A sample Action Plan: knee replacement
This is a real, complete Action Plan, but it is not your plan. It is a worked example we have published in full so you can see exactly what the paid plan contains before you buy your own.
It is built for a sample patient with knee osteoarthritis living near Basildon in Essex, whose local NHS hospital is Mid And South Essex NHS Foundation Trust. Every wait time, hospital and price below is real data for that patient, drawn from the NHS figures published in May 2026. If you just want the underlying NHS waits, the waiting times data for this condition sits on its own page. Your own plan is built the same way, from your postcode and your condition.
A note on the name. A knee replacement is the surgery; knee osteoarthritis is the condition that leads to it. The plan is built from the condition, not the operation, because your options begin long before surgery is on the table, so this sample is built from knee osteoarthritis.
Your situation
Here is what we are working from. The chapter list is below.
Chapter 1 · Are you even on the list?
In this chapter: why a lost referral looks like a long wait · confirming your GP sent it · confirming the hospital received it · what to do if it's missing
And of the patients this happens to:
- Seven in ten had to chase the NHS themselves
- Three in four said it harmed their health
(Healthwatch England, 2025)
A lost referral looks exactly like a long wait. So before you weigh any option in this Blueprint, confirm you're actually on the list. It takes two checks.
Contact your GP practice and ask:
- The date the referral was sent
- Which service it was sent to
- Whether it went via the NHS e-Referral Service or another route
Ask them to confirm it actually went, not just that it was written. You can also ask the practice to print you a copy of the referral letter for your records.
A referral can leave your GP and still not arrive. Three ways to confirm the receiving end:
- The NHS App. Look for a referral document, a referral status, or an upcoming appointment. An empty App does not always mean the referral failed. Some services don't display neatly, and some hospitals confirm receipt separately. Treat it as one signal, not the final word.
- A text, email, or letter from the hospital. Many NHS hospitals acknowledge a referral when they receive it. If you were sent a letter with a reference number and access code, use them to view the referral online through the e-Referral system.
- The hospital booking or referrals team. If nothing has appeared after a reasonable period, call them directly. Use this script:
“My GP referred me on [date] to [service]. Can you confirm the referral has been received, and tell me the current status or next step?”
- For routine e-Referral pathways, expect contact within about two weeks
- Sooner if it was marked urgent
And bear in mind:
- Some referral or appointment information takes a few days to appear in the App
- A short silence is normal
- Weeks of silence, with nothing in the App and no acknowledgement, is your cue to confirm actively, not wait
- If the hospital says it never received the referral, go back to your GP practice
- Ask them to verify the destination
- Ask them to resend it with documentation
- If your GP confirms it was sent but the hospital still can't find it, and you're being bounced between them, escalate through the hospital's PALS (Patient Advice and Liaison Service). They exist precisely to unstick this kind of limbo.
Resolving this now, before you commit to any waiting or paying decision, is one of the most valuable things this Blueprint can do for you.
Chapter 2 · What your numbers mean
In this chapter: what a median really is · what your figure is measured from · what it is and what it isn't · why it's still useful
Before you weigh any option, it helps to understand exactly what your wait figure is telling you. It's a useful number. It's also widely misread.
- At Mid And South Essex NHS Foundation Trust, the typical orthopaedic wait is about 29 weeks
- 17,233 people are currently on the orthopaedic waiting list at this hospital
(Source: NHS England RTT · May 2026)
Your figure is a median, not an average. Line up everyone waiting at your hospital from the shortest wait to the longest, and the median is the person standing in the middle. So half of patients wait less than 29 weeks, and half wait more. It's not the longest wait, and it's not the kind of average that one very long wait could drag upwards. It's the middle of the queue.
Two things shape how to read your wait figure: what it measures, and how current it is. This figure is the most recent the NHS has published (May 2026). NHS waiting-time data typically runs two to three months behind, so this is as current as the official figures get. Wait or Pay checks for new NHS data every day, so you always see the latest available the moment it's released.
Even though it won't tell you your exact wait, the median is the most honest guide there is to how long waits run at your hospital, and how your hospital compares to others. That comparison is what the rest of this Blueprint is built on. If your wait runs long, paying to shorten part of it, or choosing a faster hospital elsewhere, may be worth it. If it runs short, it may not. The number sets the stage. The next chapters show you what to do with it.
Your wait figure is a snapshot of the queue, not your personal countdown. Plan around the comparison, not a date.
Chapter 3 · Wait on the NHS
In this chapter: what waiting on the NHS involves · the 18-week limit and how your hospital measures up · how to stay on top of your wait · whether waiting is your best move
This is the path most people are already on: stay in the NHS queue, pay nothing, and wait for treatment. It's free, it's the default, and for some people it's the right choice.
