Asking your GP for a Right to Choose referral

Only a GP can make this referral, and whether to make it is a clinical decision. Here is what the conversation is actually about, what a provider's referral pack does, and what your options are if the answer is no.

The short version

Only a GP can make a Right to Choose referral. NHS West and North London ICB states that in terms.
Your GP decides whether a referral is appropriate. That is the gate, and it comes before any choice of provider.
A provider's online referral pack prepares paperwork for your GP. It is not a self-referral and it does not bind your GP.
Come with the provider named, and with an answer to what the provider offers after a diagnosis.

The appointment where you ask about this is short, and it usually gets spent in the wrong place. People arrive ready to argue that Right to Choose exists. It does exist, your GP practice almost certainly knows it exists, and that was never the question. The question is whether a referral for an ADHD assessment is clinically appropriate for you, and then which provider.

What the decision turns on

The regulation puts the judgement with the referrer. A provider or team is clinically appropriate if, in the opinion of the person making the referral, they offer services that are clinically appropriate for that person in respect of the condition for which that person is referred.

NHS South West London ICB writes the same thing into its public step list, and the order is the point. Step one is speak to your GP about an assessment. Step two is your GP will decide whether a referral for an assessment is appropriate. Step three, discussing provider options, only happens if they agree.

So the useful preparation is not about the pathway. It is about impairment: what is harder than it should be, in which settings, for how long, and what has already been tried. NICE guideline NG87 anticipates that an assessment covers behaviour and symptoms in the different domains and settings of the person's everyday life, and alongside that a full developmental and psychiatric history and observer reports and assessment of the person's mental state. So evidence across settings, evidence from further back, evidence from people who saw you in those settings, and the clinician's own assessment of how you present on the day are all what an assessing clinician will eventually be working from.

Only a GP can make this referral

NHS West and North London ICB is direct: Right To Choose lets adults or children choose an independent provider through the NHS from anywhere in England, and only a GP can make this type of referral.

This is the sentence that catches people who have filled in a provider's online form and are waiting to hear back. That form generates a referral cover letter and a referral document for you to take to your GP. It is a way of preparing the paperwork, and it carries no obligation on either side.

What to bring

A named provider, and the reason you chose it. Not just its name: what it offers after a diagnosis, whether it prescribes, and whether it assesses people in your situation.
The provider's referral pack if it publishes one, already filled in as far as you can.
A short account of impairment across more than one setting, with dates. School reports, work reviews and old letters carry more weight than a description of a bad week.
Any history of previous assessment or treatment. NICE NG87 says adults previously treated for ADHD as children or young people who present with symptoms suggestive of continuing ADHD should be referred to general adult psychiatric services for assessment, where symptoms are associated with at least moderate or severe impairment.
A question about your integrated care board's current position, since local rules on ADHD referrals have been moving.

If your GP says no

A refusal is a clinical decision and there is no appeal that overrides it. There are still things worth doing, in this order.

Ask what the decision was based on, and what would change it. Sometimes the answer is evidence of impairment in a second setting, or a period of treating something else first. Sometimes it is a local pathway your practice has been asked to use instead.

Ask whether the practice has a policy on Right to Choose referrals for ADHD, and whether that policy came from the integrated care board. If a practice has been asked not to refer, that is a commissioning position rather than a judgement about you, and knowing which it is changes what you do next.

Ask about seeing a different GP in the same practice. Clinical opinions differ and there is nothing improper about a second opinion within a practice.

If you believe the practice has handled the request unreasonably, every GP practice has a complaints process and has to tell you how to use it. That is a route to reconsideration, not a route to a referral.

What this site cannot do

ADHD Choice cannot refer you, contact your GP on your behalf, or find out where you are on a waiting list. It is an independent information site with no NHS affiliation. If a website offers to obtain a referral for you, read very carefully what it is actually selling.

After your GP agrees

Once the referral is going ahead, the choice in regulation 39 is yours, and NHS South West London ICB describes what your GP should do with you. They will have a list of providers available to make a referral to, which will include private providers paid for by the NHS. They will help you choose, and the ICB flags what to understand before you decide: how each provider would carry out the assessment, online or remotely or in person, and whether they would provide ongoing support or medication should you or your child be diagnosed.

Some referrals can be made through the NHS e-Referral Service. If you need to reach it yourself, the line is 0345 608 8888, open Monday to Friday 8am to 8pm, and 8am to 4pm at weekends and on bank holidays.

Questions people ask about this

Can I refer myself under Right to Choose?

No. NHS West and North London ICB states that only a GP can make this type of referral. Provider websites that offer a Right to Choose referral form are preparing paperwork for you to take to your GP, not referring you themselves.

What if my GP refuses a Right to Choose referral?

The referral decision is a clinical judgement and there is no appeal that overrides it. Ask what the decision was based on and what would change it, ask whether the practice is following an integrated care board position rather than making an individual judgement, consider seeing a different GP at the same practice, and use the practice complaints process if you think the request was handled unreasonably.

Does my GP have to refer me to the provider I name?

The choice of provider is yours once a referral is being made, but it is limited to providers the regulation reaches: clinically appropriate ones holding a qualifying NHS contract signed and in effect before the referral date. Your GP will have a list of providers available to refer to, and a provider that is not commissioned for the service you need is not a choice the regulation covers.