NHS Right to Choose for ADHD: What It Is, Who Qualifies, and How to Use It

Your GP can refer you to an NHS-funded ADHD assessment provider of your choosing, rather than whoever happens to be nearest or has the shortest local waiting list. That right exists. It just isn’t always explained clearly, and the landscape around it has changed considerably in the past year.

The NHS Right to Choose scheme gives patients in England a legal right, under the NHS Choice Framework, to choose which provider carries out their first outpatient mental health appointment. For adults and children waiting for an ADHD assessment, this means you can ask your GP to refer you to an NHS-contracted provider rather than joining a local waiting list that, in some areas, runs to several years.

If you have heard about Right to Choose but are unsure how it works, whether you qualify, or what to do when the process hits an obstacle, this guide covers all of it. It also reflects the current position as of early 2026, which is more complicated than the scheme’s original design suggested.

Important: provider availability, ICB restrictions, and waiting times change frequently. The regional examples in this article were accurate as of April 2026 but may have changed. Always verify current status directly with your chosen provider and with your GP before requesting a referral.

What Is the NHS Right to Choose Scheme?

Right to Choose is a patient right under the NHS Choice Framework, introduced for mental health services in 2018. If your GP agrees that a referral is clinically appropriate, you have the right to say where that referral goes.

The scheme is particularly relevant for ADHD because a number of NHS Integrated Care Boards (ICBs) across England have contracted private providers to carry out ADHD assessments on behalf of the NHS. Those providers hold NHS standard contracts and are expected to deliver assessments to NHS standards. Under Right to Choose, you can ask to be referred to one of them directly, bypassing the standard local waiting list.

If ADHD is diagnosed and medication is recommended, the intention under NICE guidance is that prescribing eventually transfers to your GP under a Shared Care Agreement. In practice, how that works, and whether it works smoothly, depends on your GP’s willingness to participate. This is covered in detail later in this guide.

One way to think about the scheme: your GP writes the referral, but you decide which envelope it goes in. The decision to refer at all remains with your GP. Right to Choose is your right to determine the destination, not the decision itself.

The scheme applies in England only. Healthcare is devolved across the UK, which means patients in Scotland, Wales, and Northern Ireland have different routes, set out briefly at the end of this guide.

Who Is Eligible for Right to Choose for ADHD?

To use Right to Choose for an ADHD assessment, two basic conditions must be met. Your GP must agree that a referral is clinically appropriate, and you must not already be receiving ADHD care through another NHS mental health service.

Beyond that, the NHS Choice Framework sets out specific exclusions. You are not eligible if:

• You are currently accessing urgent or emergency (crisis) care
• You are detained under the Mental Health Act 1983 or held in a secure setting, including prisons and immigration removal centres
• You are an active member of the armed forces (family members in England retain the same rights as other residents)
• You are already receiving mental health services through your GP surgery for the same condition

If none of those apply and your GP agrees a referral is warranted, you are eligible to exercise Right to Choose. The provider you select must hold an NHS contract somewhere in England. Not every private clinic qualifies, so it is worth confirming this on a provider’s website or asking your GP before requesting the referral.

One practical point: the referral must go through your GP. You cannot self-refer under the Right to Choose pathway. Some providers offer a private self-referral route as a separate service, but that sits outside NHS funding.

Does Right to Choose Cover Children as Well as Adults?

Yes, though the position for children is more variable than for adults. The Right to Choose framework itself does not set a minimum age; the age threshold is determined by each individual provider and reflects their clinical capacity and NHS contracting arrangements.

Some providers accept children from age five. Others start at seven, fourteen, or sixteen. A small number focus exclusively on adults. Parents should check the age eligibility of any provider before asking a GP to submit the referral.

It is also worth checking what a provider covers beyond diagnosis. For some, ADHD medication titration for children is not included within the Right to Choose pathway, even where diagnosis is. In those cases, a child would receive a diagnostic assessment under Right to Choose and then require a separate referral for medication management, typically through local CAMHS services, though local availability varies. Confirm what is included before you start the process.

One further point: children can hold a concurrent standard NHS referral alongside a Right to Choose referral. Being on the local waiting list and using Right to Choose simultaneously is permitted.

How Do You Use Right to Choose for an ADHD Assessment?

The process is more straightforward than it can sometimes appear. Here is how it typically works.

Step one: speak to your GP

Book an appointment and explain why you think you may have ADHD. Be specific about how ADHD symptoms are affecting your daily life, relationships, and ability to work or study. Many GPs will ask you to complete an ASRS form (Adult ADHD Self-Report Scale) before or during the appointment. This is a brief screening tool, not a diagnostic instrument, but completing it in advance can help move things forward.

Step two: request a Right to Choose referral

If your GP agrees a referral is clinically appropriate, tell them you want to use Right to Choose and name the provider you have chosen. Most NHS-contracted providers publish a referral form on their website that you can download and bring to your appointment. Your GP sends the referral directly to the provider.

It helps to come prepared. If your GP questions whether they need ICB approval before referring, they do not. NHS England guidance is clear that no prior commissioner approval is required for a Right to Choose referral in mental health. ADHD UK produces a downloadable letter explaining this, which can be useful to have if questions arise at the appointment.