Your NHS journey runs in stages, not one long blank wait. The exact order can vary by your hospital's local pathway, but it typically runs like this:
These are the typical stages for your hospital, not a timetable. As Chapter 2 explained, your wait figure describes the queue as it stands now, not a countdown from today, and the NHS does not publish an honest per-hospital breakdown of how long each stage takes.
The NHS Constitution gives you a legal right to start treatment within 18 weeks. At Mid And South Essex NHS Foundation Trust, 73% of patients wait longer than that.
Your expected wait of about 29 weeks gives Mid And South Essex NHS Foundation Trust the 1st longest orthopaedic waits of 126 hospitals in England. So treat 18 weeks as your entitlement, not your expectation.
Waiting doesn't have to mean waiting silently. You have real levers:
- You can chase your wait and ask where you are in the queue
- You can ask your GP to expedite if your symptoms get worse
- You can escalate if you've waited beyond 18 weeks
- You can ask whether faster options exist for cases that aren't emergencies but shouldn't wait
- And separately, you can choose a faster hospital elsewhere entirely. That's a different route, covered in Chapter 6: Choose a faster hospital, for free.
Here's exactly how to use each lever:
Using these doesn't jump the queue unfairly. It makes sure you're not forgotten in it, which on a list this size genuinely happens.
Here are all three routes at your own hospital, side by side. The shorter bars show how much sooner paying could get you seen. The next chapters take each one in turn.
Shown illustratively. Exactly how much sooner depends on your hospital, and the NHS does not publish an honest figure for it, so we do not put a precise number on this route.
Chapter 4 · Pay for the smaller steps, get treatment sooner
In this chapter: the idea behind it · the steps, one by one · why it's allowed · what it costs · where to find it near you · whether it's worth it for you
The typical wait at Mid And South Essex NHS Foundation Trust is about 32 weeks on average, with a median of 29. The wait has a long tail, though: 1 in 5 people wait over 50 weeks (NHS RTT, May 2026).
There is a way to reach treatment sooner without paying for the whole thing. You pay for the smaller parts, the consultant appointment and any scan, which cost a few hundred pounds. The NHS still covers the big part: the surgery itself, which would cost thousands privately, stays free. You are paying to move faster through the cheap steps, not to buy your way out of the NHS.
You can also see your hospital's own figures for the wait to a first appointment and to treatment on the NHS My Planned Care service.
You clear the biggest part of the wait — the months spent waiting to be seen — then re-join the NHS for your treatment. Exactly how much sooner depends on your hospital; the point is you skip the longest queue, not that you buy your way out of the NHS.
You pay privately only to be seen and diagnosed sooner; your NHS treatment is then funded and delivered by the NHS like anyone else's. One thing to be clear-eyed about: getting diagnosed privately can bring you to the NHS treatment list sooner than if you had waited for an NHS consultation. That is a real advantage, and one to weigh openly rather than a loophole. It does not change anyone else's clinical priority, and it does not affect your existing NHS waiting-list position.
First, the reassuring part: getting the scan itself is usually quick on the NHS. The scan is not the bottleneck; the wait to see a consultant is.
Getting diagnosed (you pay for this):
- A private consultation: about £200 to £500
- A private scan: about £100 to £200 at centres near you
Your treatment (free on the NHS):
The surgery itself: free. It would cost about £13,200 to £16,000 privately, and that is the part you are not paying for. That gap is the whole point.
You don't have to decide everything up front. Many people pay for the consultation and scan first, get their diagnosis, and then decide. On this route, your consultant refers you back to the NHS and your treatment is free. But if you would rather pay to be treated even faster, going fully private is Chapter 5. Paying for the diagnosis privately keeps your options open.
Before you book any private consultant, ask them one thing:
Not every private consultant does this. Some offer only fully private care. If they will not refer you back, this route does not work with them, so confirm it before you pay for anything.
Here are private orthopaedic consultants listed near you. This is a starting point, not a complete or vetted list, so always do your own checks, and ask each one the essential question above before booking.
You can look any consultant up by name or GMC number on phin.org.uk, the official private-healthcare information service, to check their record before booking.
Here is a quiet advantage of this route. Because your treatment is done on the NHS, the NHS safety net covers it fully.
If you have a complication, the NHS treats it as part of your care, free. You are not exposed to extra private bills for putting it right.
And if something goes wrong because of a mistake, NHS claims are handled by a central government scheme that is always funded, and you keep your right to NHS care throughout.
Going fully private (Chapter 5) does not give you this. There, the surgery is private, so treating complications may cost extra and any claim is against your surgeon's own insurance. Keeping the treatment on the NHS keeps the stronger safety net.
When you are ready, here is exactly what to do, in order:
- Choose a consultant from the list above, or another private consultant in your specialty.
- Ask them the essential question: “Will you refer me back to the NHS for my treatment?” Confirm this before booking.
