

A second opinion:

• might give you more information about what treatment options may be best for you, or
• might lead to a new diagnosis.

But you might not get the outcome you want. The second doctor might

• agree with the first doctor’s opinion, or
• have another opinion that you don’t agree with.

Some people ask for a second opinion because they would like a particular diagnosis or treatment. The most important thing is to give your doctor the most accurate information so they can form an expert opinion. The diagnosis or treatment you want may not be the one best suited to you.

To help a doctor to make a diagnosis you can keep a diary of your symptoms.

You might come across several professionals who might have an opinion about your mental health condition such as:

• a GP,
• a psychiatrist,
• a clinical psychologist,
• a therapist, or
• a mental health nurse.

An opinion by a GP
GP’s have mental health training but aren’t usually specialists in mental health.

GP’s can treat the symptoms of conditions such as anxiety, depression or stress, as long as they’re mild to moderate in their severity.

Your GP should refer you to a psychiatrist if they think your condition is too severe for them to treat.

An opinion by a psychiatrist
A psychiatrist is a consultant doctor who specialises in mental health conditions.

Psychiatrists can diagnose mental health conditions and offer treatment for them.

Some psychiatrists specialise specific mental health conditions.

An opinion by a clinical psychologist
A clinical psychologist has additional medical training, compared to other psychologists. They use observation, interviews and techniques such as psychometric testing to assess you.

They work in partnership with you to design and put in place support and treatment to help overcome or improve your condition. This will usually include talking therapy.

An opinion by a therapist
A therapist will work with you to treat your mental health problem by using talking therapy.

A therapist might have an opinion on what mental health condition you have. But they can’t give you a formal diagnosis for your condition.

An opinion by a mental health nurse
Mental health nurses support people with mental illnesses and have specialist knowledge on the subject. But they can’t give you a formal diagnosis.

Why might a doctor be uncertain about my diagnosis?

If you have a mental illness, your recovery may be better if a doctor diagnoses and treats your illness early. But sometimes it can be difficult for your doctor to decide your diagnosis because of the following reasons.

• Sometimes people may ignore or play down their symptoms. This can make it harder for doctors to recognise them.
• Some symptoms may change in time. Your doctor may want to wait before they make a firm diagnosis.
• Symptoms of mental illness can also be caused by physical illness or medications. Your doctor might want to do some tests first.
• A diagnosis usually stays on your medical records even if it changes later. This may mean doctors may wait to diagnose you until they are certain.
• Some people can recover quickly from an episode of mental illness. A doctor may want to see if this happens first.
• There are no scans or blood tests to help doctors diagnose mental illness. Doctors are trained to make decisions based on your history and current symptoms. It’s not always a certain science so different doctors may have different opinions.
• It can sometimes be hard to recognise early symptoms of mental illness.
• Drugs or alcohol might mask symptoms of mental illness or cause similar symptoms.

Why might a doctor be uncertain about my treatment?

You may feel that your treatment plan isn’t right and that a particular therapy or medication would help you. If your doctor doesn’t agree you could ask for a second opinion.

Although psychiatrists are specially trained in mental health, they may not be an expert in a particular condition. You may want to get a second opinion from a psychiatrist who is an expert in treating your mental illness. Your local NHS is only likely to agree to this if you have already tried the usual treatments they offer.

Medication
It is important that your doctor reviews your medication regularly. They should check that it is helping with your symptoms and whether you’re getting any side effects. Medications can work differently for different people.

Trying to find the right medication for you might be a ‘trial and error’ approach. You might feel your medication isn’t working as well as you’d hoped but your doctor won’t change it. You could ask for a second opinion.

See our webpage on Medication – Choice and managing problems for more information.

Rights

Have I got a legal right to a second opinion?

You have no legal right to a second opinion.

But if you ask for a second opinion your doctor should listen to you and discuss it with you.

They should think about your reasons for wanting another opinion and take them seriously. If they don’t agree that you need one you can ask them to explain their reasons.

See further down this page for more information about whether your request for a second opinion is refused and you want to know about what action you can take.