Step three: wait for the provider to contact you

Once the referral is received, the provider will typically ask you to complete pre-assessment questionnaires and confirm your position on their waiting list. Most assessments take place via video call, though some providers offer in-person appointments.

Step four: assessment, diagnosis, and next steps

If ADHD is confirmed, the provider will discuss treatment options with you. If medication is recommended, there is usually a titration period to find the right dose. What happens to your prescribing arrangement after titration depends on your GP’s willingness to enter a Shared Care Agreement, which we explain in detail below. For more on what living with an ADHD diagnosis involves day to day, our blog on ADHD and emotional dysregulation may be useful.

What If My GP Refuses to Refer Me Under Right to Choose?

It happens, and it is usually down to unfamiliarity rather than obstruction. Right to Choose has only been available for mental health since 2018, and some GPs still believe they need ICB approval before referring, or are unsure whether the scheme applies to ADHD. On both counts, the NHS guidance is clear that it does and that no approval is needed.

If your GP declines, ask them to state the clinical reason. A GP can legitimately decline to refer if they do not believe an ADHD assessment is clinically warranted in your case. That is an exercise of clinical judgement and within their remit. What is not within their remit is refusing on funding grounds or because they are unfamiliar with the scheme.

Practical steps if you encounter resistance:

• Ask your GP to confirm the clinical reason for refusal in writing
• Bring a support letter explaining the Right to Choose framework – ADHD UK provides a downloadable version at adhduk.co.uk
• Ask to speak with the practice manager, or request a second opinion from another GP at the same surgery
• If you believe the refusal is based on funding concerns rather than clinical judgement, you can contact NHS England’s patient choice team at england.choice@nhs.net

If the situation cannot be resolved, changing GP is an option. Before doing so, confirm that the new practice will both make the referral and accept a Shared Care Agreement for ongoing medication management.

What Is the Current Situation with ICB Restrictions?

This is where the Right to Choose picture has become significantly more complicated, and it is worth understanding before you begin.

From 2024 onwards, multiple Integrated Care Boards began using a mechanism called Indicative Activity Plans (IAPs) to cap the number of Right to Choose assessments that individual providers could carry out within their area. When a provider reached its allocated limit, new referrals in that area were effectively paused, even though patients retained a legal right to choose that provider under the NHS Constitution.

In early 2024, NHS England also proposed a payment scheme change that would have capped provider activity at roughly 25 to 40 patients per ICB area per year. In areas with thousands waiting, that figure was effectively zero. Following sustained public pressure from ADHD advocacy organisations and patients, that clause was withdrawn in October 2025. The withdrawal was confirmed by NHS England and reported across ADHD advocacy channels at the time.

The removal of the clause was a meaningful development. But it did not end regional variation. ICBs continue to operate their own activity plans, and the following restrictions were in place as of April 2026, based on published provider and ICB statements at that time:

• Greater Manchester ICB: adult ADHD Right to Choose referrals paused for some providers until April 2027
• North Central London ICB: referrals paused for some providers pending renewed funding arrangements
• Coventry and Warwickshire ICB: new ADHD referrals under Right to Choose paused for adults aged 25 and over
• South East London ICB: a mandatory adult ADHD triage service introduced from November 2025, which all new referrals must pass through before reaching a Right to Choose provider

These examples are drawn from provider websites and ICB communications published in late 2025 and early 2026. They are illustrative of the kind of variation that exists, not a comprehensive list. The position in any given area can change as new activity plans are agreed between ICBs and providers each financial year.

The practical implication: before your GP submits a referral, check the provider’s website for any current restrictions in your area. ADHD UK maintains a tracker of provider wait times and regional restrictions, updated monthly, and is the most reliable source for current information. The ADHD UK tracker is linked in the references below.

How Long Are Right to Choose ADHD Waiting Times?

Waiting times vary significantly between providers and shift over time, so any specific figure cited here may not reflect the current position. The figures below were drawn from provider websites in early 2026 and are intended to give a sense of the range, not a guarantee of current availability.

For context, standard NHS local ADHD waiting times in some areas have been reported at five to seven years. Right to Choose waiting times have generally been substantially shorter, though they vary considerably by provider and region, and have lengthened in areas affected by ICB restrictions. For the most reliable current figures, ADHD UK publishes wait time data updated monthly for the main NHS-contracted providers, and that is the right place to check before making a decision.

What Is a Shared Care Agreement, and Why Does It Matter?

This is the part of the Right to Choose process that catches most people off guard, and it is worth considering before you start.

NICE guideline NG87 sets out the expectation that once ADHD medication has been initiated and the dose stabilised through titration, ongoing prescribing should transfer to the patient’s GP under a Shared Care Agreement (SCA). This is a formal arrangement between the patient, their GP, and the specialist, under which the GP takes responsibility for repeat prescriptions and routine monitoring while the specialist provides periodic clinical oversight.