- Book your appointment. You can contact the consultant’s team directly, since you do not need a GP referral to see a private consultant. If you would prefer a GP referral, ask your GP to refer you to your chosen consultant.
- Attend the consultation and any scan the consultant arranges privately.
- Ask the consultant to refer you onto the NHS for your treatment. They do this directly, by writing to the NHS clinic, so you will not need to go back through your GP.
For your situation, paying for the smaller steps could clear most of your wait — the months spent waiting to be seen — and your NHS treatment stays free either way. If that time matters to you, this route is worth serious consideration.
Chapter 5 · Go fully private, skip the wait entirely
In this chapter: the idea behind it · the steps · what's included in the price · how to pay for it · where to find it near you · whether it's worth it for you
The typical wait at Mid And South Essex NHS Foundation Trust is about 32 weeks on average, with a median of 29. The wait has a long tail, though: 1 in 5 people wait over 50 weeks (NHS RTT, May 2026).
Going fully private means paying for the whole thing yourself: the consultation, any scan, and the treatment itself. There is no NHS list and no NHS wait, because you are not using the NHS for any of it. It is the fastest route, and it is also the most expensive, because you are paying for the treatment that the NHS would otherwise cover. For some people, the speed is worth it. For others, Chapter 4's route reaches treatment nearly as fast for far less, since the NHS still covers the surgery there. This chapter helps you tell which is which.
Before you agree to any private treatment, ask:
Private treatment is normally sold as a fixed-price package covering the surgery itself: the surgeon, the anaesthetist, theatre, your hospital stay, and follow-up. It normally does not cover the initial consultation or your scan, which is why those are listed separately above. Ask for a full written breakdown of every cost before you commit, so nothing is a surprise.
Here are private orthopaedic consultants listed near you, the same starting point as the previous chapter. This is not a complete or vetted list.
You can look any consultant up by name or GMC number on phin.org.uk, the official private-healthcare information service, to check their record before booking.
Getting diagnosed (you can do this first, then decide):
- A private consultation: about £200 to £500
- A private scan: about £100 to £200
Paying for treatment (only if you decide to go fully private):
- The surgery package: about £13,200 to £16,000
You don't have to decide everything up front. Many people pay for the consultation and scan first, get their diagnosis, and then decide what to do. You might choose to pay for the treatment privately and stay on the fast track. Or you might take your diagnosis back to the NHS, where your treatment is free (that is Chapter 4's route). Paying for the diagnosis privately keeps your options open. It does not commit you to paying for the surgery.
That treatment price is a fixed-price package, agreed before you commit. It may not include take-home medication or physiotherapy afterwards.
You may not have to pay privately for everything afterwards. Once your treatment is done, some of your recovery can come from the NHS. Your GP can often take over repeat prescriptions at standard NHS charges, and you can be referred for NHS physiotherapy, which is free, though there can be a wait. Your private team handles the immediate aftercare, like removing stitches and your first course of medication, but the longer recovery does not all have to be private. Ask your consultant to write a clear plan your GP can follow.
You do not always need to pay it all upfront. Most private hospitals offer payment plans through a regulated finance provider, letting you spread the cost over months or years, sometimes with no interest over a shorter term. These involve a credit check and depend on your circumstances, so ask the hospital what they offer.
One thing worth knowing: private health insurance will not cover a condition you already have. It is designed for future, unexpected problems, not one you are already waiting on. For something you already need treated, your realistic options are paying directly or arranging finance.
This is worth thinking about before you commit, because the safety net is different on the NHS and privately.
If you have a complication (something that can happen even when the surgery is done well), the NHS will treat it as part of your care, free. A private fixed-price package often does not cover treating complications, so you could face extra costs, or end up going to the NHS anyway. Ask whether your package covers putting complications right.
If something goes wrong because of a mistake (negligence), the difference is bigger. On the NHS, claims are handled by a central government scheme (NHS Resolution) that is always funded, and you keep your right to NHS care while you claim. Privately, your surgeon is an independent contractor who carries their own insurance, and you would claim against that. This is usually more complex, and in rare cases a surgeon's insurer may not pay out. Before you book, confirm your surgeon holds full, current indemnity insurance.
None of this means going private is unsafe. It means the safety net is thinner, and it is worth weighing. It is also one reason some people choose Chapter 4's route, where the surgery itself is done on the NHS, so the NHS safety net still covers the treatment.
When you are ready, here is exactly what to do, in order:
- Choose a consultant from the list above, or another private consultant in your specialty.
- Book your consultation directly with their team. You do not need a GP referral.
- At the consultation, ask what treatment you need, what the full price includes, and what happens if there are complications.
- Ask about payment options: whether a payment plan or finance is available, and what deposit is needed.
- Agree your price and date in writing before you commit.
