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.
The short version
- Regulation 39(6) puts clinical appropriateness in the opinion of the person making the referral.
- Establish whether the answer is a judgement about you or a local commissioning position, because the responses differ.
- Seeing a different GP at the same practice is normal and not improper.
- The practice complaints process is a route to reconsideration, not a route to a referral.
A refused referral is where this pathway most often ends, and it is worth being clear from the start that nothing here is a lever that forces a different answer. The regulation places the judgement with the referrer, and no complaint process converts a clinical opinion into a referral.
That said, a first no is frequently not a final one, and the four steps below are what tends to move it.
1. Find out what the answer was based on
Ask specifically what would change the view. The answers cluster: not enough evidence of impairment outside one setting, something else that a clinician thinks should be addressed first, or an expectation that a local pathway is used instead.
Each of those has a different next step, and you cannot pick one without knowing which you are dealing with.
2. Establish whether it is a policy or a judgement
Ask whether the practice has a position on Right to Choose referrals for ADHD and whether it came from the integrated care board. This matters because commissioner positions are real and vary: NHS Lancashire and South Cumbria ICB asked all providers of adult ADHD services to reduce the number of new adult ADHD assessments offered from April onwards for patients who had waited less than 52 weeks, while saying it remains committed to ensure residents can continue to access ADHD assessment pathways in respect of Choice legislation and continue to have a choice of provider.
If the block is a local position, the conversation to have is with the integrated care board, and the useful question is what the current route into assessment is for someone in your situation.
3. Ask to see a different GP
Clinical opinions differ, and asking to discuss the same question with another clinician in the practice is a routine request. It is not a complaint and does not need to be framed as one. Bringing a different kind of evidence to the second appointment, particularly evidence from another setting, is what makes it worth the wait.
4. Use the complaints process if the handling was unreasonable
Every GP practice has a complaints process and has to tell you how to use it. The thing it can address is process: a request that was not considered, information that was not looked at, or a blanket refusal to discuss a referral at all.
What it cannot do is substitute a different clinical opinion. Going in with the accurate expectation makes it more likely to be useful.
Be careful what a paid route buys
Questions people ask about this
Can I appeal a GP's refusal to refer me for an ADHD assessment?
Not in the sense of a body that can overturn it. Regulation 39(6) treats clinical appropriateness as the opinion of the person making the referral, so the decision is clinical. You can ask what would change the view, ask whether a local commissioning position is behind it, ask to see another GP at the practice, and use the practice complaints process if the request was handled unreasonably.
Can I change GP practice to get a referral?
You can register with a different practice, and some people do. It is worth establishing first whether the refusal was an individual clinical judgement or a local commissioning position, because a position set by an integrated care board is likely to apply to other practices in the same area too.
Where this came from
- Standing Rules Regulations 2012, Part 8 (regulations 38 to 42).
- NHS Lancashire and South Cumbria ICB: adult ADHD position statement.
- NHS South West London ICB: ADHD and autism, Right To Choose.