GPs are not legally required to sign a Shared Care Agreement. It is described in guidance as a professional courtesy. In 2025, a growing number of GP practices and networks issued guidance advising against taking on new ADHD shared care agreements, citing workload pressures. Some Local Medical Committees formally recommended that their member practices decline new SCAs for ADHD medication. This means that even where a Right to Choose assessment goes smoothly, the downstream medication pathway is not guaranteed.

If a GP refuses shared care, prescribing responsibility remains with the specialist. In practice, this usually means the patient continues to obtain medication directly from the provider, typically at private prescription cost, which can exceed £100 to £200 per month. For many people, that is not sustainable long term.

The most useful thing to do is raise the shared care question with your GP before you choose a provider and before the referral is submitted. Ask directly whether the practice will accept a Shared Care Agreement for ADHD medication if one is recommended following assessment. The answer will help you make a more informed choice about which provider to use and what to expect from the process.

The shared care question is also relevant for anyone who has gone through a fully private assessment. For a comparison of the two routes and what each involves in terms of cost and downstream medication access, see our guide on NHS vs private ADHD assessment.

Is Right to Choose Available in Scotland, Wales, and Northern Ireland?

No. Right to Choose applies in England only, and only to patients registered with a GP in England.

Wales and Northern Ireland each have their own separate processes. In both, patients can request an Individual Funding Request (IFR), a formal application for NHS funding of treatment from a provider not routinely commissioned in their local area. IFRs are generally considered a route of last resort and approval is not automatic.

Scotland does not follow NICE guidelines in the same way as England, and there is no equivalent to the Right to Choose scheme. The Royal College of Psychiatrists in Scotland has published good practice guidance on ADHD assessment, and Scotland operates a Peer Approved Clinical System for some prescribing decisions, but access to assessment remains considerably more restricted than in England.

If you are based outside England and looking for more information about your options, booking a free 15-minute consultation with The Private Therapy Clinic is a good starting point.

Right to Choose vs Paying Privately: What Is the Difference?

Right to Choose is NHS-funded, so the assessment itself carries no cost to the patient. If medication follows and a Shared Care Agreement is in place, ongoing prescriptions are issued on an NHS prescription form at standard NHS prescription charges, currently £9.90 per item in England. Whether a Shared Care Agreement can be arranged depends on your GP, as discussed above.

A fully private assessment means paying for the assessment out of pocket, typically between £700 and £2,000 depending on the provider, the complexity of the case, and whether the assessment covers ADHD only or additional conditions. The benefit is speed and flexibility: no GP referral is required, no ICB restrictions apply, and the process can often begin within weeks. The trade-off is cost, and the shared care question does not disappear, since a privately diagnosed patient who wants NHS prescribing will still need their GP to agree to a Shared Care Agreement.

For a more detailed breakdown of costs, waiting times, and how to think through which route suits your situation, see our separate guide on NHS vs private ADHD assessment.

Frequently Asked Questions

Can my GP refuse a Right to Choose referral on funding grounds?

No. A GP can decline to make a referral if they do not believe an ADHD assessment is clinically appropriate for you. That is a legitimate clinical decision. What they cannot do under NHS guidance is refuse solely because of concerns about cost or ICB funding. If you believe funding concerns are driving the refusal, ask the GP to confirm the clinical reason in writing.

Do I need my local ICB to approve the referral before my GP can refer me?

No. NHS England guidance is explicit that no prior commissioner approval is required for a Right to Choose referral in mental health. GPs sometimes believe otherwise, but this is a common misunderstanding. The provider does not require ICB approval before carrying out your assessment either.

What if my chosen provider is not currently accepting referrals from my area?

Check the provider’s website before your GP appointment. If your preferred provider is paused in your area, you can choose a different eligible provider. ADHD UK’s wait times tracker lists current provider availability by region and is updated monthly.

Does Right to Choose cover medication as well as assessment?

The Right to Choose pathway covers the assessment itself and, where clinically appropriate, the medication titration process. Whether ongoing prescribing after stabilisation transfers to your GP depends on whether they will enter a Shared Care Agreement. That is not guaranteed. Some providers will continue to prescribe directly if shared care is declined, though this typically involves private prescription costs. It is worth clarifying this before you start.

Can I use Right to Choose if I have already been diagnosed privately?

Not for the assessment itself, as that has already taken place. Depending on your circumstances and your provider’s NHS contracts, you may be able to access Right to Choose for ongoing medication management, but this varies and your GP’s willingness to participate in shared care remains a factor. Speak to your GP about your specific situation.

Does Right to Choose apply to autism assessments as well?

Yes. The same NHS Choice Framework applies to autism assessments, and many NHS-contracted providers offer both. For more on the autism assessment pathway, see our autism assessments page.

How The Private Therapy Clinic Can Help

The Private Therapy Clinic is an NHS Right to Choose provider for ADHD assessments, holding NHS standard contracts to carry out assessments for patients registered with a GP in England. Like all Right to Choose providers, we are subject to the same NHS contracting arrangements and ICB activity plans described in this guide. If you are considering whether to use Right to Choose, or want to understand whether a private assessment might be more appropriate for your situation, you are welcome to book a free 15-minute consultation to talk through the options.

If your GP has raised questions about the referral process, our team can help you think through what to say. The right support is available. Sometimes the harder part is working out how to reach it.