NHS Right to Choose for an ADHD assessment

Right to Choose is a duty on NHS commissioners in England to offer you a choice of provider once your GP makes a referral. It is not a right to be referred, it carries no promised waiting time, and integrated care boards now cap how many assessments they will fund with each provider.

The short version

The duty sits in regulation 39 of the Standing Rules Regulations. It requires commissioners to offer you a choice of any clinically appropriate provider holding a qualifying NHS contract.
Whether you are referred at all is your GP's clinical decision, not yours. Regulation 39(6) says a provider counts as clinically appropriate only in the opinion of the person making the referral.
It is not a queue-jump. NHS South West London ICB answers this directly: Right To Choose does not guarantee quicker assessment.
Since 2025 commissioners have been using Indicative Activity Plans to cap how much assessment activity they fund with each provider, so a referral can be accepted and then sit.
The pathway runs on services commissioned by the NHS in England and starts with a GP practice in England. Check whether it is open to you.

Most people meet the phrase Right to Choose in the same order. A GP says the local ADHD service has a waiting list measured in years. Someone in a forum says there is a way to be referred to an independent provider on the NHS instead. The phrase gets passed around as if it were a shortcut, and by the time it reaches you it has usually lost the three conditions that make it work.

So here is the shape of it, before anything else. Right to Choose is a duty on NHS commissioners, not a service you apply to. It gives you a choice of who assesses you at the moment a referral is being made. It does not decide whether that referral happens, it does not come with a date, and it reaches only providers that already hold the right kind of NHS contract.

Where the right actually comes from

The duty is written into regulation 39 of the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012. That instrument is secondary legislation made under the National Health Service Act 2006, which matters for reasons covered further down.

Regulation 39(1) puts the obligation on the commissioner rather than on you: a relevant body must make arrangements to ensure that a person who requires an elective referral, and for whom that body has responsibility, is given the choices specified in paragraph (2).

Paragraph (2) then sets out two limbs. The first covers a first outpatient appointment with a consultant or a member of a consultant's team. The second is the one that usually applies to ADHD, because many assessment teams are led by a senior professional who is not a consultant psychiatrist.

in relation to an elective referral for mental health services in respect of which the patient's first outpatient appointment is not with a consultant or a member of a consultant's team, inclusive of any subsequent treatment required as a result of that elective referral, of— (i) any clinically appropriate health service provider with whom any commissioning body has a qualifying contract, and (ii) any clinically appropriate team led by a named health care professional who is employed or engaged by that health service provider.

Regulation 39(2)(b), the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012

The NHS translates the same thing into plain words on its own pages. In most cases, you have a right to choose which mental health service provider you go to in England, and you have the legal right to choose which service provider and clinical team you are referred to for your first appointment.

NHS England has described patient choice as a regulatory requirement since 2012, in a publication dated 25 May 2023. The NHS Constitution for England frames it as a right too: you have the right to make choices about the services commissioned by NHS bodies and to information to support these choices.

None of those formulations say what a lot of the internet says they say. Read them again and notice that every one of them is about choosing between providers you are being referred to, not about obtaining a referral.

The three conditions that have to hold

Strip the regulation down and there are three gates between you and an assessment under this pathway. Each one is a real place where people get stopped.

A referral has to be in progress. The regulation defines an elective referral as a referral by a general medical practitioner, a general dental practitioner or an optometrist for treatment that is not identified as being immediately required at the time of referral. In practice, for ADHD, that means your GP.
The referral has to be clinically appropriate in the referrer's judgement. Regulation 39(6) is explicit: a provider 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.
The provider you name has to hold a qualifying contract. Regulation 39(8) defines that as an NHS Standard Contract signed and in effect before the date on which the referral is made, which is a commissioning contract for the service required, and which is not put in place solely to provide that service to one named individual.

Gate two is the one people underestimate. NHS South West London ICB writes its step list in the same order, and step two reads: your GP will decide whether a referral for an assessment is appropriate. If that decision goes the other way, the choice in regulation 39 never opens, because there is no referral for it to attach to.

Gate three is the one that has quietly changed. A provider without a qualifying contract is not a choice you can make, however good it is, and the contract is the instrument commissioners have been using to manage spending.

What Indicative Activity Plans changed

In October 2025 NHS England published an advisory note to integrated care boards about ADHD service delivery and prioritisation. It opens by acknowledging that referral volumes are far outstripping capacity, and it then sets out what systems may do about that.

