Guides to the Right to Choose pathway

Every guide below is written for England, where the legal right in regulation 39 of the Standing Rules Regulations 2012 applies. The pathway needs a GP referral, so it is not a self-referral route, and it does not run in Wales, Scotland or Northern Ireland. The guides are grouped by the stage they answer, roughly in the order the questions arrive.

The pathway

What Right to Choose actually gives you

One thing, precisely: a choice of who assesses you, at the moment a referral is being made. Not the referral itself, not a date, and not a provider outside the contract net.

What Right to Choose does not do

Six things this pathway is regularly said to do that it does not. Each one has a source behind it, and each one is a place people lose months.

The law

The regulation behind Right to Choose

Part 8 of the Standing Rules Regulations 2012 contains the whole thing: regulation 38 defines the referral, 39 creates the duty, 40 and 41 remove services and people from it.

Is Right to Choose a legal right?

The NHS calls it a legal right and a regulation imposes a real duty. It is also secondary legislation, conditional on a contract, and it carries no timing promise. All of those are true together.

What a qualifying NHS contract means

Your choice reaches providers that hold a specific kind of contract, defined in four parts by regulation 39(8). That definition is also where the current rationing happens.

Eligibility

Who the Right to Choose duty leaves out

Two lists exclude people from the choice: one in the regulations, one written by each provider. The second one is longer, less visible and the more common reason a referral goes nowhere.

Why being registered with a GP in England matters

The pathway starts at a GP practice in England. Without that registration there is no referrer, and without a referrer the choice in regulation 39 never opens.

Why Right to Choose is an England pathway

The duty is imposed on commissioners in England by an English statutory instrument, and the NHS says its related rights apply only to services commissioned by the NHS in England.

Urgent and crisis care sits outside the choice

Regulation 40(2) removes any service where it is necessary to provide urgent care, and the NHS lists urgent, emergency or crisis treatment among the situations with no legal right to choose.

The referral

How to ask your GP for a Right to Choose referral

Come with impairment, not with the law. The pathway is rarely the sticking point; whether an assessment is clinically appropriate for you is.

What to do if your GP says no

There is no appeal that overrides a clinical decision. There are four things worth doing instead, and they work best in order.

What a Right to Choose referral pack contains

Providers publish a pack for you to take to your GP. It is preparation, not permission, and understanding what it is stops a common and costly misunderstanding.

The provider

Questions to ask a Right to Choose provider

Eight questions, asked before the referral is sent, that separate providers on the things that will still matter in three years.

Provider exclusion criteria explained

The regulations exclude a short list of people. Providers exclude a longer one, written by each provider, published inconsistently, and applied after the referral arrives.

Online and remote ADHD assessments

Some providers assess only online. An ICB tells patients to understand the format before choosing, and NICE describes an assessment that spans the settings of everyday life, a full developmental and psychiatric history, and observer reports and assessment of the person's mental state.

Adult and child pathways are not the same

Different providers, different age cut-offs, different reported waits and, in at least one area, a restriction that applies to adults only.

The wait

How long the NHS ADHD wait is where you live

No source this site could read gives a waiting time for a named area of England. What exists is NHS England Digital's national referral count, a set of reported ranges from the ADHD taskforce, and two local checks that beat any national average.

Does the 18-week standard cover an ADHD assessment?

Usually not. The NHS excludes non-consultant-led mental health services from that right, and many ADHD assessment teams are not consultant-led.

Support while you are waiting

NHS England expects commissioners to support people on the list and to signpost local organisations. Whether that exists near you is a question worth asking out loud.

Can you be prioritised on the waiting list?

Some systems review their lists, and NHS England has warned in the same breath that untested triage is likely to present risks including potential harm to patients.

Diagnosis

Who can diagnose ADHD

NICE reserves it to named professions, on the basis of a full clinical and psychosocial assessment. No questionnaire, screener or website can do it, including anything on this site.

Adults who were assessed or treated as children

NICE describes a specific route for adults previously treated as children who still have symptoms, and it is worth naming in the GP appointment because it is a different starting point.

After diagnosis

Annual reviews and ongoing care

Who reviews you each year is part of what you choose at referral, and it is more fragile than it looks. If a provider stops offering reviews, the fallback is a new assessment and a new waiting list.

Shared care agreements explained

Shared care moves routine prescribing from a specialist to your GP practice once you are stable. It is an arrangement the practice has to accept, which is why it is worth asking about early.

What if your GP declines shared care

One ICB states Right to Choose covers ongoing prescriptions when a practice declines. NHS England's final ADHD Taskforce report says many shared care arrangements are no longer in place, so plan for both answers.

Titration and starting ADHD medication

Titration is the period of adjusting medicine and dose after a diagnosis. It is a separate service with its own wait, and not every provider runs one.

ADHD medication supply problems

Shortages have affected this pathway and providers and commissioners have said so. What is in short supply changes, so the current answer comes from your prescriber and your pharmacy.

Money

What Right to Choose costs you

The assessment is paid for by the NHS. What remains is the prescription charge at the counter, and the cost of the route you take if this pathway is closed to you.

Prescription charges and prepayment certificates

The recurring cost of ADHD medication in England is the per-item charge. The NHS publishes two prepayment options and states the break-even point for each in its own words.

Right to Choose compared with a private assessment

The comparison people make is price against speed. The comparison that matters is what happens to prescribing afterwards, and what the NHS will accept if you come back.

What changed

What Indicative Activity Plans mean for you

Commissioners now agree in advance how much assessment activity they will fund with each provider. Your right to choose that provider is unchanged. The queue behind it is not.

What changed in 2025 and 2026

A taskforce reported, NHS England issued prioritisation advice, and commissioners started capping funded activity. The entitlement did not move; the capacity behind it was rationed.

How to check your ICB's current position

Local rules differ and move, and no national list of them is reliable. Two checks give you the current answer: your integrated care board's own page and your GP practice.

Context

How many people have ADHD

Population prevalence and recorded prevalence are far apart, and the gap between them is the clearest available explanation of why the queue keeps growing.

How many people with ADHD get treatment

A quarter of children and fewer than a sixth of adults with ADHD received pharmacological treatment, with regional rates varying by up to twelve-fold.

What the ADHD Taskforce recommended

NHS England set up an independent taskforce, which reported in two parts: findings in June 2025 and recommendations in November 2025. Here is what each part says to someone waiting.