Second opinions

This section 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 section will also look at what your options are if you ask for a second opinion and do not get one. This section is for people with a diagnosed mental health condition and their carers.

Overview

  • In this section ‘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, 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.
  • 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 your local NHS Clinical Commissioning Group (CCG) will decide if they should pay for this.
  • 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.
  • If you ask for a second opinion but get turned down you can complain.

About 

What is a second opinion?

A second opinion is when you ask a doctor to look at your diagnosis or treatment plan again because you don’t agree with it.

You may want a second opinion if you disagree with your diagnosis or treatment.

After a second opinion you may have more information about what options may be best for you. Or the second doctor may agree with you about your diagnosis or about the best way forward.

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

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.

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

You might come across a number of 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 are not specialists in mental health. GPs can treat the symptoms of mild to moderate mental health conditions such as anxiety, depression or stress.

Your GP should refer you to a psychiatrist if they think your condition is too severe for them to diagnose or 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 in a specific mental health condition.

An opinion by a clinical psychologist

A clinical psychologist is a psychologist who also has medical training. They are trained to look at how people think and behave and assess a patient’s problem.

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 of 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 of your condition.

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 your diagnosis because of the following reasons:

  • 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 usually stays on your medical records even if it changes later. So 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 so 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 and that a particular therapy or medication would help you. If 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.

You can find more information about ‘Medication – Choice and managing problems’ by clicking here.

Can a relative, friend or my carer ask for a second opinion for me?

A relative, friend or your carer can ask for a second opinion for you if you give them permission.

If a relative, friend or your carer asks for a second opinion for you they should have all the relevant information about your condition. And properly understand it.

Rights

Have I got a 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 for reasons.

Getting a second opinion on the NHS

How do I get a second opinion on the NHS?

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

When you ask for a second opinion 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 the opinion of the professional who gave the 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 that you would like to explore all your options before settling on long-term treatment.

If the opinion was given by your GP

If your original opinion was give by your 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 about local GP practices.
  • Ask your GP to refer you to a psychiatrist. Your GP will only do this if they think your condition is severe enough.

If the opinion was given by a therapist, a mental health nurse or a clinical psychologist

The original opinion might have been given by a therapist, a mental health nurse or a clinical psychologist. If it was you can ask to see a psychiatrist.

If you are with a mental health team such as a community mental health team (CMHT) you can ask your usual contact person there.

If you are not with a 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.

If the opinion was given by a psychiatrist

In this section we refer to ‘CCGs’. A CCG is a clinical commissioning group. Each area has its own local CCG. The CCG commissions and pays for NHS services in its area.

You could get a second opinion from:

  • a psychiatrist that works for a team that is funded by your local CCG,
  • a psychiatrist that works for a team that is not funded by your local CCG, or
  • a psychiatrist who works for a specialist service that is funded by NHS England.

An opinion from a psychiatrist that works for a team that is funded by your local CCG

Your doctor or mental health team might agree to arrange a second opinion for you with a psychiatrist who works for:

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

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

An opinion from a psychiatrist that works for a team that is not funded by your local CCG

You might want to see a psychiatrist that works for a team in a different NHS trust that is not funded by your local CCG.

Your local CCG would have to agree to fund this as they will be responsible.

You would need to see your GP and they would need to help you to apply to your local CCG for funding. It would be up to your CCG to decide whether they funded the referral.7

An opinion from a psychiatrist who works for a specialist service that is funded by NHS England

Please see the following section for more information.

Private doctors and specialists

Where can I get a specialist second opinion?

How you can get a specialist second opinion depends on who runs the service and who funds it.

NHS ‘Tier 3’ specialist services are funded by the local CCG.

NHS ‘Tier 4’ specialist services are funded by NHS England.

A local specialist second opinion

There may be a Tier 3 specialist mental health service in the area funded by your local CCG that specifically deals with your condition. For example, if you have an eating disorder, there might be a specialist eating disorder service. You can ask your doctor about this.

