Second opinions

This page explains why you might ask for a second opinion and how to ask for it. You do not have a right to a second opinion, but you can ask for one. This factsheet will also look at what your options are if you ask for a second opinion and do not get one.

Overview

  • If you disagree with your doctor about your diagnosis or treatment, tell them why. Give the doctor more information to see if they will change their mind. An advocate might be able to help you with this.
  • 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. 
  • You can ask for a second opinion, but you have no legal right to one.
  • If your GP or psychiatrist agrees that a second opinion will help, they will try to arrange one for you.
  • If your doctor thinks you need a second opinion in a different part of the country, your local NHS Clinical Commissioning Group (CCG) will decide if they should pay for this.
  • If you ask for a second opinion but get turned down, you can complain.
  • There are some specialist NHS services that are experts in particular mental illnesses. You can ask for a second opinion from this sort of service if you feel you need it. Your local NHS will only agree to this if they think you really need one.

Should I ask for a second opinion? 

You may want a second opinion if you feel there is uncertainty about your diagnosis or treatment. After a second opinion you may feel that there is some healthy debate about what options may be best for you, or the second doctor may agree about the best way forward.

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 make the best decision
for you. The diagnosis or treatment you want may not be the one best suited to you.

It is important to remember that having a second opinion may not lead to a different opinion.

Uncertainty about your diagnosis

If you have a mental illness, your recovery may be better if a doctor spots and treats your illness early. But sometimes it can be difficult for your doctor to decide.

  • It can be hard to recognise early symptoms of mental illness. Drugs or alcohol can cause similar symptoms, and your doctor might not be certain about what has caused them.
  • Sometimes people may ignore or play down their symptoms. This can make it harder for doctors to recognise them.
  • Some symptoms may change as you get older. 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.
  • Your doctor may wait to make sure they do not give you a wrong diagnosis.
  • A diagnosis stays on your medical records even if it changes later. Therefore, doctors may wait to diagnose you until they are certain.
  • Some people can recover from one or two episodes 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 is not always a certain science, and different
    doctors may give you a different diagnosis.
  • Even if a doctor is sure about your diagnosis, you or a carer, friend or relative may find it difficult to accept. 

Uncertainty about treatment 

You may feel that your treatment plan is not right. If you feel that a particular therapy or medication would help you but your doctor does not 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 mental health and whether you are getting any side effects. Medications can work differently with different people. 

Trying to find the right medication for you might be a “trial and error” approach. However, if you feel your medication is wrong and your doctor will not change it you could ask for a second opinion.

 

 

Have I got a right to a second option?

Unfortunately you have no legal right to a second opinion. But your doctor should not dismiss it if you bring it up. They should think about your reasons for wanting another opinion and take them seriously. If they don’t
agree that you need one, ask for reasons.

 

How do I get a second opinion on the NHS?

There are two types of second opinion in the NHS:

  • a local second opinion, and
  • an out-of-area specialist second opinion.

Local second opinion

This is an opinion from another doctor in your local NHS. For example, if your psychiatrist has diagnosed you then the second opinion would be from another psychiatrist in their team or from a different local team.

If your GP has diagnosed you but you disagree, you could ask them to pass your details to a psychiatrist. This is not the same as a second opinion. But if they won’t offer this, you could ask for a second opinion
from another GP.

There may not be a formal procedure for asking for a local opinion. It is best to talk it through with your doctor. Make it clear what outcomes you are looking for. You could mention:

  • why you feel the diagnosis or treatment option is uncertain,
  • how this uncertainty makes you feel,
  • how having a second opinion would make you feel more certain,and comfortable with treatment, and
  • any problems you have had with treatment so far.

It is generally best not to criticise your doctor’s opinion if you can avoid this. You can acknowledge their opinion but say that you are aware that there are often differences of opinion and you would like to explore all your options before settling on long-term treatment.

There may be a specialist mental health service in your area. In this situation, you may be able to get a specialist opinion more easily without having to go out-of-area.

Out-of-area specialist second opinion

The procedure for asking for an independent second opinion outside your local NHS depends on local policies. You may have to ask for details of the ‘individual funding request’ policy.

If your local NHS agrees that you should have a second opinion outside their area, they will have to pay for this. 

What happens when I ask for an independent second opinion?

If your doctor agrees you need an independent second opinion, they will help you to apply to your local Clinical Commissioning Group (CCG). Applying directly to the CCG is called making an ‘individual funding
request’ (IFR). Your GP or healthcare professional has to send your IFR to the CCG. You can send a letter with the IFR about why you want a second opinion.

The CCG looks after the money for your local NHS trust and decides what to spend it on. They will decide if they will pay for an independent second opinion for you. Your local CCG may have agreed to use a particular
specialist service when people need expert opinions. 

How hard is it to get an independent second opinion?

It can be difficult to get an independent second opinion. This might be because:

  • your doctor thinks you don’t need one, or
  • your CCG will not pay.

