Right to Choose ADHD Referral: How to Ask Your GP

If you have been waiting years for an ADHD assessment, or if your GP has been reluctant to refer you at all, you may have more options than you realise. The NHS Right to Choose policy exists specifically for situations like this, and it is one of the most underused patient rights in England.

This article explains what Right to Choose is, how it applies to ADHD referrals, and exactly what to say to your GP to use it.

Why ADHD Waits Are So Long

ADHD diagnosis rates in the UK have risen sharply over the past decade. Awareness has increased, criteria have broadened, and many adults are seeking assessments for the first time having gone unrecognised through school and into working life. NHS adult ADHD services have not grown to match this demand. Waits of three to five years are common. In some areas, the waiting list has been closed entirely.

For children, the picture is similar. CAMHS referrals for ADHD assessments in many areas carry waits that stretch well beyond what is acceptable, with families left managing significant difficulties at school and at home in the meantime.

The result is that many people either pay for a private assessment out of pocket, give up entirely, or spend years on a list that barely moves. None of these outcomes is good. But there is a fourth option.

What Is Right to Choose?

Right to Choose (RTC) is a legal right under the NHS Constitution and regulations made under the Health Act 2012. It gives patients in England the right to choose which approved provider carries out certain NHS treatments and assessments, rather than defaulting to their local NHS provider.

For ADHD, this matters enormously. Several independent providers are registered with NHS England as Right to Choose providers for ADHD assessments. Many of these providers have significantly shorter waits than local NHS services, sometimes weeks rather than years. Crucially, the assessment is funded by the NHS: you do not pay.

Right to Choose for ADHD assessments currently applies most clearly to adults. For children, how RTC applies depends on local commissioning arrangements and ICB policy. It is worth asking your GP and your ICB directly whether it applies in your area. The answer varies, but the question is always worth asking.

Why GPs Sometimes Push Back

This is important to understand, because you may encounter resistance.

Some GPs are not aware that RTC applies to ADHD pathways. Others are aware but believe their local CCG or ICB has opted out, which is sometimes true but not always verified. Some have been given guidance that steers patients toward the local waiting list first. A small number have policy-level objections to private providers operating within the NHS.

None of this means your GP is acting in bad faith. It means the system is inconsistent and that advocating clearly for yourself is necessary.

Knowing your rights and making a specific, informed request changes the dynamic of the conversation. It shifts it from “can I have a referral” to “I would like to exercise a specific legal right.” Those are different conversations with different outcomes.

How to Ask Your GP

The most common mistake people make is asking generally for an ADHD referral without mentioning Right to Choose. This routes you straight onto the local waiting list by default.

Instead, be specific from the start of the conversation:

“I would like to be referred for an ADHD assessment and I would like to exercise my NHS Right to Choose. I have identified [provider name] as an approved RTC provider and I would like to be referred there.”

A few things to have ready before the appointment:

1. A specific provider name. Your GP cannot choose for you; the right belongs to you. Research RTC-eligible ADHD providers in advance. Confirm they are currently accepting RTC referrals before your appointment, as capacity changes.
2. Evidence of your difficulties. Come with specific examples: difficulties with focus, organisation, time management, memory, impulsivity, or emotional regulation. Describe the impact on your work, relationships, or daily life. The more concrete and specific, the stronger the case for referral.
3. Written confirmation. Ask your GP to confirm in writing that the referral has been made and to which provider. If they decline to make the RTC referral, ask them to document the reason. This creates a record you can use if you need to escalate.

What If Your GP Refuses?

If your GP declines to make an RTC referral, you have several options.

First, ask them to explain the reason in writing. This matters because it forces clarity: if the refusal is based on a misunderstanding of RTC policy, the written explanation often reveals that, and you can address it directly.

Second, contact your ICB's Patient Advice and Liaison Service (PALS). PALS can clarify whether RTC applies in your area and can advocate on your behalf if a referral has been unreasonably refused.

Third, consider a formal complaint to the practice. This is a significant step and not always necessary, but it is an option if PALS engagement does not resolve the issue. Practices are required to have a complaints process under NHS regulations.

Fourth, request a second opinion from another GP at the same practice. You are entitled to do this.

Across all of these, a clear, factual written record of what was requested and what was said helps enormously.

While You Wait

Whether you use RTC or end up on a local waiting list, the wait itself is a period where things can still move forward.

For adults, keeping a diary of how ADHD symptoms affect your daily functioning creates useful evidence for the assessment itself. Note specific incidents: missed deadlines, forgotten appointments, difficulties in meetings, problems with relationships. Patterns are more convincing than general descriptions.

For children, the school is a key source of evidence. Ask the SENCO to document concerns in writing. If your child is struggling significantly, ask the school to place them on the SEND register and explore whether a request for an Educational Health and Care Plan (EHCP) assessment is appropriate. An EHCP application does not require an ADHD diagnosis.

SENDIASS (Special Educational Needs and Disability Information, Advice and Support Service) teams offer free, independent support to families navigating this. They are available in every local area and can advise on both the EHCP process and the ADHD pathway.

The Letter Problem

One of the most consistent barriers people face is not knowing what to write and to whom.

Requesting an RTC referral in writing rather than verbally often works better. A letter can be more precise, gives your GP something to act on without needing to remember the details, and creates a record from the start. Similarly, escalating to PALS, writing to a school's SENCO, or requesting an EHCP assessment all require letters that are clear, factual, and reference the right frameworks.

Most people are not trained to write like this, and doing it while exhausted and frustrated is hard. Getting the tone and content right matters: too vague and the letter gets ignored; too aggressive and it creates unnecessary friction.

How refEarly Can Help

refEarly is a free tool built by a GP to help families and adults navigate the neurodevelopmental pathway. It provides ready-to-use letter templates for the situations described in this article: requesting an RTC referral, chasing a wait, escalating to PALS, writing to a school's SENCO, and requesting an EHCP assessment, among others.

Each template is grounded in the actual legal frameworks that apply in England, written to be factual and appropriately assertive without being confrontational. You can personalise the template with your details, refine the language using built-in AI assistance, and download or copy it in seconds.

It will not change the system. But it can make sure you are navigating it as effectively as possible.