An out of area specialist second opinion

There may be a specialist mental health service that specifically deals with your condition. But it might be under an NHS trust not funded by your CCG.

You would need to see your GP and they would need to help you to apply to your local CCG for funding. It would be up to your CCG to decide whether they funded the referral.

An opinion from a psychiatrist who works for a specialist service that is funded by NHS England

There are some specialist mental health services that are funded directly by NHS England and not a CCG. 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 can refer you to the service. There may be a long wait to access the service.

Details of specialist services

The following specialist services see people from all areas of England. 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.

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: 020 3228 4322 or 020 3228 4276
Address: Fitzmary 2, Bethlem Royal Hospital, Monks Orchard Road Beckenham BR3 3BX
Email: slm-tr.nps@slam.nhs.uk
Website: www.national.slam.nhs.uk/services/adultservices/psychosis/contact-us/

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.

The Regional Affective Disorders Service
This is a Northumberland, Tyne and Wear NHS Foundation Trust Service. It offers specialist outpatient and inpatient care for patients with difficult-to-treat mood disorders.

Outpatient service contact details:

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

Inpatient service contact details:

Telephone: 0191 246 8606
Address: Gibside Ward, St Nicholas Hospital, Gosforth, Newcastleupon-Tyne NE3 3XT
Email: RADS@ntw.nhs.uk
Website: www.ntw.nhs.uk/services/regional-affective-disorders-inpatientservice-rads-specialist-service-newcastle/

Do I need to see a private doctor?

A private doctor is one that you have to pay for yourself. You don’t need to see a private doctor to get a second opinion. But you might decide to see a private doctor if:

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

Please bear in mind:

  • there is a chance a private doctor might agree with the NHS, and
  • the NHS don’t have to accept a private doctor’s opinion.

If you are going to see a private doctor it is best to see a psychiatrist. They are specialist consultant doctors who specialise in mental health. So they are trained and qualified to give diagnoses regarding mental health conditions.

There is no database, list or internet site 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 ask your GP or your mental health team if they will accept the opinion of the psychiatrist you have chosen.

You can read more about accessing private healthcare on the following webpage on The Mental Health and Money Advice website: www.mentalhealthandmoneyadvice.org/en/mental-health-care/how-do-i-pay-for-private-treatment-and-therapy/how-do-i-access-private-mental-healthcare/

If you decide to, think carefully about your reasons for going outside the NHS and if you can afford private treatment.

Problems

What should I do if the second opinion is refused?

At times it can be difficult to get a second opinion. This might be because:

  • your doctor thinks you don’t need one,
  • your CCG will not pay for a referral to a Tier 3 service, or
  • A specialist Tier 4 service will not agree to assess you.

It may be more likely that you’ll be successful if the following apply to you.

  • 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 can’t 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 you will get a second opinion.

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.

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. There are some sample letters at the end of this factsheet.

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: www.nhs.uk/Service-Search/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363; Or you can call NHS 111 and they can tell you.

Make a complaint

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

  • your GP surgery,
  • your Clinical Commissioning Group (CCG),
  • the team your psychiatrist works for, or
  • a specialist service.

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

You can find more information about ‘Complaints’ by clicking here.

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 is 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 is not a statutory service. So it just depends on the area you live in as to whether the service is available to you.

To find your local NHS Complaints Advocacy Service you can:

To find a 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.

You can find more information about ‘Advocacy’ by clicking here.

Get a solicitor

You might have exhausted the complaints procedure but still not be 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.’

The costs of a solicitor vary. You might be entitled to legal aid.

You can find more information about ‘Legal advice – How to get help from a solicitor’ by clicking here.

Useful Contacts

Clinical Commissioning Groups
You can find your local Clinical Commissioning Group details on the following website.

Website: www.england.nhs.uk/ccg-details/#ccg-l

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