The mechanism it points to is contractual. The new NHS Standard Contract Activity Management provisions can be used to ensure that each provider delivers the right level of activity. Those provisions allow commissioners to agree or set an Indicative Activity Plan with each provider, whether contracted or non-contract activity, and to manage activity by reference to that plan.

Translated: the integrated care board and the provider agree, in advance, roughly how many assessments will be funded in a financial year. Your right to choose that provider is untouched. The rate at which the provider can work through the people who chose it is not.

You can watch this land differently in different places. NHS South West London ICB put Indicative Activity Plans in place for each of its Right to Choose ADHD providers from 1 July 2026, and says in the same breath that GPs across its six boroughs will continue to be able to make referrals whenever it is clinically appropriate to do so. NHS West and North London ICB is blunter: to be clear, we have not paused assessments, there are just very long waitlists for these services, and some providers may have already reached their IAP limit for 2026/27 and are therefore operating a waiting list.

NHS Lancashire and South Cumbria ICB went further for adults. It asked all providers of adult ADHD services, commissioned both locally and nationally, to reduce the number of new adult ADHD assessments they offer from April onwards for patients who have waited less than 52 weeks, while stating that it is committed to ensure that residents can continue to access ADHD assessment pathways in respect of Choice legislation and continue to have a choice of provider.

Local rules differ and they change

There is no national list of what each integrated care board is doing, and any list published on a site like this one would be out of date within weeks. The only current answer for your area is your own ICB's ADHD page and your GP practice. Ask both before you settle on a provider.

It is not a queue-jump, and the NHS says so

The single most common misreading of this pathway is that it is the fast route. NHS South West London ICB answers that question on its own page, under the heading Does choosing a private provider with Right To Choose mean the assessment will happen sooner, and the answer begins with the word No.

No. While waiting times can differ between NHS and private providers, and being able to choose the provider may mean you can choose one to receive an assessment more quickly, Right To Choose does not guarantee quicker assessment.

NHS South West London ICB, page last updated 17 August 2026

That is a careful sentence and it is worth reading twice. It concedes that waits differ between providers, so choosing well can help. It refuses to turn that into a promise. Both halves are true at once, and only one of them tends to survive the retelling.

There is also no waiting-time backstop to fall back on. The NHS says that if you are referred for a physical or mental health condition you have the legal right to start non-urgent consultant-led treatment within maximum waiting times, and the maximum for non-urgent consultant-led treatment is 18 weeks. The same page then removes most ADHD assessments from that right, because it says the right does not include non-consultant-led mental health services. If the team assessing you is not consultant-led, the standard is not a ceiling on your wait, and it is not something you can point to.

Who the right does not cover

Two regulations carve out exceptions, and the NHS repeats them in consumer language. Regulation 40 removes services subject to the cancer diagnosis duty, maternity services, and any service where it is necessary to provide urgent care. Regulation 41 removes categories of person entirely.

When there is no legal right to choose, as the NHS lists it
Situation	Where it comes from
You need urgent, emergency or crisis treatment	Regulation 40(2), and the NHS's own list
You are already having care for the condition and this is an onward referral	NHS list of exceptions
You are a prisoner or on temporary release from prison	Regulation 41(b)
You are detained in other prescribed accommodation, for example a secure training centre or an immigration removal centre	NHS list of exceptions
You are a serving member of the armed forces	Regulation 41(c)
You are being held in hospital under the Mental Health Act 1983	Regulation 41(a)

On top of the legal exceptions sit the provider's own rules, which are not in any regulation and vary from one organisation to the next. NHS South West London ICB is direct about this: although anyone registered with a GP in England is legally entitled to access Right To Choose, each provider will have their own inclusion and exclusion criteria. It gives examples, saying this may mean you are not eligible for an assessment from a particular provider based on certain pre-existing needs, for example having a moderate to severe learning disability or an addiction.

So eligibility is really two questions stacked. Does the legal right reach you, and does the particular provider you want accept someone in your situation. A yes to the first tells you nothing about the second.

What happens step by step

The clearest public description of the sequence comes from NHS South West London ICB, which numbers it one to six.

Speak to your GP about an assessment if you think you or your child may have ADHD or autism.
Your GP will decide whether a referral for an assessment is appropriate.
If they agree, your GP will discuss with you options of provider organisations to undertake the assessment. They will have a list of providers available to make a referral to, which will include private providers paid for by the NHS.
Your GP will help you choose a provider. Before making your choice, it is important you understand how each provider would carry out the assessment, online or remotely or in person, and if they would provide ongoing support or medication should you or your child be diagnosed.
Your GP will send a referral to your chosen provider.
The provider will contact you to arrange an assessment.

