NHS Right to Choose for ADHD in 2026: The Complete Action Guide

What Is NHS Right to Choose?

NHS Right to Choose (RTC) is a legal right enshrined in the NHS Constitution for England and backed by the NHS Choice Framework. It gives you the right to choose which provider you are referred to for your first outpatient appointment — including outpatient mental health services such as ADHD assessment.

In practice: if your GP agrees you need an ADHD assessment, you can name a specific approved provider. The NHS pays the provider directly. You pay nothing for the assessment itself.

This matters because NHS ADHD waiting lists currently run to 3–7 years in most parts of England, while Right to Choose providers typically see patients within 2–12 weeks of a completed referral.

The Legal Basis: Why Your GP Cannot Just Say No

Many GPs are unfamiliar with Right to Choose or actively discourage its use. Understanding the legal basis helps you respond confidently.

• NHS Constitution (2015, updated 2023): Section 2a gives patients the right to make choices about their NHS care and to have those choices respected.
• NHS Choice Framework: Requires commissioners and providers to implement patient choice for first outpatient referrals, including to mental health providers.
• NHS England Right to Choose guidance (2022): Explicitly extends RTC to mental health outpatient services. States GPs cannot refuse on cost grounds.
• Your GP cannot refuse your Right to Choose request unless they have a specific, documented clinical reason why that provider is unsuitable for you personally — not a blanket practice policy.

Am I Eligible?

You are eligible for Right to Choose ADHD assessment if:

• You are registered with an NHS GP in England.
• Your GP agrees that an ADHD assessment is clinically appropriate for you.
• The provider you choose holds a current NHS Standard Contract for ADHD assessment.
• This is a request for a first outpatient appointment — not a repeat referral or ongoing care.

Which Providers Accept Right to Choose in 2026?

Not every private ADHD clinic holds an NHS Standard Contract — you must choose a provider that is approved. These are the main providers currently accepting Right to Choose referrals in England:

• CARE ADHD — online assessments, typically 4–8 weeks wait. Adults only. Accepted across most of England.
• Psychiatry UK — online and phone assessments, adults and children (varies by ICB). NHS-commissioned pathway includes titration in some areas.
• ADHD 360 — online assessments, adults and children. One of the largest RTC providers by volume.
• CATS (Community Assessment & Therapy Services) — children and young people, East of England region.

Step-by-Step: How to Get a Right to Choose Referral

1. 1

   Prepare your evidence

   Before your GP appointment, complete the ASRS-5 or ASRS-v1.1 self-screening questionnaire and bring a copy. Write down 5–10 specific examples of how ADHD symptoms affect your daily life — work, relationships, finances, safety. The more concrete, the better. If you have supporting evidence (school reports, letters from employers, previous mental health assessments), bring those too.

2. 2

   Choose your provider in advance

   Use our provider finder to identify an RTC provider that is active in your area. Note their full registered name, their NHS contract reference if available, and how to contact them. Some providers (Psychiatry UK, ADHD 360) have specific RTC referral portals your GP will need to use.

3. 3

   Book a GP appointment and state your reason

   Book a longer appointment (10–15 minutes minimum — double if available) and tell reception it is to discuss a referral for ADHD assessment. This primes the GP and reduces the chance of being told to "come back for a separate referral appointment."

4. 4

   Use this exact phrase at the appointment

   Say: "I would like to exercise my NHS Right to Choose and be referred to [provider name] for an outpatient ADHD assessment. This is my right under the NHS Constitution and the NHS Choice Framework." Present your symptom evidence. If the GP is unfamiliar, offer to send them the NHS England RTC guidance URL — it is publicly available.

5. 5

   Handle a slow or reluctant GP

   If the GP is hesitant but not outright refusing, ask them to make the referral at that appointment rather than "look into it." A decision deferred is often a decision denied. If they say they need to check with the practice manager or ICB, ask when you should expect to hear back and confirm this in writing via the practice email.

6. 6

   Follow up with the provider

   Once the GP sends the referral, contact the provider directly to confirm receipt. Most RTC providers will need you to complete their own online registration form separately. Timelines only begin once the provider has your completed referral — chasng this is your responsibility.

What to Do When Your GP Refuses

GP refusals are unfortunately common. The approach depends on why they are refusing.

• Ask for the reason in writing. Without a written reason, escalation is very difficult. Say: "Could you email me the specific clinical or policy reason for the refusal?"
• If they cite a practice policy: Practice-level policies cannot override your constitutional rights. Contact your ICB's Patient Advice and Liaison Service (PALS) and ask them to clarify.
• If they cite ICB guidance: ICBs cannot remove Right to Choose — only NHS England can. Ask PALS whether the ICB guidance explicitly overrides the NHS Choice Framework or whether it is advisory only.
• File a formal complaint: Every NHS practice has a formal complaints process. A complaint triggers a mandatory written response within 40 working days.
• Contact your MP: Parliamentary questions about ICB RTC blocking have produced faster responses than PALS in many cases. Your MP can write to the ICB chief executive directly.
• Request an FOI (Freedom of Information): If the GP or ICB cites a policy, you can request the full text of that policy under FOI. Use our FOI template letter to do this quickly.
• Seek peer support: ADHD UK and ADHD Action both publish template refusal letters and have active communities of patients who have navigated this successfully.

ICB Status: Where Right to Choose Is Being Restricted

Since 2023, several Integrated Care Boards have issued guidance restricting which RTC providers GPs can refer to. The trigger was a £164 million overspend on private ADHD providers in 2023–24 — far beyond NHS England's projections.

Common restriction tactics include "preferred provider" lists that exclude some approved providers, letters to GP practices discouraging RTC referrals, and in some cases suspending specific providers from ICB-approved lists.

NHS England's official position is that ICBs cannot abolish Right to Choose — it is a constitutional right. However, enforcement is currently the patient's responsibility, not the ICB's.

After Your Assessment: What Happens Next?

Right to Choose covers your initial outpatient assessment. What comes afterwards depends on your ICB contract and provider:

• Diagnosis confirmed: The provider writes to your GP with the diagnosis and a treatment recommendation.
• Titration: The process of finding your correct medication dose. Sometimes included in the NHS contract — ask the provider explicitly before accepting the referral. If not included, titration typically costs £300–£600 privately.
• Shared care agreement: Once titrated and stable, your provider will ask your GP to take over ongoing NHS prescribing. GPs sometimes refuse this — see our Shared Care guide if you hit that obstacle.
• Annual reviews: May be included in the provider's NHS contract or require private payment. Confirm before accepting.
• Ongoing prescribing: If shared care is in place, your GP issues NHS prescriptions. If not, you will need to continue with private prescriptions — typically £50–£150/month depending on medication and pharmacy.

Right to Choose vs Paying Privately: Which Is Right for You?

For most patients, Right to Choose is the better option. But there are situations where going fully private makes sense:

• RTC is better if: you have no money saved for an assessment, your GP is willing to refer, and you can wait 4–12 weeks.
• Paying privately is better if: your GP is refusing and challenging them feels too stressful, you need an assessment faster than RTC providers can offer, or you want a face-to-face assessment with a local consultant.
• Cost comparison: RTC assessment = £0. Private assessment = £375–£1,500 depending on provider and format.
• Speed: RTC typically 4–12 weeks. Private can be 1–4 weeks if you pay upfront.
• Post-diagnosis: The pathway is the same — you still need shared care and a GP regardless of how you were assessed.

Frequently Asked Questions