How to Choose a Surgeon and a Hospital

Part of The Joint Replacement Guide — Phase 6: The Bigger Picture · Article 40 of 44 · Hip & Knee

Key Points

  • In England, most NHS patients referred for planned, consultant-led treatment have a legal right to choose a suitable healthcare provider and the consultant-led team responsible for their care.
  • Choosing a consultant-led team does not guarantee that the named consultant will personally perform every appointment or the operation.
  • Useful information includes National Joint Registry profiles, hospital inspection reports, waiting-time information and what you learn during your consultation.
  • Published figures need context: volume and outcomes matter, but they do not provide a complete ranking of surgeons or hospitals.
  • It is reasonable to ask who is likely to perform your operation and about their experience with the procedure being proposed.

Your Right to Choose

If you are being referred for a first outpatient appointment for planned, consultant-led NHS treatment in England, you will usually have a legal right to choose the healthcare provider and the consultant-led team responsible for your care.[1,2]

Your options may include NHS hospitals and some independent hospitals that provide the required treatment under an NHS contract. The provider and service must be clinically appropriate for your needs and able to provide the treatment being requested.

There are exceptions. The legal right does not apply in every situation—for example, to emergency or urgent care, certain urgent cancer pathways, some onward referrals when you are already receiving treatment for the same condition, and some highly specialised circumstances.[1] If you are uncertain whether the right applies to you, ask your GP or referral team to explain your available options.

Choosing a named consultant-led team does not necessarily mean that the named consultant will personally see you at every appointment or perform the operation. Other suitably trained members of that consultant’s team may be involved in your assessment and treatment.[2] If being operated on by a particular surgeon is important to you, ask the hospital directly what can realistically be offered.

Sources of Information Worth Using

The National Joint Registry publishes surgeon and hospital profiles containing information such as the number and types of joint replacements recorded and selected outcome measures.[3] These profiles can help you understand a surgeon’s usual practice, but they should not be treated as a simple league table. The reporting periods, available measures and number of patients included can differ, and small numerical differences may not be statistically or clinically meaningful.

The Care Quality Commission publishes inspection reports and ratings for hospitals and other healthcare services in England.[4] These reports can provide useful information about areas such as safety, leadership and the general organisation of care. However, a rating may apply to the hospital or trust more broadly, may have been issued some time ago, and may not specifically assess the hip or knee replacement service you are considering.

You can also review NHS waiting-time information, hospital patient information and the outcome information published by individual units or surgeons. Waiting times are estimates rather than guaranteed treatment dates and can change according to demand and your clinical needs.

Volume and Outcomes—Useful, but Not Everything

Regularly performing a particular procedure helps a surgeon and the wider team maintain their experience. It is therefore reasonable to ask how frequently the surgeon and hospital perform the operation being proposed—particularly if it is a complex or revision procedure.

However, volume alone does not establish that one surgeon is better than another. Published results can be influenced by the complexity and health of the patients treated, the procedures undertaken, the length of follow-up and the number of cases available for analysis.

Joint replacement also depends on the wider service: anaesthesia, nursing, physiotherapy, infection prevention, pre-operative assessment and access to appropriate support if a complication occurs. The experience and organisation of the whole team therefore matter alongside the surgeon’s individual figures.

Your Consultation Matters

A good consultation should leave you with a clear understanding of:

  • why joint replacement is—or is not—being recommended;
  • the reasonable alternatives;
  • the expected benefits and important risks;
  • the proposed implant, fixation and surgical approach where relevant;
  • what recovery is likely to involve; and
  • who will be responsible for the different stages of your care.

You should feel able to ask questions without being rushed or dismissed. Confidence in your surgeon should come from clear communication, realistic expectations and a considered plan—not from a promise of a guaranteed result, because no surgeon can guarantee a complication-free or completely pain-free outcome.

Questions Worth Asking

  • Who is likely to perform my operation, and will they be a consultant or another appropriately supervised member of the team?
  • How frequently do you and this hospital perform this type of procedure?
  • Is my operation considered routine or more complex?
  • What implant, fixation method and surgical approach would you usually recommend for someone in my situation, and why?
  • What are the most important benefits and risks in my individual case?
  • How does the hospital approach pre-operative optimisation, pain relief and rehabilitation?
  • What should I expect after discharge, and whom should I contact if I develop a problem?
  • Where can I view the surgeon’s and hospital’s published outcome information?

Not every surgeon will recommend the same implant or technique. A difference in practice does not necessarily mean that one approach is wrong; several established methods may be reasonable. What matters is whether your surgeon can explain the proposed choice in relation to your health, anatomy and needs.

If You Have Complex Needs

For routine primary joint replacement, factors such as travelling distance, waiting time, support after discharge and your confidence in the team may reasonably influence your choice.

If you require complex revision surgery, have substantial bone loss, a previous joint infection, an unusual deformity or significant medical needs, relevant specialist expertise may be particularly important. In that situation, a tailored discussion with your GP and orthopaedic team may be more helpful than choosing a hospital on general reputation alone.

In More Depth

The right to choose principally applies when you are first referred for consultant-led outpatient care. It is not an unrestricted right to demand any particular treatment, hospital or individual surgeon. The treatment must be clinically appropriate, and the provider must offer the required NHS service.[1,5]

If you believe you have not been offered a choice when the legal right applies, first raise this with your GP or referral team. If the issue cannot be resolved, the NHS Choice Framework explains how to contact the relevant Integrated Care Board or raise a concern.[1]

This article provides general information and does not replace individual clinical advice. Choice rights and available services can change, so consult the current NHS Choice Framework and discuss the options applicable to you with your GP or referral team.

References

  1. Department of Health and Social Care. NHS Choice Framework: what choices are available to you in your NHS care.
  2. NHS. About NHS hospital services: choosing a hospital or consultant.
  3. National Joint Registry. Surgeon and hospital outcomes publication.
  4. Care Quality Commission. Find and compare care services, inspection reports and ratings.
  5. NHS England. Patient choice guidance.

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