How to use Right to Choose
Learn about NHS Right to Choose and how you can use it for an ADHD or autism assessment.
Summary
- Right to Choose gives you the option to have your NHS care done by any part of NHS England. If you have a long local NHS wait time, you can go elsewhere.
- Right to Choose is an NHS England patient choice right. It does not apply in Wales, Scotland or Northern Ireland.
- Whether a referral is necessary is a decision made by a medical professional (usually your GP). You then have a choice on where that referral goes. “Your GP writes the referral letter, you can write the envelope.”
- Several NHS areas have chosen to outsource their ADHD assessment services.
- These are private companies providing NHS services to NHS standards. If you opt for medication, you would receive an NHS prescription.
- You can be referred directly to those NHS outsourced providers. Our providers and waiting times page lists them, with the waits they report to us.
- Once you have chosen your provider, you need to follow their directions (usually on their website) on the exact process to take it forward. Usually it means downloading some forms, filling them in, and then giving them to your GP.
- Once your medication is stable you can ask your GP to take over prescribing under a “shared care” agreement. Your GP does not have to agree. If your GP says no, most Right to Choose providers keep prescribing for you, but a small number still require shared care, so check before you choose. Each provider’s shared care position is on our providers and waiting times page.
- Some local NHS areas now restrict Right to Choose. See Right to Choose changes and restrictions for what each area has told us, and check your local area page before you choose.
Step by step
- Check you can use itYou need to be registered with a GP in England and not already under a service for the same condition. The full list of exceptions is below.See the full list of exceptions
- Pick a providerCompare providers on our waiting times page, and check your local area page for any restrictions.Compare providers
- Ask your GP to refer youTell your GP you want to use Right to Choose and which provider. Give them the provider’s forms.
- If your GP says noThis is usually a misunderstanding. Give your GP our letter for GPs.Download the letter for GPs (PDF)
Introduction
For adults and children, there are two main Assessment paths: NHS or Private. However, within the NHS, there are two options for you.
The NHS generally means the default option of your GP sending your referral to join the local service waitlist. However, in England only (Healthcare is devolved; other nations have not chosen this), you have NHS Right to Choose. The right to send your referral somewhere else in NHS England. In summary, Right to Choose is the right to not be caught in your local NHS and instead be seen anywhere in NHS England.
A number of NHS areas outsource their ADHD services. We colloquially call those the “Right to Choose Providers”. You can have your NHS referral sent directly to them. You will receive an NHS service to NHS standards, and, as part of the NHS, if you opt for medication, you will receive an NHS prescription.
Right to Choose within mental health has been available since 2018, but not all patients, GPs or other clinicians are aware of it and how it works. We’ve got an explanation targeted for people going through the ADHD Assessment process below.
For how Right to Choose fits into the diagnosis pathway, see the adult diagnosis pathway. We’ve also got a downloadable support letter for anyone who finds their GP has initially declined them.
You will also find more information on the NHS website: NHS: your choices in the NHS
The Right to Choose rules
You can use Right to Choose when
- the NHS practice is in England (different rules apply for Scotland, Wales and Northern Ireland)
- the General Practitioner has agreed to make a clinically appropriate outpatient referral
Of note: the decision to make a referral is the GP’s responsibility and separate from Right to Choose. Right to Choose is a patient’s right to decide where that referral is to.
The provider must
Patients cannot refer to just any provider. The provider must:
- have a commissioning contract with any Integrated Care Board (ICB) or NHS England for the required service
- have the service and team led by a consultant or a mental healthcare professional
You cannot use Right to Choose if you are
The above is designed to be wide ranging in its application to patient choice. However, there are certain restrictions. Patients cannot use Right to Choose if they are:
- already receiving mental health care following an elective referral for the same condition
- referred to a service that is commissioned by a local authority, for example a drug and alcohol service (unless commissioned under a Section 75 agreement)
- accessing urgent or emergency (crisis) care
- accessing services delivered through a primary care contract
- in high secure psychiatric services
- detained under the Mental Health Act 1983
- detained in a secure setting. This includes people in or on temporary release from prisons, courts, secure children’s homes, certain secure training centres, immigration removal centres or young offender institutions
- serving as a member of the armed forces (family members in England have the same rights as other residents of England)
Common GP questions
For the avoidance of any doubt: it is our clear understanding that an ADHD Assessment falls under Right to Choose.
As a charity we are passionate about helping people with ADHD. Long NHS waiting lists are why we point people to Right to Choose.
If you are being denied your Right to Choose, or denied ADHD care you are entitled to, we want to help. Come to one of our free drop-in advice clinics, where we can talk it through and advise you.
We can't get involved in individual service problems, such as appointment delays or paperwork with a provider. For those, contact the provider or your GP practice first.
Find out your local situation
Right to Choose for ADHD Assessments has been very successful in reducing ADHD wait times and helping people access this needed medical care.
However, NHS England has brought in Indicative Activity Plans which allow local ICBs (your local NHS) to restrict the services you can access. The restrictions are on a provider basis, so one provider might be restricted and another not. We do not believe those to be legally correct or morally correct, and we are campaigning against them.
If your GP initially declines your Right to Choose
The vast majority of GPs understand Right to Choose and appreciate the need for many patients to use it to bypass long NHS waiting lists (we are campaigning against those). Within ADHD UK we’ve heard countless stories of GPs helping their patients with it and are grateful to them for doing so.
In a very small number of cases we know of GPs initially refusing to allow a patient their Right to Choose. In the majority of these cases it has been due to a slight misunderstanding and not appreciating it was a patient right. To help people in that situation we have a downloadable letter for you to give your GP.