What Is Secondary Care in the NHS? Primary vs Secondary Care
Secondary care is the specialist care you are referred to, usually by your GP. Here is how it fits with primary and tertiary care, and what to expect when you are referred.
Updated · 5 min read
Secondary care is specialist NHS care that you usually reach through a referral, rather than going directly. It includes hospital outpatient clinics, planned operations and specialist services such as cardiology or orthopaedics. Your GP, dentist or optometrist is part of primary care, which is your first point of contact. When they think you need a specialist's opinion or treatment, they refer you on to secondary care.
The three levels of NHS care
| Level | What it means | Examples |
|---|---|---|
| Primary care | Your first point of contact with the NHS | GP surgeries, community pharmacies, dentists, opticians |
| Secondary care | Specialist care you are usually referred to | Hospital outpatient clinics, planned surgery, specialist tests |
| Tertiary care | Highly specialised care, usually in specialist centres | Specialist cancer, heart surgery or neurosurgery centres |
Primary care
NHS England describes primary care as the first point of contact in the healthcare system, the "front door" of the NHS. It includes general practice, community pharmacy, dental services and optometry (eye health).
Secondary care
Secondary care is provided by specialists, such as hospital consultants and their teams, who do not usually see you first. You normally need a referral. It is often delivered in hospitals, but some specialist clinics run in community settings.
Examples include:
- outpatient appointments with a specialist, such as a cardiologist or dermatologist
- tests such as scans, endoscopies and biopsies
- planned (elective) operations, such as hip replacements or cataract surgery
- specialist physiotherapy or rehabilitation after a hospital stay
Tertiary care
Tertiary care is highly specialised treatment, usually in regional or national specialist centres. Patients are often referred there from secondary care.
Emergency care
A&E is part of hospital care, but you can go there without a referral in an emergency. The NHS website says that, generally, you cannot refer yourself to a hospital specialist on the NHS, except for sexual health clinics and A&E.
How you get into secondary care
- You see your GP (or another primary care professional, such as a dentist or optometrist).
- They decide if a referral is needed. The NHS website says whether you are referred depends on what your GP feels is clinically necessary. They may suggest trying tests or treatments first.
- A referral letter is sent with your medical history and what the specialist should look at.
- You book your first appointment, often through the NHS e-Referral Service. Your GP may book it with you, you can book online using your appointment request letter, or you can phone the e-Referral Service on 0345 608 8888.
Our guide on booking or cancelling NHS appointments explains how to manage the appointment once it is booked.
Your rights when you are referred
Choice of hospital
In most cases, you have a legal right to choose which hospital in England you go to for your first outpatient appointment. The NHS website says this includes many private hospitals that provide NHS services. You can also choose a consultant-led team.
If you are not offered a choice, ask your GP why. If you are still refused, you can contact your local integrated care board (ICB).
Choice does not apply in some situations, including urgent or emergency care, maternity services, and for people serving in the armed forces.
Maximum waiting times
Under the NHS Constitution, if your GP refers you for a non-urgent condition, you have the right to start consultant-led treatment within 18 weeks of referral, unless you choose to wait longer or waiting is clinically right. If you are likely to wait longer than the maximum time, you can ask to be moved to a different provider.
For urgent suspected cancer referrals, cancer should be confirmed or ruled out within 28 days.
Is secondary care free?
Hospital treatment is free if you are ordinarily resident in the UK. Visitors may be charged for some care. Some services, such as A&E, are free to everyone.
Secondary care and your GP
Your GP is still involved after you are referred. Specialists write to your GP with their findings and recommendations, and the NHS website says they should aim to give you a copy of their letters. If you do not get one, you can ask. When your specialist treatment finishes, you are usually discharged back to your GP's care.
Hospital care that is free for everyone
Hospital treatment is free if you are ordinarily resident in the UK. The NHS website lists some services that are free to everyone in NHS hospitals in England, including overseas visitors:
- A&E services, but not emergency treatment once you have been admitted
- family planning services, but not termination of pregnancy or infertility treatment
- treatment for most infectious diseases, including sexually transmitted infections
- treatment for conditions caused by torture, female genital mutilation, domestic violence or sexual violence (with some exceptions)
If you are visiting or have recently moved to England, check the NHS guidance on charges before you need care.
When the NHS does not routinely offer a treatment
If your GP thinks you need a treatment that is not routinely offered by the NHS, they can submit an individual funding request to your integrated care board (ICB). The ICB decides whether to fund it in your case.
Questions about secondary care
Can I pay to skip the queue?
You can choose to see a private specialist, but you pay for that care. The NHS website advises getting a GP referral letter even for private care.
Is a community clinic secondary care?
It can be. If a specialist team runs the clinic and you were referred, it is usually secondary care, even if it is not in a hospital.
Sources
Checked on 14 October 2026:
- NHS England: Primary care
- NHS website: Referrals for specialist care
- NHS website: About NHS hospital services
- NHS website: Guide to NHS waiting times in England
This guide explains the general rules for staff in England using 2026/27 figures. It is not financial advice. Your employer, payslip or NHS Pensions statement has the final word on your own pay.