NHS Right to Choose for ADHD and Autism Assessment: A Parent’s Guide

Nobody tells you about Right to Choose. You are told the waiting list is three years, you are handed a leaflet, and you are left to either wait or find two thousand pounds. Most parents never learn there is a third option that is free, legal, and has been sitting in the regulations since 2014.

This guide explains exactly what it is, whether it applies to your child, how to ask, and the five things that go wrong. I have checked every legal point against the regulations and every waiting time against the published NHS figures, because this is the sort of decision where a confident guess is worse than nothing.

First, the scale of the problem

You are not imagining the wait. The published NHS figures for March 2026:

• 270,701 people had an open referral for suspected autism. Of those, 163,484 were children, and 89.7% of all referrals had been open at least 13 weeks.
• For children specifically, the median wait to a first appointment was 470 days. More than eight in ten children waiting over 13 weeks had no recorded contact at all.
• For ADHD, there were up to 803,658 open referrals, including 182,745 children aged 5 to 17. Of those children, 69,500 had been waiting two years or more.
• New ADHD referrals were up 29.5% in a year.

Sources: NHS England autism statistics and ADHD management information. For context, NICE guidance says an autism assessment should begin within three months of referral.

What Right to Choose actually is

When your GP refers your child for a first appointment, you have a legal right to choose which NHS-funded provider does it. It is not a favour, a local scheme or a loophole. It comes from regulation 39 of the Standing Rules Regulations 2012, which says the NHS “must make arrangements to ensure that a person who requires an elective referral is given the choices specified”.

You may choose any clinically appropriate provider that holds an NHS contract, anywhere in England. That includes independent providers who do NHS-funded work, which is why the waits are often shorter. Your child stays an NHS patient throughout and you pay nothing.

The right was extended to mental health services in 2014 to bring them in line with physical health. NHS England’s own guidance confirms that remotely delivered assessments, and it names autism and ADHD specifically, can fall under it.

Does it apply to children? Yes, but read this part properly

There is no age limit anywhere in the regulations, and the NHS Choice Framework states plainly that it applies to people of all ages in England. Several NHS bodies publish parent-facing guidance saying so: NHS Cornwall and Isles of Scilly, for example, tells families they have “a legal right to choose which NHS-funded service carries out a child or young person’s Autism or ADHD assessment”.

Where it gets fiddly is not the law but the plumbing:

• The service usually needs to be consultant-led, or led by a named mental health professional. Some local children’s neurodevelopmental teams are neither, which changes how the right applies. A few ICBs say so openly.
• The provider must hold an NHS contract and must accept your child’s age. This is where most families actually fall out, and it catches people by surprise. Psychiatry-UK, one of the biggest providers, states it cannot do ADHD assessments for under-18s under Right to Choose. Healios covers autism for ages 7 to 16. Clinical Partners takes children from 5. Always check the age range before you pin your hopes on a provider.

How to actually use it

1. Choose your provider first. Check they hold an NHS contract, cover your child’s age, and are accepting referrals right now. Most publish their current waiting time.
2. Get their referral form. Nearly all of them have one on their website. There is no national NHS form.
3. Ask your GP to refer. This is the bit that cannot be skipped: the legal right only applies to a referral from a GP, dentist or optometrist. A referral from school, a SENCo or a paediatrician does not trigger it. Hand the GP the completed provider form.
4. Your GP does not need permission from anyone. No funding approval, no panel, no individual funding request. NHS England is explicit that prior commissioner approval is not required where a patient exercises the legal right, even if the local NHS has no existing contract with that provider.

If the GP says no. A GP can decline only on clinical grounds, because the law leaves “clinically appropriate” to the referrer’s judgement. What a GP cannot do is refuse because of cost, or because the ICB has not approved the provider. If you are refused for the wrong reason, raise it with the practice first, then your ICB, then NHS England at england.choice@nhs.net. GPs are also expected to offer around five options where that is practical.

