Second Opinion Request (Community Mental Health)

This policy establishes clear guidance for Community Mental Health teams within NHS Lothian on the consistent and equitable management of patient requests for second opinions regarding diagnosis or treatment plans. Recognizing the General Medical Council’s position that patients have the right to seek a second opinion, the policy balances patient autonomy with clinical judgment, ensuring that requests are considered thoughtfully and respectfully.

Applicable to all adult patients under Adult Community Mental Health Services—including General Adult Psychiatry, Older People’s Mental Health, and Substance Use Services—this policy defines the process and responsibilities involved in handling second opinion requests. It outlines the appropriate roles of patients, healthcare professionals, and third parties, while emphasizing the importance of patient consent and clear communication.

The policy promotes a structured referral and triage system to facilitate second opinions, ensuring timely access to alternative clinical perspectives without compromising the primary clinician’s role. It also addresses the management of refused or repeated requests, emphasizing transparency, documentation, and escalation protocols when necessary.

Additionally, it provides guidance on resolving disagreements between clinicians and patients, encouraging the use of advocacy services and alternative appeal mechanisms where appropriate. Exceptional circumstances requiring external referrals or additional approvals are clearly defined.

Overall, this policy aims to enhance patient-centred care, promote trust and collaboration between patients and clinicians, and ensure safe, effective, and equitable mental health clinical care.