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.

The short version

An Indicative Activity Plan sets an agreed level of activity between a commissioner and a provider.
NHS South West London ICB implemented them for each of its Right to Choose ADHD providers from 1 July 2026.
NHS West and North London ICB says it has not paused assessments and that some providers may have reached their limit for 2026/27 and are operating a waiting list.
The effect is a longer wait behind an accepted referral, not a refusal of the referral.

If you were following this pathway a couple of years ago and came back to it recently, this is the thing that changed. Nothing in the regulation moved. The contracts underneath it did.

What NHS England told systems

The October 2025 advice note to integrated care boards opens by naming the pressure: we are aware that the rising need for ADHD services continues to present a significant challenge, with referral volumes far outstripping capacity.

It then points at the mechanism. The new NHS Standard Contract Activity Management provisions can be used to ensure that each provider delivers the right level of activity, and 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.

What two ICBs did with it

NHS South West London ICB states that from the 1 July 2026 it has implemented Indicative Activity Plans for each of its Right to Choose ADHD providers, to make sure it can help maximise the support available to local people within its resources. It describes the plans as setting an agreed level of activity with each provider, helping it manage demand and expenditure while continuing to offer patient choice within available resources. In the same material it confirms 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 more direct about the consequence. To be clear, it says, it has not paused assessments, there are just very long waitlists for these services. It adds that some providers may have already reached their IAP limit for 2026/27 and are therefore operating a waiting list.

Read together, those two statements describe the same situation from two angles: referrals keep being made and accepted, and the rate at which they convert into appointments is now capped in advance.

What it means when you choose

Two people choosing the same provider from different parts of England are not necessarily joining the same queue, because the plan is agreed between that provider and each commissioner separately. A provider's own national wait figure can therefore be a poor guide to your wait.

The two questions worth asking are whether your integrated care board has an activity plan in place with the provider you want, and whether that provider is currently within its plan for the financial year. Neither answer will be a date. Both are better information than an advertised average.

Questions people ask about this

Does an Indicative Activity Plan mean my referral will be refused?

Not as these ICBs describe it. NHS South West London ICB says GPs will continue to be able to make referrals whenever it is clinically appropriate, and NHS West and North London ICB says it has not paused assessments and that some providers may have reached their limit for 2026/27 and are operating a waiting list. The effect shows up as waiting behind an accepted referral rather than as refusal.

Can commissioners cap Right to Choose activity legally?

The choice in regulation 39 runs through providers holding a qualifying NHS Standard Contract, and NHS England's October 2025 advice points commissioners to the contract's Activity Management provisions to agree an Indicative Activity Plan with each provider. So the capping happens inside the contract the choice depends on, rather than by removing the choice.