The myth that stops families using it

Parents are regularly told they are ineligible because their child “has already been assessed” or has seen someone before. That is worth unpicking, because the law and the provider’s own rules are two different things.

The legal exclusion is narrower than people think. NHS England’s guidance says the right does not apply to someone already receiving care and treatment for the condition they are being referred for, and then adds, in the same breath, that it does apply for new episodes of care regardless of whether a patient has been seen for that condition previously.

So a past appointment does not automatically bar you in law. An individual provider may still decline you under its own criteria, which it is entitled to do, but that is a provider decision, not a legal one. Knowing the difference is worth a polite second conversation.

The genuine legal exclusions are narrow: children detained under the Mental Health Act, those in prison or secure accommodation, members of the armed forces, urgent or emergency care, and maternity.

Five catches nobody warns you about

This is the part I would want a friend to tell me, so here it is straight.

• You cannot sit on two waiting lists for the same assessment. If you go down the Right to Choose route, your local referral for that same need is usually closed. If the local list is genuinely near the top, switching can cost you. You can generally use Right to Choose for one condition and stay local for another.
• Many of these providers diagnose but will not prescribe. A fast diagnosis can land you at the back of a different queue for medication. Ask before you refer: “if my child is diagnosed, who prescribes and who titrates?”
• Your GP may refuse shared care afterwards. GPs are not obliged to take on prescribing. They can decline if the medication is not stable, monitoring is not arranged, or they do not feel able to prescribe safely. This is the single most common trap, and it is worth asking your surgery its policy before you choose a provider.
• Some areas are now rationing it. Several ICBs began capping how much Right to Choose activity they fund during 2025 and 2026, while others remain completely open. It is postcode-dependent, not a national shutdown. There is a named list further down this page.
• It is not always faster. Waits under Right to Choose range from around 12 weeks to over a year depending on provider and area. Treat it as a genuine alternative, not a guaranteed shortcut.

Is your area quietly rationing it? Check before you refer

This is the part that has changed most, and the part almost nothing online tells you honestly. Right to Choose is still your legal right everywhere in England. But through 2025 and 2026 a number of Integrated Care Boards started limiting how much of it they will pay for, using a contract mechanism rather than by refusing anyone outright.

Here is how the squeeze works, because once you see it you can ask the right question. A Right to Choose referral is paid for as what the NHS calls non-contract activity, because the provider you pick holds its contract with a different area, not yours. NHS England’s own advice to systems in October 2025 pointed commissioners at activity management plans that can be applied to exactly that kind of activity. The same rulebook also says a plan “must not in any way restrict patient choice of provider”. Both things are written down. In practice, one document said do not restrict choice and another handed over the tool that limits it.

The practical effect was put plainly in a Bristol area freedom of information response: when a provider hits its limit it will still accept your referral, it just cannot assess you until the next financial year. That is the bit that catches families out. The referral is accepted, so nothing looks wrong, and the wait quietly becomes a year.

Areas with published restrictions, from the ICBs’ own pages and FOI responses:

Checked 26 July 2026 against ICB publications and freedom of information responses. This changes constantly, so treat it as a prompt to ask, not a final answer.

It is genuinely not everywhere. Nottingham and Nottinghamshire stated in March 2026 that it has no activity caps, funding limits or restrictions on Right to Choose providers at all. North Central London publicly denied pausing. Coventry and Warwickshire did restrict new ADHD referrals to under-25s in May 2025, and then reversed it, with the new policy implemented on 14 May 2026. So do not let anyone tell you the door is shut nationally. It is not.

You will also see a widely shared list claiming 42 ICBs are restricting Right to Choose. I checked several of the areas it names against those ICBs’ own published material and could not find the restriction it alleges. Be careful with it.

What to actually do: search your ICB’s name plus “right to choose” and read their own page, and ask the provider directly, “are you currently able to assess new referrals from my ICB this financial year, or only accept them?” That one sentence gets you a straighter answer than anything else.

How to tell a good provider from a bad one

Choosing the provider is the whole point of Right to Choose, and it is the part parents get the least help with. Two things are worth knowing before you pick.

