Right to Choose is a legal entitlement under the NHS Constitution that allows patients in England to request a referral to any provider that holds an NHS contract for the service they need. For ADHD assessment, it has become one of the most useful routes for patients who would otherwise face NHS waits running into years. This article explains how it works, where it applies, and how to use it.
The legal basis
Right to Choose is set out in the NHS Constitution for England and is supported by NHS England guidance [1, 2]. The core entitlement: where a GP refers a patient for a first outpatient appointment, the patient has the right to choose any clinical commissioning group (now Integrated Care Board, ICB) area provider that:
- Holds an NHS contract for that specific service
- Has the necessary clinical expertise
- Has capacity to accept the referral
This applies to most elective NHS services in England, including specialist ADHD assessment. The patient does not pay; the assessment remains NHS-funded.
Where it applies
Right to Choose currently applies in England. It does not exist in the same form in Scotland, Wales or Northern Ireland. Patients in those nations rely on NHS referral plus private assessment as the main routes.
In England, the entitlement is well established for ADHD. Adult autism access through Right to Choose is more variable: some providers hold contracts for adult autism assessment, but the picture is less consistent than for ADHD. Ask your GP what is available in your area.
For children, Right to Choose can apply to paediatric ADHD assessment in some areas. Local arrangements vary; the GP referral conversation will clarify what is on offer.
What the patient does
The practical sequence is straightforward in most cases:
1. Identify a provider
Find an NHS-contracted provider that offers the service you need. Most providers publish this information clearly on their website. NeuroFX is an NHS-contracted Right to Choose provider for ADHD assessment in England.
2. Ask your GP for a Right to Choose referral
The GP completes the referral form. Some GP practices are familiar with Right to Choose; others need a polite reminder of the patient's entitlement under the NHS Constitution. Most providers offer a referral template the GP can use.
3. Wait for the provider to confirm acceptance
Most providers respond within a few weeks. Once accepted, the assessment is scheduled. Waiting times under Right to Choose are usually considerably shorter than the equivalent NHS service, though they vary by provider.
A more detailed read on the practical mechanics is in How Right to Choose works in practice.
What Right to Choose covers
The Right to Choose referral typically covers:
- The full assessment, to the NICE NG87 (ADHD) or CG142 (autism) standard [3, 4]
- A written report
- Where ADHD is diagnosed and medication is appropriate, an initial period of medication titration
- Shared care handover to the NHS GP once stable, subject to local ICB acceptance
The provider invoices the NHS for the work. The patient pays nothing.
What Right to Choose does not cover
A few things are worth knowing:
- Right to Choose covers the first outpatient appointment and the service that flows from it. It does not generally cover services outside the original referral, such as separate psychological therapy.
- If shared care for medication is declined by the local ICB, ongoing private prescribing may be needed. Right to Choose does not cover private prescriptions.
- Right to Choose does not let you switch providers mid-pathway without further GP involvement.
- Right to Choose does not apply to urgent or emergency care, or to services where local commissioning explicitly excludes it.
Right to Choose versus going private
For patients in England facing long NHS waits, Right to Choose is usually the first option to consider. It is NHS-funded; the assessment is to the same NICE standard; and it preserves access to subsequent NHS shared care where the ICB accepts it.
Patients sometimes choose private assessment instead of Right to Choose when:
- Right to Choose waiting times are still longer than they need or prefer
- They want a specific provider, a specific clinician, or a specific assessment package not available through their Right to Choose provider
- Right to Choose is not available for their specific situation (for example, more limited adult autism access)
- They prefer the flexibility of self-funded prescribing rather than relying on shared care acceptance
For a wider comparison, what private adult ADHD assessment actually looks like is worth reading alongside this article.
Common GP responses
A few responses GPs sometimes give to a Right to Choose request, and what each one usually means:
- "That is not something we do." Right to Choose is a national entitlement, not a local service. The GP can complete the referral whether or not the practice is familiar with the specific provider. A polite reference to the NHS Constitution usually resolves it.
- "Why not wait for the NHS service?" This is often a reasonable clinical question. The honest answer is that waits in many regions run into years. Right to Choose is the patient's entitlement either way.
- "The local ICB will not accept shared care." This may be true, and it is worth knowing in advance. It does not affect Right to Choose for the assessment itself; it affects what happens later if medication is initiated. The provider will usually offer continued prescribing where shared care is declined.
- "We need to do our own ADHD screening first." Some practices do this. The screening is not a barrier to a Right to Choose referral; it is information the GP gathers.
What this means in practice
- If you are in England and the NHS wait in your area is long, Right to Choose is usually the first option to explore.
- Identify a NICE-aligned NHS-contracted provider before your GP appointment, and bring their referral template if available.
- Be ready for the GP to be unfamiliar with the specific provider; that is normal and does not block the referral.
- Check whether your local ICB accepts shared care for ADHD medication. The Right to Choose provider can advise.
- Right to Choose is not available in Scotland, Wales or Northern Ireland. NHS referral and private assessment are the main routes in those nations.
When to speak to a professional
If you are recognising the pattern in yourself or your child, speak to your GP and ask about Right to Choose if you are in England. NeuroFX is an NHS-contracted Right to Choose provider and also offers private adult ADHD assessment from our Bedford clinic where Right to Choose is not the right fit. Seek same-day help via 111 (or 999 in an emergency) for any mental health crisis.
Sources
- NHS England. Your choices in the NHS. https://www.england.nhs.uk/contact-us/yhc/your-choices-in-the-nhs/
- Department of Health and Social Care. The NHS Constitution for England. https://www.gov.uk/government/publications/the-nhs-constitution-for-england
- NICE. Attention deficit hyperactivity disorder: diagnosis and management. NG87. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/ng87
- NICE. Autism spectrum disorder in adults: diagnosis and management. CG142. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/cg142