NHS West and North London ICB adds the constraint that trips people who try to self-refer: 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. A provider's own online referral form is a way of preparing the paperwork for your GP, not a way around your GP.

Some bookings can go through the NHS e-Referral Service, which you can also reach by phone on 0345 608 8888, open Monday to Friday 8am to 8pm and 8am to 4pm at weekends and on bank holidays.

What you get and what you pay

Under this pathway the NHS pays the provider. NHS West and North London ICB describes it as access to a wider range of provider organisations, NHS and private, paid for by the NHS.

Medication is covered too, and more broadly than people expect. NHS South West London ICB states that the cost of any ADHD prescriptions, from both NHS and private organisations, will be covered by Right to Choose, that this includes first prescriptions to help stabilise medication, and that it also covers ongoing prescriptions if a GP does not agree to take over prescribing through a shared care protocol.

What you still pay is the ordinary English prescription charge at the counter. The National Health Service sets that charge at £9.90 per item, checked on 15 September 2026, and it is charged for each item rather than for each prescription.

NHS prescription charge in England

£9.90

per item, unless you are exempt

NHS, NHS prescription charges. Checked 15 September 2026. The assessment itself is paid for by the NHS under this pathway.

How durable is this right

It is worth being clear-eyed about what kind of right this is, because the reassuring version of the answer is the wrong one.

The duty lives in regulations made under the National Health Service Act 2006. Regulations can be amended by ministers without a new Act of Parliament, and this instrument has already been amended several times, including changes commencing in January 2024 and April 2024. Nothing here is a prediction that it will change. It is a caution against reading it as permanent.

The narrower and more immediate point is the contract condition in regulation 39(8). Your choice reaches providers that hold a qualifying NHS Standard Contract signed and in effect before the date your referral is made. Contracts get renegotiated, and Indicative Activity Plans sit inside them. That is not the right being withdrawn. It is the right continuing while the supply behind it is rationed, which from where you are sitting can feel like the same thing.

The practical consequence is simple. If this pathway is open to you today and you want to use it, the thing that decays is not your entitlement but the position you would have held in a queue.

What this site is and is not

ADHD Choice is an independent information site with no affiliation to the NHS, to any integrated care board or to any assessment provider. It cannot make a referral, move one along or find out where you are on a list. Only a GP can refer you under this pathway.

Everything above traces to a named source. Where a number does not exist, or exists but could not be read at its source, the page says which of the two it was instead of estimating one. The sources for this page are listed below.

Questions people ask about this

Is Right to Choose a legal right or just NHS guidance?

It is a duty in regulations. Regulation 39 of the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 requires NHS commissioners in England to offer a choice of provider when a GP makes a non-urgent referral, and the NHS describes this as a legal right to choose. It is secondary legislation rather than an Act of Parliament, so it can be amended without new primary legislation, and the choice only reaches providers holding a qualifying NHS contract at the time of referral.

Does Right to Choose mean my GP has to refer me?

No. The choice applies once a referral is being made. Whether to refer is your GP's clinical decision: regulation 39(6) treats a provider as clinically appropriate only in the opinion of the person making the referral, and NHS South West London ICB's own step list says the GP will decide whether a referral for an assessment is appropriate. If your GP declines, ask what would change that view, and ask about your practice's complaints process.

Will Right to Choose get me assessed faster?

Not necessarily, and no one will promise you a date. NHS South West London ICB answers this in its own words: Right To Choose does not guarantee quicker assessment. Waits differ between providers, so choosing carefully can make a difference, but integrated care boards now cap funded activity through Indicative Activity Plans, and a provider that accepts your referral may still have a long list.

Does Right to Choose apply everywhere in the country?

It is an England pathway. The duty applies to NHS commissioners in England and it starts with a GP practice in England. The NHS says its waiting-time rights apply only to services commissioned by the NHS in England. This site does not cover the separate health services in Scotland, Wales and Northern Ireland, and makes no claim about how assessments are arranged there.

Can I be excluded from Right to Choose?

Yes, in two different ways. The regulations exclude urgent care, and exclude people detained under the Mental Health Act 1983, people in or on temporary release from prison or other prescribed accommodation, and serving members of the armed forces. Separately, each provider sets its own inclusion and exclusion criteria: NHS South West London ICB gives a moderate to severe learning disability or an addiction as examples of needs that can make a particular provider unsuitable.