NHS Right to Choose for ADHD: The Complete 2026 Guide

What Is the NHS Right to Choose?

The NHS Right to Choose is a legal right enshrined in the NHS Constitution for England. It gives patients the right to choose the provider they are referred to for their first outpatient appointment — including mental health outpatient services such as ADHD assessment.

For ADHD, this means: if your GP agrees you need an ADHD assessment, you can ask to be referred to any CQC-registered provider that holds a relevant NHS Standard Contract, not just your local NHS ADHD service. The NHS pays — there is no upfront cost to you.

Waits at RTC providers are typically 2–12 weeks, compared to 3–7+ years on many NHS waiting lists. This makes RTC the most impactful single change available to most patients.

Am I Eligible for Right to Choose?

You are eligible if all of the following apply:

• You are registered with an NHS GP in England (not Wales, Scotland, or Northern Ireland — different rules apply).
• Your GP agrees you need an ADHD assessment and is willing to make a referral.
• The provider you choose holds an NHS Standard Contract for ADHD assessment in your ICB area.
• You are requesting a first outpatient appointment, not a follow-up or ongoing care.

How to Request a Right to Choose Referral

1. 1

   Make a GP appointment

   Request an appointment specifically to discuss ADHD assessment and a potential referral. Come prepared with evidence of your symptoms and how they affect your daily life. If you have completed a screening questionnaire such as the ASRS, bring a copy.

2. 2

   Research your chosen provider first

   Before your appointment, identify the provider you want to be referred to. Use our finder to check they accept Right to Choose in your ICB area. Note their full name, CQC registration number, and NHS contract type.

3. 3

   State your rights clearly

   Tell your GP: "I would like to exercise my NHS Right to Choose and be referred to [provider name] for an ADHD assessment." Your GP is legally required to facilitate this unless they have a specific clinical reason why this provider is unsuitable for you.

4. 4

   Handle resistance appropriately

   If your GP pushes back, ask them to explain in writing why they cannot fulfil your Right to Choose request. Do not accept a vague "we don't do that" response. Escalate to your ICB's PALS service if the GP refuses without clinical justification.

5. 5

   Follow up with the provider

   Once your referral is sent, contact the provider directly to confirm receipt. Some providers require patients to self-refer alongside the GP referral letter.

Why ICBs Are Restricting Right to Choose in 2026

The NHS Right to Choose for ADHD has faced significant pushback from Integrated Care Boards since 2023. The trigger was a £164 million overspend on private ADHD providers in 2023–24, far exceeding NHS England's projections.

Several ICBs have responded by issuing guidance limiting which RTC providers GPs can refer to, creating "preferred provider" lists, writing directly to GP practices to reduce RTC referrals, and in some cases suspending certain providers from approved lists entirely.

NHS England's position is that Right to Choose cannot be abolished by ICBs — it is a constitutional right. However, enforcement is weak and patients currently bear the burden of challenging restrictions.

What to Do If Your GP Refuses

• Ask for the reason in writing. A verbal refusal is very difficult to challenge.
• Contact your ICB's Patient Advice and Liaison Service (PALS). They can clarify current policy and escalate on your behalf.
• Make a formal complaint. Every NHS practice and ICB has a formal complaints procedure with a mandatory response within 40 working days.
• Contact your MP. Parliamentary pressure on ICB blocking of RTC has produced rapid responses.
• Seek independent advice from ADHD UK, ADHD Action, or ADHD Foundation — all publish template letters for challenging refusals.

Does Right to Choose Cover the Full ADHD Pathway?

The RTC referral typically covers your initial ADHD assessment appointment only. What happens next depends on your provider and ICB:

• Some providers include titration within their NHS contract — ask specifically before accepting the referral.
• Most providers offer titration as an add-on at your own cost (typically £300–£500 privately).
• Ongoing prescribing after titration usually requires a shared care agreement with your GP.
• Annual reviews may be included in the NHS contract, or need to be arranged privately.
• Always confirm exactly what is covered before accepting a referral to avoid unexpected costs.

Frequently Asked Questions