Getting a second opinion on the NHS

How do I get a second opinion on the NHS?

When you ask for a second opinion make it clear:

• why you feel your diagnosis or treatment option isn’t right,
• your specific reasons for this, and
• any problems you have had with treatment so far, if applicable.

It’s generally best to not criticise the opinion of the professional who gave it, if possible. You can acknowledge their view, but say that you would like a second opinion for the reasons you’ve given.

It’s important to explain how your diagnosis or treatment is negatively affecting your life. And explain why a second opinion might help. The stronger your reasons, the more likely it is that you will get a second opinion.

Your options will depend on what type of professional gave the original opinion.

What can I do if the opinion was given by my GP?

You can do the following.

• Ask for an opinion from another GP in the practice.
• Move to a new GP practice and see a GP there. You can search for local GP practices using the following link www.nhs.uk/Service-Search/GP/LocationSearch/4 or you can call NHS 111 to ask.
• Ask your GP to refer you to a psychiatrist. Your GP will only usually do this if they think your condition is severe enough.

The demand to register at some GP practices might be high. You can contact the practice to ask if you can register with them. Some practices may be unable to take on new patients for now. You may have to go on a waiting list.

What can I do if the opinion was given by a therapist, a mental health nurse or a clinical psychologist?

You can ask to see a psychiatrist.

If you’re with an NHS mental health team, you can ask your main contact there.

If you aren’t with an NHS mental health team, you can ask your GP to refer you to a psychiatrist. You normally have to wait to see a psychiatrist. Waiting times can vary around the country. You can ask your GP about this.

What can I do if the opinion was given by a psychiatrist?

In this section we refer to ‘ICBs’. An ICB is an integrated care board. Each area has its own local ICB. The ICB commissions and pays for NHS services in its area.

In July 2022 ICBs replaced clinical commissioning group (CCGs).

You could get a second opinion from a psychiatrist from:

• a team that’s funded by your local ICB,
• a team that’s funded by another ICB, or
• a specialist mental health service.

A second opinion from a psychiatrist from a team that’s funded by your local ICB
Your doctor or mental health team might agree to arrange a second opinion from a psychiatrist who works for:

• the same team as the psychiatrist who gave the original opinion,
• a different team in the same NHS trust, or
• a team in a different NHS trust which is funded by your local ICB.

It should be relatively easy for an appointment like this to be arranged. This is because your local ICB is responsible for funding the service. But you normally have to wait to see a psychiatrist and waiting times can vary around the country.

An opinion from a psychiatrist from a team that’s funded by another ICB
You might want to see a psychiatrist from a team in a different NHS trust that isn’t funded by your local ICB.

Your local ICB would have to agree to fund this.

You would need to see your GP to help you to apply to your local ICB for funding.

An opinion from a psychiatrist from a specialist mental health service
Please see the section below for more information on second opinions from a psychiatrist from a specialist mental health service.

Can a loved one or my carer ask for a second opinion for me?

A loved one or your carer can ask for a second opinion for you if you agree. It’s best if you explain to them why you’re asking for the second opinion.

A loved one or your carer might be able to ask for a second opinion without your consent. If you lack mental capacity to make decisions someone else may be able to ask for a second opinion for you. They might be able do this if:

• you have appointed them as your attorney under a Lasting Power of Attorney for Health and Welfare, or
• the Court of Protection have appointed them as your Deputy by court order.

See our webpage on Mental capacity and mental illness for more information.

Private doctors and specialists

How can I request a specialist second opinion on the NHS?

You might want to request a second opinion from a specialist NHS mental health team. So, for example, you might live with an eating disorder. You may want to request an opinion from a specialist team that deals with that condition.

Some types of NHS mental health teams are available in every area. Such as community mental health teams (CMHTs), crisis teams and early intervention in psychosis teams.

But your local area may or may not have certain specialist mental health teams. Each area has an integrated care board (ICB). They decide what to spend the NHS's money on in that local area. So, services can be different in areas run by different ICB’s.

Some specialist services are funded directly by NHS England. These usually only treat people who have tried all other recommended treatment for their mental illness.

