What Is NHS Right to Choose? A GP's Guide to Referring for ADHD/Autism Assessments

If you're a GP in England, you've likely had a parent sit across from you, exhausted, asking why their child has been waiting over a year for an autism or ADHD assessment, and asking whether there's anything you can do.

There often is. It's called NHS Right to Choose, and it's one of the most underused tools available to primary care for shortening neurodevelopmental assessment waits. This guide walks through what it is, who's eligible, and exactly how to refer, so you can act on it in the same appointment, not after a follow-up search later.

What Is NHS Right to Choose?

NHS Right to Choose is a legal entitlement, set out in the NHS Constitution, that allows patients in England to choose to be referred to a different NHS-funded provider than their local default service, provided that provider offers the same or a comparable service and is a qualified NHS provider under the NHS Standard Contract.

For neurodevelopmental pathways specifically, this means that instead of referring a child into an Integrated Care Board's (ICB) standard autism or ADHD assessment service, where waits frequently exceed 12–24 months in many parts of England, a GP can refer directly to an alternative NHS-commissioned provider, at no cost to the family, often with significantly shorter waiting times.

It's important to be precise with parents about what this is not: it isn't private healthcare, and it isn't queue-jumping. The provider is delivering an NHS-funded service under the same NHS Standard Contract framework, just with more capacity than the local pathway.

Who Is Eligible?

Right to Choose applies broadly to NHS-funded, non-emergency, consultant-led (or equivalent specialist-led) services in England. For children and young people's ADHD and autism assessments, eligibility generally requires:

• The patient is registered with a GP practice in England
• The referral is for a first appointment with a service, not an ongoing treatment already in progress elsewhere
• The chosen provider holds an NHS contract to deliver that specific assessment type

Right to Choose does not apply in Wales, Scotland, or Northern Ireland, a distinction worth confirming with families who've moved from other parts of the UK or who ask why a provider "isn't taking new NHS patients" in their area.

You can check our autism referral criteria here, our ADHD referral criteria here, and our combined assessment criteria here.

Why GPs Are Central to This Pathway

Right to Choose referrals cannot be self-initiated by families. A GP referral is required, and for combined ADHD and autism concerns, most providers, including Paloma Health, require a separate referral for each condition, since they are assessed as distinct clinical pathways with different assessment tools and clinician teams.

This puts GPs in a genuinely pivotal role: many parents don't know Right to Choose exists until they ask, and many won't ask unless prompted. A five-minute conversation and a correctly written referral letter can be the difference between an 18-month wait and an 8–16 week one.

How to Refer: A Step-by-Step Guide

1. Confirm the concern warrants a specialist referral. Take a brief history covering developmental milestones, school/nursery feedback, and functional impact across settings (home, school, social). You don't need to complete a full diagnostic workup, that's the assessment provider's job, but a clear description of presenting concerns strengthens the referral.
2. Discuss options with the family. Explain that they can choose their local ICB-commissioned service or exercise their Right to Choose to refer to an alternative NHS provider. Be transparent that wait times and service models (remote vs. in-person) vary between providers.
3. Write the referral letter. Include:
   • Patient demographics and NHS number
   • Presenting concerns and duration
   • Relevant developmental, educational, and family history
   • Any existing reports (school observations, health visitor notes, previous assessments)
   • A clear statement that the referral is being made under NHS Right to Choose to the named provider
4. Send the referral directly to the chosen provider, following their specified referral route (many accept referrals via NHS e-Referral Service (e-RS), secure email, or a dedicated referral portal).
5. Signpost the family on what happens next, approximate timelines, what the assessment process involves, and that they'll receive a written outcome report shared back with your practice.

What to Tell Parents About the Process

Setting expectations well reduces follow-up queries to your practice. It's worth being clear that:

• Assessments typically involve parent/carer questionnaires, an interview, and structured observation of the child
• A written outcome report is produced regardless of whether a diagnosis is given, along with practical recommendations
• The report is shared with the referring GP practice to ensure continuity of care
• If ADHD medication is subsequently needed, ask whether the provider offers ongoing prescribing or whether this will return to a shared care arrangement with your practice

Common GP Questions About Right to Choose

Does this cost my practice or the ICB anything? No, the assessment is NHS-funded through the same commissioning mechanisms as the standard pathway. Right to Choose providers are paid via the NHS Standard Contract, not by the referring practice.

Can I be blocked from referring by my ICB? ICBs cannot unlawfully deny a patient's Right to Choose where the provider meets the qualifying criteria, though in practice some practices report friction or a lack of familiarity with the process. If you encounter resistance, providers experienced with Right to Choose (including Paloma Health) can usually support the practice with the relevant NHS guidance to resolve this.

What if the assessment doesn't lead to a diagnosis? Families still receive a full outcome report with recommendations and signposting to other appropriate support — this is not solely a pass/fail diagnostic gate.

Is there an age limit? This varies by provider and condition. As an example, Paloma Health currently assesses autism from age 2 up to 18, and ADHD from age 8 up to 18 — always confirm current age ranges directly with the provider before referring, as these can change.

Why This Matters for Your Patients and Your Practice

Long neurodevelopmental waiting lists don't just delay diagnosis, they delay access to school-based support (such as an EHCP application), appropriate parenting strategies, and, in some cases, timely medication for children who are struggling significantly. GPs who proactively raise Right to Choose are often solving two problems at once: reducing a family's distress and reducing repeat consultations driven by a lack of progress on a stalled referral.

How Paloma Health Supports GPs Through This Process

Paloma Health is an NHS Right to Choose provider offering autism assessments (ages 2–18) and ADHD assessments and treatment (ages 8–18) for children and young people in England, with hybrid and fully remote options. Assessments follow NICE and NHS guidelines, are led by a multidisciplinary clinical team, and typically offer first appointments within 6–16 weeks of referral.

We're happy to support GP practices directly with any questions about the referral process, required documentation, or general queries from your patients.

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