ADHD Referrals

NHS Right to Choose for ADHD Referrals

Understanding Patient Choice in ADHD Assessments and Treatment

Introduction

The NHS Right to Choose is a policy in England that gives patients increased control over their healthcare decisions, including the ability to choose where they receive their treatment and assessments. This is particularly relevant for individuals seeking an assessment or treatment for Attention Deficit Hyperactivity Disorder (ADHD), as waiting times for referrals can be lengthy in some areas.

What is the NHS Right to Choose?

The NHS Right to Choose is a legal right that allows patients in England to choose which provider they are referred to for certain NHS services, including outpatient mental health services. This applies to most patients who are referred by their GP for a first outpatient appointment. The policy enables patients to select from any provider in England that has a contract with the NHS to provide the required service.

How Does It Apply to ADHD Referrals?

If you or your child need an ADHD assessment and your GP agrees a referral is necessary, you can use the Right to Choose to select any NHS-commissioned provider that offers ADHD assessments, provided they accept referrals under the Right to Choose scheme. This can help bypass lengthy local waiting lists and may enable you to access services sooner.

Commonly, the process involves:

  • Discussing your concerns with your GP.
  • Requesting a referral under the NHS Right to Choose.
  • Choosing a provider that offers ADHD assessments and accepts Right to Choose referrals.
  • Your GP sending the referral to your chosen provider.

How Does a GP Decide if You Are Eligible for an ADHD Referral?

Your GP will generally assess your eligibility for an ADHD referral based on a combination of factors, including:

  • Taking a detailed history of your symptoms and how they impact your daily life, education, or work.
  • Reviewing any relevant background information, such as reports from schools, employers, or family members describing issues with attention, hyperactivity, or impulsivity.
  • Considering whether symptoms began in childhood and have persisted over time.
  • Checking if your symptoms meet criteria for referral according to national clinical guidelines (such as NICE guidelines for ADHD). See summary below.
  • Ruling out other possible causes for your symptoms, such as anxiety, depression, or other medical conditions.
  • Discussing any previous assessments or treatments you may have had for mental health or behavioural concerns.

If, after this evaluation, your GP feels an ADHD assessment is clinically appropriate, they can proceed with the referral using the Right to Choose policy. If not, they may suggest alternative support or interventions.

Eligibility

To be eligible for the NHS Right to Choose for ADHD referrals, you must:

Benefits of Right to Choose

  • Potentially shorter waiting times for ADHD assessment and treatment.
  • Greater control over your healthcare journey.
  • Ability to select providers with expertise that suits your needs.

Limitations and Considerations

  • The Right to Choose applies only to first outpatient appointments—not to specialist inpatient care or emergency services.
  • Some providers may have capacity limits or specific eligibility criteria.
  • This policy currently applies in England; arrangements differ in Scotland, Wales, and Northern Ireland.
  • Your GP needs to send the referral to your chosen provider; self-referral is typically not possible.

It is important to note that while you may choose an alternative provider for ADHD assessment or treatment, GP practices are not obliged to accept shared care arrangements with these providers. Your GP may decide not to take on shared management of medication or follow-up if they feel it is outside their remit or if clinical guidance is lacking.

Conclusion

The NHS Right to Choose empowers patients by allowing them to select their preferred provider for ADHD assessments and treatment, helping many avoid long local waiting lists and access timely support. However, while this can offer greater choice and flexibility, we do not participate in shared care with external providers, so it is vital for you to choose a provider who can prescribe for you long term should you need it.

NICE GUIDELINES

1.3 Diagnosis

1.3.1

ADHD should only be diagnosed by a specialist psychiatrist, paediatrician or other appropriately qualified healthcare professional with training and expertise in diagnosing ADHD, on the basis of:

  • a full clinical and psychosocial assessment of the person; this should include discussion about behaviour and symptoms in the different domains and settings of the person’s everyday life and

  • a full developmental and psychiatric history and

  • observer reports and assessment of the person’s mental state. **[2008]**As an option, use QbTest to help diagnose ADHD in people aged 6 to 17 years as recommended in NICE’s diagnostics guidance on digital technologies for assessing ADHD. [2024]

    1.3.2

A diagnosis of ADHD should not be made solely on the basis of rating scale or observational data. However, rating scales such as the Conners’ rating scales and the Strengths and Difficulties Questionnaire are helpful added tools, and observations (for example, at school) are useful when there is doubt about symptoms. [2008]

1.3.3

For an ADHD diagnosis, symptoms of hyperactivity, impulsivity or inattention should:

  • meet the diagnostic criteria for hyperkinetic disorder in DSM‑5 or ICD‑11 (but exclusion based on a pervasive developmental disorder or an uncertain time of onset is not recommended) and

  • cause at least moderate psychological, social, or educational or occupational impairment based on interview or direct observation in multiple settings and

  • be happening often, occurring in 2 or more important settings including social, familial, educational or occupational settings. [2008, amended 2018]

    1.3.4

As part of the diagnostic process, include an assessment of the person’s needs, coexisting conditions, social, familial and educational or occupational circumstances, and physical health. For children and young people, their parents’ or carers’ mental health should also be assessed. [2008, amended 2018]

1.3.5

Consider ADHD in all age groups, with symptom criteria adjusted for age-appropriate changes in behaviour. [2008]

1.3.6

Take children and young people’s views into account wherever possible when determining the clinical significance of impairment resulting from ADHD symptoms. [2008]

 

Proceeding with your referral…

If you wish to proceed with your ADHD referral, please choose an NHS Right to Choose provider from this list https://adhduk.co.uk/right-to-choose/right-to-choose-wait-times/ and get back in touch with us. Please ensure they do not require a shared care agreement.