What is a Fracture Clinic?
May 13, 2026
What is a fracture clinic? A fracture clinic is a specialist outpatient clinic—run by a trauma and orthopaedics (T&O) team—that reviews and manages people who have broken bones or rela...
If your GP refers you to a hospital specialist for a non-urgent condition, you are placed on what is known as the 18-week pathway. In the NHS, this is your legal right under the NHS Constitution (England), though current pressures in 2026 mean these targets are frequently missed.
The Referral-to-Treatment (RTT) pathway is the maximum time you should wait for non-urgent consultant-led treatment.
The Target: 92% of patients should start treatment within 18 weeks of their referral being received by the hospital.
The Reality: While this remains a legal right, national backlogs mean many patients currently wait longer than 18 weeks.
When does the “18-Week Clock” start?
The clock starts the moment the hospital or specialist service receives your referral letter or electronic booking from your GP (or another healthcare professional like a physiotherapist).
The 18-week goal isn’t just about your first appointment; it is about reaching a definitive clinical outcome. The “clock stops” when:
You start treatment: This could be an operation, a procedure, or starting a new medication.
A decision is made not to treat: If a consultant determines treatment isn’t necessary and discharges you.
Active Monitoring begins: If you and your doctor agree to monitor the condition without immediate intervention.
You decline treatment: Or if you fail to attend (DNA) your first appointment.
Note on “Clock Pauses”: If you choose to delay your treatment (for example, if you are offered two dates and turn them both down for personal reasons), the hospital may “pause” your 18-week clock.
If your condition is worsening or you feel the wait is too long, you have several options to expedite the process:
Exercise Your Right to Choose: You have a legal right to choose which hospital you are referred to. You can use the NHS App to compare waiting times at different trusts.
Contact the Consultant’s Secretary: If your symptoms have changed, your GP can send an “expedite letter,” or you can contact the department secretary to ask about cancellations.
Ask for “Hot Clinics”: Some departments have specialized units for cases that aren’t quite emergencies but are too urgent for the standard 18-week list.
Use PALS: If you have been waiting significantly longer than 18 weeks, contact the hospital’s Patient Advice and Liaison Service (PALS) to ask for an update.
2-Week Cancer Pathway
The 18-week pathway is for routine, non-urgent care. If your GP suspects you may have cancer, you should be referred under the Two-Week Wait (2WW) system. This is a separate, high-priority pathway.
Mental Health & Specialised Services
Some services, such as community mental health or complex neurosurgery, may operate under different targets. Always ask your GP which specific pathway you have been placed on.
| Feature | Details |
| Legal Status | A right under the NHS Constitution (England) |
| Applies To | Non-urgent, consultant-led elective care |
| Target Time | 18 weeks from referral to start of treatment |
| Starting Point | When the hospital receives the referral |
| Ending Point | First treatment, discharge, or active monitoring |
Are you currently waiting for an appointment and want to know how to check your position on the list, or do you need help understanding if your specific condition falls under the 18-week rule?
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