First, the regulation gap. Most people assume any NHS-funded provider has been inspected. For assessment-only services, that is not necessarily true. The Care Quality Commission’s own registration guidance, updated in March 2026, says it does not treat diagnosis of ADHD or autism as treatment, and that a provider offering only diagnosis, with no treatment, does not need to register for that activity. The Department of Health and Social Care confirmed the same thing in a written answer to Parliament in April 2025: independent providers offering only diagnosis “are not within scope of CQC registration, as the regulations currently stand”. The independent ADHD Taskforce recommended in November 2025 that this be fixed, saying the CQC “should have oversight of all ADHD service providers”. As of today it has not been.

To be fair to the system, NHS England’s patient choice guidance does require a qualifying Right to Choose provider to be CQC registered, hold a provider licence and be able to meet the NHS Standard Contract. So the gap matters most if you are paying privately rather than going through Right to Choose. It is still worth two minutes of checking either way.

Second, quality really does vary, and this is documented. A BBC Panorama investigation broadcast on 15 May 2023 sent a reporter, who an NHS consultant had assessed as not having ADHD, to three private clinics. All three diagnosed him. One accepted afterwards that he should not have been able to obtain a prescription and said it had updated its processes; another said its prescription policy had regrettably not been followed; the third stood by its diagnosis. The Royal College of Psychiatrists responded that week, and the consultant involved said something that should be pinned to every article on this subject:

“I see many people in my clinics who’ve received a diagnosis from a private provider that we cannot accept due to concerns about quality. This is heartbreaking as I must tell them we cannot accept their diagnosis and they must be reassessed. This must change.”

It has started to change, and this is the single most useful new fact in this whole guide. From 1 April 2026, NHS England’s payment guidance for ADHD and autism assessment services says that reports from independent providers, specifically including those provided under Right to Choose, should be accepted by NHS-commissioned titration services unless there is a clear clinical reason not to, in order to avoid unnecessary reassessments. Read the scope carefully, because it matters: it binds NHS-commissioned titration services, not your GP, and the word is “should”, not “must”. But if you are told your child must be assessed all over again, that document is the thing to quote.

And the system does act on bad providers. In December 2025 one Right to Choose provider was issued with a suspension notice over concerns about service management, safety oversight and continuity of care, and ICBs moved affected patients to other providers. Keep that separate in your head from the budget caps above: a suspension is about safety, a cap is about money. They get reported as if they are the same thing and they are not.

So, before you name a provider on that referral:

• Look them up on the CQC website by name. If nothing comes up, that is not automatically damning given the gap above, but it is worth asking them why.
• Ask who carries out the assessment and what their profession and ADHD or autism training is. NICE requires a specialist psychiatrist, paediatrician or other appropriately qualified professional with training and expertise in diagnosing it.
• Ask whether they follow NICE guideline NG87, and whether the assessment includes observer reports, for example from you and from anyone who teaches your child.
• Ask how long the assessment appointment itself is. A diagnosis reached in under an hour, with no informant information, is the exact pattern Panorama found.
• Ask what happens next: who prescribes, who titrates, and what they do if your GP declines shared care.

What it costs privately, and the number to judge it against

If you are weighing paying privately, here is a useful yardstick that almost nobody knows about. For 2026/27 the NHS published national guide prices for these assessments: £950 for a child ADHD assessment, £1,350 for autism, and £1,500 combined. That is what the NHS itself reckons the work is worth.

Published private self-pay prices for children, checked 26 July 2026:

Prices verified from providers’ own pages on 26 July 2026 and change regularly. Always confirm before booking.

Watch the ongoing costs, not just the headline. The assessment is the cheap part. Titration and reviews add up: monthly titration fees, follow-up appointments from around £180 to £310, repeat prescription admin charges of £40 to £75 a month where a GP will not take over, and annual renewals of several hundred pounds. Ask any private provider for the whole first-year cost in writing, not the assessment price.

