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ADHD and Autism Enquires

Right to Choose

What is Right to Choose?
In England, under the NHS, you now have a legal right to choose your mental healthcare provider, including for Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) assessments. This service, offered through the NHS, is free of charge.

Introduction to Right to Choose Referrals
Did you know that NHS patients have the legal right to select their mental healthcare provider? This important right allows you to explore alternative providers if the waiting time for an ADHD or ASD assessment is too long. Right to Choose, introduced in 2018, is still a relatively new system, and many patients may not be aware of these options.

Who Can Offer Right to Choose Assessments?
Several clinics across the UK offer Right to Choose ADHD and/or ASD assessments. To be eligible to provide this service, clinics must also offer the same service to the NHS in England. Private-only clinics are not eligible. Checking a provider’s website is a good way to determine if they offer the services you need.

Which Providers Offer Right to Choose Assessments?
The list of clinics offering Right to Choose assessments is constantly evolving. Currently, several clinics are available, but there may be other providers worth researching as well.

Important Resources

Things to Consider About Right to Choose
It’s important to note that many clinics offering these assessments can diagnose ADHD or ASD but may not provide medication titration. This means you might need a local NHS referral if medication is required to manage symptoms.

When Can You Not Use Right to Choose?
There are certain restrictions on eligibility for Right to Choose referrals. You are not eligible if:

  • You require urgent or emergency treatment.
  • You are already receiving care for the condition you are seeking an assessment for.
  • The provider you choose cannot provide appropriate care for your condition.
  • You are a prisoner or in specific secure settings such as a secure hospital or under the Mental Health Act.
  • You are a serving member of the armed forces.

How to Request a Right to Choose Referral from Your GP
Have an open conversation with your GP about your concerns regarding ADHD or ASD. Your GP may suggest a referral for an official assessment. With waiting times for ADHD and ASD assessments in Manchester over a year, Right to Choose can offer faster alternatives, reducing the long wait for diagnosis and support.

What Happens After Choosing a Clinic?
Once you select a clinic, either you or your family (if the patient is a child) will need to research and decide which provider to choose. Your GP cannot advise on which clinic to select. After making your choice, email or send an admin E-consult with your selection and any relevant forms to ensure an efficient referral process. The NHS standard contract (section 7.9) dictates the use of the e-RS referral system but does not require the use of a form to accompany such a referral. Your GP will make the referral by letter but will not complete forms created by the providers.

How Much Quicker Will Right to Choose Be?
The speed of the assessment depends on your chosen clinic and whether they offer medication titration. Generally, Right to Choose assessments can take anywhere from 12 weeks to 12 months—much quicker than the local NHS alternatives, which have waiting times of up to 7 years. If a clinic offers a diagnosis but not medication titration, you may need an additional referral for post-diagnostic support,which can take up to 24 months locally. Your GP will not initiate specialist medication and will only prescribe once the patient is stable on a dose and if the provider can meet the same standard for shared care as local NHS services.

Why Choose Right to Choose If Medication May Not Be Easily Accessible?
Many patients find that a diagnosis is sufficient for obtaining additional support from schools or employers, or they may not need medication at all for managing their conditions.

Further Questions?
If you have additional questions, a simple call to your surgery may provide answers. For further research, here are some helpful resources:

Information on ADHD

  • AHD UKD: A charity offering free advice and information on ADHD and Right to Choose referrals
  • ADHD Foundation: The UK’s leading neurodiversity charity, offering services for those who live with ADHD, Autism, Dyslexia, DCD, Dyscalculia, OCD, Tourette’s Syndrome and more
  • NHS Website
  • Mind: ADHD and mental health

Information on ASD

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What is a Shared Care Agreement?

A Shared Care Agreement (SCA) is a formal arrangement between an NHS hospital specialist and a GP, allowing care to be safely shared between both services. It is used when a patient starts a specialist medicine or treatment in hospital that may need ongoing prescriptions or monitoring from their GP.

Before your care is transferred to your GP, the specialist must ensure:

  • You are stable on the treatment
  • All monitoring and follow-up arrangements are clearly outlined
  • Your GP has agreed to take over prescribing and monitoring responsibilities

Shared Care is designed to support safe, joined-up care. Your hospital or specialist remains involved, and they are responsible for providing clear advice and support throughout. Shared care agreements are typically developed for specialist drugs or medications that require ongoing monitoring, such as: ADHD medications, specialist arthritis medications, specialist skin medications, and some specialist drugs with known side effects.

Your GP can only take over shared care if they feel it is safe and appropriate to do so — it is not automatic. The hospital or specialist team must continue prescribing until your GP formally agrees to take over. All Shared Care arrangements in the NHS are voluntary — GPs can decline requests if they do not feel it is safe or manageable.

Can my private specialist arrange Shared Care with my NHS GP?

Shared Care Agreements (SCAs) are generally only established between NHS specialists and NHS GPs. These agreements allow a safe, planned transfer of prescribing and monitoring responsibilities when it is clinically appropriate and agreed by all parties.

Shared Care is not normally available for private patients. If you are under the care of a private consultant, they remain fully responsible for:

  • Prescribing your medication
  • Providing any required monitoring or tests
  • Managing your ongoing care

If you are currently receiving prescriptions from a private provider and do not have an agreed shared care arrangement in place with us, you will need to continue obtaining your prescription from your private service provider. Unfortunately, we will not be able to take over these prescriptions.

NHS GPs are not obligated to take over prescribing initiated privately, nor arrange monitoring for medication prescribed privately. This is supported by national guidance from the British Medical Association (BMA), which states that GPs are not expected to enter into shared care arrangements with private providers due to issues of governance, clinical responsibility, and potential health inequalities.

Why not? It’s about safe and equitable NHS care

The NHS Constitution promotes equitable care, meaning access to NHS services should be fair and based on clinical need — not ability to pay. Offering shared care support to private patients risks creating unfair advantages and undermines this principle.

Unless your private provider is delivering a commissioned NHS service (for example via a Right to Choose pathway), they cannot usually enter into shared care with your NHS GP. In such cases, allowing private-initiated treatments to be picked up in the NHS without proper governance could compromise clinical safety, governance, and transparency.

What can I do if I want NHS support?

If you want your NHS GP to take over prescribing:

  1. You will need to be referred to an NHS consultant for review and approval of the treatment.
  2. If the NHS consultant agrees, they may initiate a formal Shared Care Agreement.
  3. Your GP will then consider whether to accept shared care based on safety, capacity, and clinical suitability.