Right to Choose for ADHD and Autism Assessments (England)

In many cases you have the legal right to choose where you have your NHS treatment. If a GP needs to refer you for a physical or mental health condition, in most cases you have the legal right to choose the hospital or service you would like to go to. That includes many private providers, if they provide services to the NHS and it does not cost the NHS any more than a referral to a standard NHS hospital.

For ADHD, the NHS says you can ask for an NHS appointment at any clinic, including a private clinic, if it provides ADHD services for the NHS in England. Waits for assessments vary and can be several months or years, and the NHS suggests you may be able to find a clinic with a shorter waiting list through your GP using Right to Choose.

The legal basis is regulation 39 of the NHS Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012. It requires the NHS body responsible for you to make sure that if you need an elective referral for mental health services, you are offered a choice of any clinically appropriate provider with an NHS qualifying contract, and any clinically appropriate team led by a named health care professional at that provider.

The assessment is with an ADHD specialist, such as a psychiatrist for an adult or a paediatrician or child and adolescent psychiatrist for a child. If you need help choosing because you have a disability, a mental health condition or another impairment, tell the healthcare professional who referred you so they can consider your additional needs.

The same right applies to autism. The NHS says that in England you can choose which NHS service does the assessment, and you may be able to find a clinic with shorter waiting times. GPs can often refer children and adults to a local autism team. For children, the child's school may need to make the referral, or a health visitor if the child is not school age.

If you are finding it hard to get a referral, you could ask to speak to someone else, such as another GP. This is called getting a second opinion. If your referral is accepted it can take a few months or longer to get an assessment, and a GP or education professional can tell you what support is available while you wait.

The choice applies only at the point of referral, from your GP, dentist or optometrist, and only to providers that have an NHS contract to provide the service you need. Your referrer decides whether a provider is clinically appropriate for you, in their opinion. For mental health, the service must be led by a consultant or mental health professional.

You do not have a legal right to choose where your outpatient appointment takes place if you are:

• ✗No: already receiving care and treatment for the condition you are being referred for, and this is an onward referral
• ✗No: using urgent, emergency or crisis services
• ✗No: a prisoner, or detained in other prescribed accommodation such as a secure children's home or an immigration removal centre
• ✗No: held in a hospital setting under the Mental Health Act 1983
• ✗No: a serving member of the armed forces

The full list is in the NHS Choice Framework on GOV.UK, which also says the guidance applies to people of all ages in England.

You should always be offered a choice at the point of referral and a chance to discuss the options. If you feel you have not been, take these steps in order:

The maximum waiting time standard to begin treatment or assessment is usually 18 weeks. You can ask to be referred to a different provider if you have to wait, or have already waited, more than 18 weeks before starting treatment or assessment for a physical or mental health condition, as long as your referral is not urgent and the service you need is led by a consultant. It may not always be possible to change provider, for example if you need specialist care.

Waiting times start from the day your referral is made through the NHS e-Referral Service, or when the provider you chose receives your referral letter. For ADHD the NHS warns that waits for specialist services can be several months or years, so compare providers before you book.

A diagnosis from a Right to Choose provider does not mean your GP will automatically prescribe ADHD medicine. The NHS says a GP may be able to take over prescribing ADHD medicines, but only if there is a "shared care agreement" between the GP and the ADHD specialist. Before you choose a provider, ask the specialist or your GP what happens to prescribing after the assessment.

A diagnosis can matter beyond health care, but it does not decide a PIP claim on its own: PIP depends on a long-term condition and the difficulty it causes with everyday tasks or getting around. See our guides on PIP for ADHD, PIP for autism and whether ADHD or autism counts as a disability.

A government-commissioned independent review into mental health conditions, ADHD and autism published an interim report. It says it does not yet have a sufficiently clear understanding of the contribution made by private assessments and Right to Choose pathways, and that it will be important to examine variation in assessment conversion rates and provider-level practice, especially in autism pathways involving independent and Right to Choose services. This guide will be updated if the rules change.

Right to Choose as described here is an England arrangement. The NHS Choice Framework applies to people in England, and the NHS describes Right to Choose for ADHD and autism as a choice of NHS services in England. If you live in Wales, Scotland or Northern Ireland, ask your GP how referrals for ADHD and autism assessments work where you live, because these rules do not apply there.