So, the specialist team could be:

• a ‘Tier 3’ specialist service, funded by your local ICB,
• an out of area a ‘Tier 3’ specialist service, funded by another ICB, or
• a ‘Tier 4’ specialist service, funded by NHS England.

How do I get a second opinion from a local ‘Tier 3’ specialist service?
You can ask your doctor about this.

Your local ICB is responsible for funding the service. So, it should be relatively easy to arrange an appointment, as long as:

• your doctor agrees to refer you to the service for a second opinion, and
• you fit the service’s criteria and they agree to provide the opinion.

But there might be a waiting time for the appointment. You can ask your doctor about this.

How do I get a second opinion from an out of area ‘Tier 3’ specialist service?
This is an out of area NHS specialist mental health service that’s funded by another ICB.

To get the second opinion from the service:

• your local ICB would have to agree to fund the consultation, and
• the specialist mental health service would have to agree to provide the opinion.

You would need to see your GP so they can help you to apply to your local ICB for funding. If your ICB agree to fund the consultation, there may be a wait time for the appointment. You can ask your GP about this.

How do I get an opinion from a ‘Tier 4’ specialist service, funded by NHS England?
There are some specialist mental health services that are funded directly by NHS England. These services usually only treat people who have tried all normal recommended treatment for their mental illness. They are known as ‘Tier 4’ services.

These services are usually specialists in a single condition or group of conditions.

Each service will have their own admission criteria. If your doctor agrees that you meet the criteria, they might refer you to the service. There may be a long wait to access the service.

Details of ‘Tier 4’ specialist services
The following specialist services see people from all areas of England. There might be other NHS specialist services too.

These services offer expert assessment and treatment. They are set up for people whose conditions are complex.

There are also individual professionals throughout the country not linked with a specialist service.

South London and Maudsley NHS Foundation Trust National Psychosis Service
They provide a national, specialist outpatient assessment, treatment and rehabilitation service. It’s for people, aged over 18, who have complex psychosis. They treat people's physical and mental health. Their aim is to help people maintain their health and to reduce the risk of hospital readmission. They encourage people, and their carers, to be actively involved in all decisions made about their treatment and care.

Phone: 020 3228 4418
Address: Maudsley Hospital Denmark Hill London SE5 8AZ
Email: nps@slam.nhs.uk
Website: www.slam.nhs.uk/service-detail/service/national-psychosis-service-outpatients-121
You can see the eligibility criteria here: www.slam.nhs.uk/service-detail/service/national-psychosis-service-outpatients-121

Mood disorder specialists

The following are specialist services that offer second opinions and treatment reviews for people who have mood disorders such as bipolar disorder and clinical depression.

Northumberland, Tyne and Wear NHS Foundation Trust Regional Affective Disorders Service
This service offers specialist outpatient and inpatient care for patients with difficult-to-treat mood disorders. You must live in the North-East of England and be 18 or over.

Outpatient service contact details:

Telephone: 0191 246 8606
Address: Wolfson Unit, Campus for Ageing and Vitality, Newcastle-upon-Tyne NE4 6BE
Email: RADS@cntw.nhs.uk
Website: www.cntw.nhs.uk/services/regional-affective-disorders-outpatient-service-rads-specialist-service-newcastle/

Inpatient service contact details:

Telephone: 0191 245 6830
Address: Gibside Ward, St Nicholas Hospital, Gosforth, Newcastle-upon-Tyne NE3 3XT
Email: RADS@ntw.nhs.uk
Website: www.cntw.nhs.uk/services/regional-affective-disorders-inpatient-service-rads-specialist-service-newcastle

Can I get a second opinion from a private psychiatrist?

A psychiatrist is a consultant doctor who specialises in mental health conditions. Psychiatrists can diagnose mental health conditions and offer treatment for them.

A private psychiatrist is one that you pay for yourself. You might want to see one if:

• you can’t get a second opinion on the NHS, or
• you disagree with the NHS’s second opinion.

Please bear in mind:

• the private psychiatrist might agree with the NHS opinion or might have a different opinion to you, and
• the NHS don’t have to accept a private psychiatrist’s opinion.