It may be more likely that you’ll be successful if:

  • all the usual treatments have not worked for you. This is called being ‘treatment resistant’
  • your mental health is not improving as quickly as your doctor expects. You may be in and out of hospital, or you may have been in hospital for a long time
  • the side effects of your medication are seriously affecting your health and your doctor cannot find any answers or alternatives 

It is important to explain how your diagnosis or treatment is negatively affecting your life and why a second opinion might help. The stronger your reasons, the more likely it is that your CCG will agree.

What should I do if the second opinion is refused?

If your doctor refuses a second opinion

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. Although this situation can be very frustrating, it is important to be polite. You will need to persuade the doctor to change their mind, so focus
on the reasons why you think it will be helpful.

If your doctor still refuses, you could ask in writing. It can be easier to get your point across in a letter.

Contact PALS

You could talk to your local Patient Advice and Liaison Service (PALS). 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 or Rethink Mental Illness Advice Service could search for you.

Use an advocacy service

A community advocate could help you to ask for a second opinion. An advocate is someone independent from mental health services who can help to make your voice heard when you are trying to resolve problems.  There may be a local advocacy service in your area which you can contact for support. You can search online or Rethink Mental Illness Advice Service could search for you.

Make a complaint

If you still have no success you could complain using the NHS complaints procedure. If your complaint is about your GP, ask the surgery for details of the complaints procedure. Your psychiatrist will work for a particular NHS service. To complain, ask the service for details of their complaints policy, or talk to PALS.

If the CCG refuses funding

Clinical Commissioning Groups (CCG) have to make hard decisions about what they will pay for. This can make it harder to get funding for an independent second opinion. If you do not get funding for a second opinion, you could contact your local CCG directly. You can ask them to reconsider. There is information about how to find your local CCG at the end of this page. 

Sometimes getting a community care solicitor could help. The costs of a solicitor vary. You might be entitled to legal aid but you would need to discuss your situation with a solicitor.

Private doctors and specialists

Do I need to see a private doctor?

A private doctor is one that you have to pay for yourself. You do not need to see a private doctor to get a second opinion. If you decide to, think carefully about your reasons for going outside the NHS and if you can
afford private treatment.

Bear in mind that the private doctor might agree with the NHS. If they don’t, the NHS does not have to follow their decision about your diagnosis or treatment options.

Rethink Mental Illness does not have lists of private psychiatrists, and the advice service cannot make recommendations. If you would like to find one, you could ask your GP. You could also research online to see what services are available, and then ask them about the level of service they offer and their costs.

Where can I get a specialist second opinion?

If you feel you need a specialist opinion, there are some NHS services that specialise in certain conditions. They can see people from all areas of England. There are details of some below, but this is not an exhaustive list.

These services offer expert assessment and treatment. They are set up for people whose conditions are complex or where someone’s correct diagnosis or treatment is unclear.

Some mental health trusts also have specialist services for other mental health conditions such as obsessive compulsive disorder, eating disorders or trauma. There are also individual professionals throughout the country not linked with a specialist service.

Psychosis Service

This service specialises in expert, evidence-based treatment for people with complex psychosis or who have psychosis and another mental illness. They specialise in new treatments for people who struggle with
other treatment options.

Telephone: (Tel: 020 3228 4322 (inpatients) or 020 3228 4418 (outpatients)

Address: Bethlem Royal Hospital, Beckenham, BR3 3BX
Email: nps@slam.nhs.uk
Website: www.national.slam.nhs.uk/services/adultservices/psychosis/contact-us/

Mood disorder specialists

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

Affective Disorder Unit

This service provides specialist assessment and treatment for people with complicated or treatment-resistant mood disorders, including depression and bipolar disorder.

Telephone: 020 3228 4678/4696
Address: Bethlem Royal Hospital, Beckenham, BR3 3BX
Email: carol.bell2@slam.nhs.uk
Website: www.national.slam.nhs.uk/services/adultservices/affectivedisorders/contact-us/

Specialist Services for Affective Disorders

This Manchester Mental Health and Social Care Trust service provides specialist assessment, psychological treatment and help and advice for patients, relatives and referring clinicians on Affective Disorders.

Telephone: 0161 882 1000 (Switchboard number)
Email: Kirsten.bond@mhsc.nhs.uk or Shirley.foster@mhsc.nhs.uk.
Website: www.mhsc.nhs.uk/services/specialist-services/specialist-servicefor-affective-disorders.aspx

The Regional Affective Disorders Service

This Northumberland, Tyne and Wear NHS Foundation Trust service offers specialist outpatient and inpatient care for patients with difficult-to-treat mood disorders.

Telephone: 0191 245 6830/6831
Address: St Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon
Tyne, NE3 3XT
Email: RADS@ntw.nhs.uk
Website: www.ntw.nhs.uk

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