For your situation, going fully private could get you treated about 32 weeks sooner than waiting (NHS RTT, May 2026). It is the fastest route, but you pay for the treatment too. If speed matters most and the cost works for you, it is worth considering.
Chapter 6 · Choose a faster hospital, for free
In this chapter: what this right is · your faster options · how to switch · what the travel really means · when it does not apply · what to do
The care is still free NHS care, done to the same standards. The catch is not cost, it is geography: a faster hospital may be further away. The NHS will let you choose, but it will not tell you which hospital is faster. That is what this chapter does.
Here are NHS hospitals treating orthopaedic patients faster than your current 29-week wait, the biggest time savings first. Use the route link on each to check the real journey from your postcode:
Show 49 more faster hospitals within 100 miles
There are two ways in, depending on where you are.
If you are already waiting: you can ask to move even if you have been on the list for months. If you will wait longer than 18 weeks, you have the right to ask to be moved to a hospital that can see you sooner. Contact the hospital you are waiting at, or your local Integrated Care Board (ICB), and ask to switch to a named faster hospital.
If you have not been referred yet: when your GP refers you, they will offer a shortlist of hospitals and you choose. Tell your GP you would like one of the faster hospitals above. You confirm your choice through the NHS e-Referral Service.
One thing to know: once you choose a hospital, it normally handles your whole course of treatment, not just the first appointment. So factor in the travel for follow-ups too.
Be honest with yourself about the journey. A faster hospital may be further away, which can be a lot if you are less mobile or do not drive. But distances vary, and you may be willing to travel further if you have family or friends to stay with near a hospital. Use the route links to check the real drive from your postcode to each one, so you are deciding on the true journey, not a guess.
There is help. If you are on a low income, the Healthcare Travel Costs Scheme can refund reasonable travel costs to a hospital you were referred to. And if it is medically necessary for someone to travel with you, they may be able to claim too. Ask the hospital about the scheme.
This right covers routine, planned referrals. It does not apply to urgent care, or to an urgent referral for suspected cancer, where you should be seen fast wherever you are. If your referral is urgent, speed is already the priority and switching is not the route.
When you are ready, here is how to switch:
- Pick a faster hospital from the list above that you could realistically travel to.
- If you are already waiting: contact your current hospital's booking team or your ICB and ask to move your care to that named hospital, because you will wait longer than 18 weeks.
- If you are not yet referred: tell your GP you want to be referred to that hospital, and confirm it through the NHS e-Referral Service.
- Ask about the Healthcare Travel Costs Scheme if the cost of travel is a concern.
- Factor in follow-up trips, since your chosen hospital handles your whole course of treatment.
For your situation, Kent Community Health NHS Foundation Trust could get you treated about 22 weeks sooner, at no cost. Use the route link to check the journey from your postcode. If you can manage the travel, this is worth doing.
Chapter 7 · Taking action
Whichever path you choose, the same practical skill helps: knowing how to check where you are in the NHS system, and how to chase your place politely when it goes quiet. The patients who get seen sooner are usually the ones who keep track and follow up.
Most NHS referrals in England go through the e-Referral Service. Open the NHS App, go to Appointments, then Referrals, and look for your reference number and estimated wait. If nothing shows within about two weeks of your referral, contact your GP surgery to confirm it was sent and accepted.
Your plan includes ready-to-send letters, already filled in with your details. Here is the shape of each one, with its opening line.
“Dear PALS team, I am writing to ask for help with my wait for orthopaedic treatment at my local hospital…” The rest, with your dates and details and the specific questions to ask, is in your own plan.
“Dear [consultant]’s secretary, I am a patient waiting for orthopaedic treatment…” The full letter, including how to describe what has changed, is in your own plan.
Your GP can confirm your referral was sent, discuss switching to a faster hospital, and review your referral if your symptoms have genuinely changed. If chasing does not work, there is a ladder: the booking team or consultant’s secretary first, then PALS, then your Integrated Care Board, and finally a formal complaint. Your plan walks through each rung, with who to contact and what to say.
Chapter 8 · Your Personal Guide
The paid plan does not end when you finish reading. For 90 days from your purchase, you have a Personal Guide: a real person, reachable on WhatsApp, who knows how the NHS system works and helps you act on this plan.
Your Guide can explain any part of your plan or a letter you have received, help you work out which step to take next, help you chase your place in the queue, and think through your options with you when the wait feels overwhelming. It is one person, not a call centre, so you always get a real reply.
Your Guide is not a doctor and does not give medical advice. For anything clinical, always speak to your GP, call NHS 111, or in an emergency call 999.
Access to the Personal Guide comes with the plan. It is included in the one-off price, so the link to start a conversation is given to you once you have your own plan. This sample does not include the live link.
That is the whole plan, for one sample patient. To get the same thing for your own hospital and condition, build your own plan from your postcode. It takes a couple of minutes.