The NHS may be more likely to accept the opinion of a private psychiatrist if they work for the NHS too. You can check with your NHS doctor is they’ll accept the opinion of your private psychiatrist. You can do this before you have your appointment with your private psychiatrist.

There is no database, list or single internet site that we know of where you can search for local or suitable psychiatrists. Rethink Mental Illness can’t recommend a psychiatrist for you.

If you want to see a private psychiatrist, you can ask your GP about it.

You can try to choose a psychiatrist who specialises in the type of condition you have. You can look them up on the medical register. It’s a list of doctors in the UK, showing their registration status, training and other useful information: www.gmc-uk.org/registration-and-licensing/the-medical-register

You can read more about accessing private healthcare here:
www.mentalhealthandmoneyadvice.org/en/mental-health-care/how-do-i-pay-for-private-treatment-and-therapy/how-do-i-access-private-mental-healthcare

Problems

What can I do if a second opinion is refused?

If your doctor refuses a second opinion, you can think about the following options.

Ask again

Ask your doctor why they think you don’t need a second opinion. If you still feel that you need one, try to clear up any misunderstandings and ask again. Be clear and specific with your reasons as to why you don't agree with the original opinion.

Explain the reasons why a second opinion will be helpful. This may help you to change the doctor’s mind.

If your doctor still refuses you could ask in writing. There are some sample letters you can download from the factsheet link at the top of this page.

Contact PALS

You could talk to your local Patient Advice and Liaison Service (PALS). The NHS say that PALS are there to help patients resolve problems with care and treatment.

You could ask PALS if there is a local policy on second opinions. If there is, you can then mention the policy when asking your doctor to reconsider.

You can find your local PALS by searching on the NHS Choices website: www.nhs.uk/service-search/other-services/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363. Or you can call NHS 111 and ask for their contact details.

Make a complaint

If you still have no success, you can complain using the NHS complaints procedure. Who you complain to will depend on your situation. But you might complain to:

• your GP surgery,
• your local integrated care board (ICB),
• the team your psychiatrist works for,
• a specialist service, or
• NHS England.

You can ask for the complaints procedure of the service you are complaining to.

See our webpage on Complaining about the NHS or social services for more information.

Use an advocacy service

An advocate is someone independent from the NHS. They can help to make your voice heard when you are trying to resolve problems. Advocacy services are usually free to use.

There are different types of advocacy services. The types that might be of use to you in this situation are.

• NHS complaints advocacy – This service can help if you want to complain about the NHS. It’s a statutory service, which means that there has to be a service in your area.
• Community or mental health advocacy – This service could help if you don’t want to make a formal complaint about the situation. But you want help dealing with professionals in the NHS about your second opinion. This isn’t a statutory service, meaning it isn’t available in every area of England.

To find your local NHS complaints advocacy service you can:

• search on the internet – type in ‘NHS complaints advocacy service [city/ county/ London borough]’,
• call NHS 111,
• ask your local NHS Trust or look on their website, or
• ask your local Patient Advice and Liaison Service (PALS). You can search for your local PALS service at www.nhs.uk/Service-Search/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363

To find your local community or mental health advocacy service you can try the following.

• Search on the internet – type in ‘advocacy in [city/ county/ London borough]’.
• Contact your local NHS complaints advocacy service to ask if they know of any community or mental health advocacy in your area.

See our webpage on Advocacy for more information.

Get legal advice

You might have gone through the complaints procedure but still not been able to get a second opinion.

You could get legal advice from a solicitor. Seeing a specialist solicitor might help. You can search on the Law Society’s website and choose solicitors for ‘Social welfare, health and benefits’: www.solicitors.lawsociety.org.uk

The costs of a solicitor vary. You might be entitled to legal aid or be able to get other free legal help.

See our webpage on Legal advice – Getting help from a solicitor for more information.

Useful Contacts

NHS integrated care boards
You can find your local NHS integrated care boards details on the following website.

Website: www.england.nhs.uk/integratedcare/integrated-care-in-your-area