You do not need a diagnosis to get support at school

This is the most expensive misunderstanding in the whole system, and it is worth stating plainly: an EHCP does not require a diagnosis. Families spend thousands chasing one because they believe it is the gateway. It is not.

The Children and Families Act 2014 defines special educational needs as a learning difficulty or disability calling for special educational provision. No diagnosis appears anywhere in it. The duty to assess is triggered where a child “has or may have” special educational needs. The SEND Code of Practice puts it best: the purpose of identification is to work out what action is needed, “not to fit a pupil into a category”. The Equality Act duty to make reasonable adjustments does not require a diagnosis either.

A diagnosis is genuinely needed for one thing: prescribing ADHD medication. For school support, needs evidence does the work. Our guides to EHCPs and home education and school avoidance cover what that evidence looks like.

Right to Choose: FAQ

What is NHS Right to Choose for ADHD and autism?

It is a legal right in England to choose which NHS-funded provider carries out your child’s assessment, instead of waiting for the local service. It comes from regulation 39 of the Standing Rules Regulations 2012. You can pick any clinically appropriate provider holding an NHS contract, your GP makes the referral, and it is free.

Does Right to Choose apply to children?

Yes. There is no age limit in the regulations and the NHS Choice Framework applies to all ages in England. In practice the limits come from providers, not the law: each sets its own age range, and some do not take under-18s for ADHD at all. Check the provider’s age criteria before asking your GP to refer.

Can my GP refuse a Right to Choose referral?

Only on clinical grounds, because the law leaves clinical appropriateness to the referrer. A GP cannot refuse because of cost or because the local NHS has no contract with that provider, as no funding approval is needed. If you are refused for a non-clinical reason, raise it with the practice, then your ICB, then NHS England at england.choice@nhs.net.

Is Right to Choose actually faster?

Often, but not always. Waits typically run from about 12 weeks to over a year depending on provider and area, against a median of 470 days for children on local autism lists. Since 2025 some ICBs have capped activity, so check your area and the provider’s current wait rather than assuming.

Do I have to pay for Right to Choose?

No. It is NHS-funded care delivered by an NHS-contracted provider, so there is no charge to you. Paying privately is a separate route, typically £700 to £2,500 for a child assessment, plus ongoing titration and review costs.

Is Right to Choose being restricted or paused in 2026?

Not nationally. It remains a legal right across England. But several Integrated Care Boards have capped how much Right to Choose activity they fund, including Greater Manchester, Hampshire and Isle of Wight, the Bristol area, West Yorkshire and Cheshire and Merseyside. A capped provider will still accept your referral but may not assess you until the next financial year. Other areas, such as Nottingham and Nottinghamshire, have confirmed no caps at all. Check your own ICB’s page before referring.

Do NHS services have to accept a Right to Choose diagnosis?

From 1 April 2026 NHS England’s payment guidance says diagnostic reports from independent providers, including those under Right to Choose, should be accepted by NHS-commissioned titration services unless there is a clear clinical reason not to, to avoid unnecessary reassessment. Note the limits: it says should rather than must, and it binds titration services rather than your GP.

Does my child need a diagnosis to get an EHCP?

No. The Children and Families Act 2014 defines SEN by need, not diagnosis, and the SEND Code of Practice says identification is about working out what action is needed rather than fitting a child into a category. A diagnosis is required to prescribe ADHD medication, but not for school support or an EHCP.

Where to go next

If the wait is the reason your child is not coping in school, you may also be weighing up leaving altogether. Our guides on school avoidance, home educating an autistic child and home educating a child with ADHD cover that honestly, including the times when leaving is the wrong answer.

Next step, if an assessment is what you actually need: our free EHC needs assessment request letter generator writes the request for you, argued on the real legal test. Councils refused 43,300 of these in 2025 and over nine in ten challenges succeed.

More on this: everything we have on SEND, EHCPs and neurodivergent kids is gathered in the SEND hub, including the free EHC needs assessment letter generator.