Right to Choose for autism and ADHD assessment: how it actually works

What Right to Choose actually is

A legal right within the NHS, not a private alternative.

The NHS Constitution and the NHS Choice Framework give patients in England the right to choose their provider when referred for outpatient care, including most consultant-led services. For ADHD and autism assessment, this means you can ask your GP to refer you to a provider other than the local NHS team.

The right has been part of NHS arrangements since 2008 (in its current form) and was reinforced in the NHS Constitution. Providers who hold an NHS contract or are listed by NHS England as approved providers count. The assessment is funded by the NHS, paid by your local Integrated Care Board (ICB). (NHS Constitution; NHS Choice Framework. See References.)

You do not pay anything. You do not need to use the provider's private route. The same provider may offer both NHS Right to Choose and private services; the route determines the cost.

Who can use it (and the under-18 question)

The clearest case is for adults (18+). Under-18 access is much more variable.

Adults (18+): Right to Choose for ADHD and autism assessment is well-established. Providers are contracted with NHS England or with ICBs; the assessment is NHS-funded; the wait is generally shorter than the local NHS pathway.

Under-18s: The picture is mixed. Some providers do offer Right to Choose autism and ADHD assessment for older children and young people, but coverage depends on your ICB's local commissioning arrangements. In some ICBs, under-18 RTC for autism/ADHD is fully commissioned; in others, only adults are covered; in a few, RTC is limited or paused due to funding caps. Check your local ICB position before referral.

A 16- or 17-year-old in education is a common case where adult RTC can begin to apply. Once the young person reaches 18 they have full adult rights. For younger children, the standard CAMHS or paediatric pathway is usually the route, with private assessment as the only faster alternative where local RTC is not commissioned.

The main NHS-funded providers in 2026

Two are dominant. Several others provide Right to Choose in specific ICB areas.

• Psychiatry-UK (psychiatry-uk.com). The largest UK Right to Choose provider for ADHD and adult autism assessment. Online assessment via video. Adult ADHD and autism; some under-18 capacity in specific ICBs.
• ProblemShared (problemshared.net). Online NHS-funded assessment for adult ADHD and autism, plus post-diagnostic support and some titration. Subject to ICB funding caps.
• Clinical Partners (clinical-partners.co.uk). Right to Choose available in some ICBs; both adult and (more limited) under-18 pathways.
• RTN Mental Health, Diagnostic Healthcare, and a small number of other providers offer RTC under contracts with specific ICBs. ADHD UK maintains an updated list.

Not all providers cover all ICBs, and not all ICBs cover all providers. Check your local ICB website or call NHS 111 for the current Right to Choose providers in your area. ADHD UK and other patient groups maintain regularly updated lists. (ADHD UK Right to Choose page. See References.)

How to get a Right to Choose referral

A specific GP conversation that activates the legal right.

1. Pick the provider. Check the provider's website that they are accepting Right to Choose referrals from your ICB area. Note their current wait time (publicly displayed by most providers).
2. Book a GP appointment. Specifically mention Right to Choose; the GP receptionist may initially say it's not available. The GP themselves should know.
3. At the appointment, explain why you want an assessment. Use the words: “Under the NHS Constitution, I would like to exercise my Right to Choose and be referred to [provider] for an [autism / ADHD] assessment.”
4. GP writes the referral letter. Most providers have a template referral letter on their website that the GP can use directly.
5. Provider accepts. You receive a confirmation and (in due course) an assessment appointment.

If the GP refuses (rare but happens), the route is: ask for the refusal in writing with reasons, escalate to the practice manager, then to the ICB, then to NHS England's complaints route. Citing the NHS Choice Framework usually unlocks the process.

The 2026 reality: funding caps and waits

The legal right exists. The practical access has tightened in 2025-26.

From 2024 onwards, several ICBs have imposed funding caps on Right to Choose providers, in the face of unsustainable demand growth. As of 2025-26:

• Waiting times for Psychiatry-UK and ProblemShared have extended significantly, in some cases to 12-18 months for initial assessment. Still typically faster than local NHS pathways but no longer the 4-6 month wait of 2022.
• Some ICBs have temporarily paused new RTC referrals to specific providers when funding caps are reached.
• Post-diagnosis services (especially ADHD medication titration) have similar pressures; titration via RTC can run alongside assessment but adds time.
• ICB-imposed funding caps are contested. NHS England has issued reminders that the legal right cannot be unilaterally removed by ICBs, though it can be managed.

What the assessment actually looks like

The assessment is NHS-grade and follows NICE standards. The format is online.

A typical Right to Choose assessment includes:

• Pre-assessment questionnaires. AQ-10 (autism), DIVA-5 or similar for ADHD, mood and anxiety screens.
• An informant questionnaire for a parent or partner who knew you in childhood (relevant for adult assessment of childhood-onset conditions).
• A diagnostic interview with a consultant psychiatrist, clinical psychologist or specialist practitioner, via secure video call. Typically 90 minutes to 2 hours.
• A written report. Sent within 4-8 weeks of the interview, with the diagnostic conclusion and recommendations.
• Post-diagnostic support. Varies by provider. May include medication titration (for ADHD), psychoeducation, signposting.

The diagnostic standard is the same as for face-to-face NHS assessment: NICE NG87 for ADHD, CG142 (adults) or CG170 (under 19s) for autism.

After diagnosis: treatment, support, school

A diagnosis through Right to Choose is a full NHS diagnosis. It opens the same doors as any other route.

• ADHD medication. Titration can continue with the RTC provider (more common for adults) or transfer to your local NHS team via a shared care agreement with the GP.
• School / college support. The diagnostic report is admissible evidence for SEN Support, EHC needs assessment, university Disabled Students' Allowance, and workplace Access to Work.
• Reasonable adjustments at work or college. Under the Equality Act 2010, the report supports the disability declaration and triggers the duty.
• Local NHS specialist services. A diagnosis via RTC entitles you to subsequent local NHS care on the same basis as any other NHS diagnosis.

Common GP pushbacks and the answers

Five common GP responses, with the answer.

• “We don't do Right to Choose here.” The right is a national NHS right, not a local opt-in. Ask the GP to check the NHS Choice Framework and the ICB's Right to Choose page.
• “That provider is private.” Most large providers offer both private and NHS RTC routes. Ask the GP to refer specifically via the NHS Right to Choose pathway.
• “You need to try the local service first.” Not legally required. You can choose the provider at point of referral.
• “Your symptoms aren't severe enough for assessment.” The threshold for referral is “may have” not “definitely has.” NICE specifically warns against gatekeeping autism and ADHD assessments.
• “We can't do shared-care prescribing.” Some GPs decline shared-care for ADHD medication, citing local prescribing agreements. This is becoming more contested; some shared-care agreements have been challenged successfully. Take advice from ADHD UK if this affects you.

What to do this week

Three things.

1. Pick a provider. Check Psychiatry-UK and ProblemShared for current waits and ICB coverage. ADHD UK and similar charities maintain regularly-updated lists.
2. Book the GP appointment. Use the script: “Under the NHS Constitution, I would like to exercise my Right to Choose and be referred to [provider] for an autism / ADHD assessment.”
3. Print the provider's referral template and take it to the appointment. Most providers publish a standard letter the GP can use directly.