Right to Choose Guidance - Adults seeking an assessment for Attention Deficit Hyperactivity Disorder (ADHD) and / or Autism
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In this section:
What is Right to Choose (RTC)?
Do you need an assessment?
Using your Right to Choose
When does Right to Choose apply?
When does Right to Choose not apply?
What happens in an assessment
Medication and treatment
After your assessment
NHS locally funded assessment service pathways
What is Right to Choose (RTC)?
The "Right to Choose" means you can pick the healthcare provider for your autism or ADHD assessment. If your GP refers you, you can choose from NHS or private providers who work with the NHS. Your GP will explain your options so you can decide what's best for you.
More information regarding your legal right to choose is available here.
Do you need an assessment?
If you think you might be autistic or have ADHD, learning about these conditions can help you decide if an assessment is right for you. Helpful resources:
- ADHD Information: Attention deficit hyperactivity disorder (ADHD) - Symptoms - NHS
- Autism Information: Signs of autism in adults - NHS
It can also be helpful to think about how your experiences effect everyday life with the characteristics of ADHD or autism. For workplace, education settings or life challenges, consider speaking to your employer or tutor, local mental health services, or support groups. They may offer advice or additional support while you go through the assessment process.
Using your Right to Choose
Your GP will consider your concerns and overall health before making a referral.
They will give you a list of Right to Choose provider service options for you to choose from.
Before deciding on the right one, check their website for details like:
- Location
- Quality of care
- If they follow NHS guidelines:
Some providers require a referral form, which you may need to fill out for your GP.
Please note that GP's and Integrated Care Board's cannot recommend specific providers.
When does Right to Choose apply?
Based on NHS England guidance, you have the legal Right to Choose a provider if:
- The GP refers you for a first outpatient appointment.
- The referral is appropriate for your needs i.e. you are showing significant signs of autism and/or ADHD.
- The service is led by a consultant or mental health professional.
- The provider is funded by the NHS.
When does Right to Choose not apply?
Based on NHS England guidance, you cannot use a Right to Choose a provider if:
- You have self-referred.
- You are already receiving care for the same condition.
- The service is funded by a local authority or primary care.
- The care is urgent or an emergency.
- You are in the armed forces.
- You are in a secure hospital under the Mental Health Act.
More information regarding your legal right to choose can be found here.
What happens in an assessment
Assessments usually include:
- Discussions about your life history, (including childhood, adolescence, birth, and infancy) and current challenges.
- Input from family members or close contacts who can provide insight into your experiences i.e. a partner, parent, or older sibling.
- Family history (including any family history of neurodevelopmental and/or psychiatric disorders).
- Medical and mental health history
- Education and employment history
- Observations and standard tests.
Before the assessment, prepare by gathering information about:
- Your developmental history e.g. how you learnt skills, developed milestones and your behaviours when you were a child.
- Work, relationships, and daily challenges
- Substance misuse history
- Forensic/offending history
- History of trauma
- Previous evaluations or treatments.
If ADHD medication is considered, your medical history will also be reviewed.
The assessment should also include a discussion regarding alternative explanations for potential signs and symptoms of Autism/and or ADHD where other conditions have previously been diagnosed.
If the Right to Choose provider does not do a full and thorough assessment and report, your GP may refuse shared care for medication. The local NHS specialist neurodevelopmental service may also not accept the report as evidence of valid a diagnosis. In these cases, further referrals or re-assessments might be necessary.
Medication and treatment
NHS assessments and treatments are free. If you are prescribed medication, your GP may take over prescribing once you are stable. This is called a "Shared Care Protocol."
However, if the GP is unhappy with the quality of the assessment, they may decline shared care, and the original provider may continue prescribing medication.
ADHD medications require careful monitoring and should only be given to those who need them, following a full medical history check and a confirmed diagnosis. This is why the GP will ensure the assessment is thorough and meets the necessary quality standards.
If the provider only offers assessments, you might need a referral to another local NHS funded service, for treatment, which could increase waiting times.
Your GP will need to make this referral. They should include the full assessment report from the Right to Choose provider so the local NHS funded service has enough information to support your treatment needs.
The local NHS funded service checks if the assessment meets quality standards before starting or continuing any medication. If it doesn't, they may refuse to start or continue any medication. In such cases, a re-assessment by the locally funded NHS service may be needed, which could lead to further waiting times.
After your assessment
You should receive a report with findings and recommendations. The provider should discuss next steps with you, such as therapy, medication, or workplace/education adjustments.
- Support without a diagnosis: You do not need a diagnosis to request adjustments at work or in education. However, ADHD medication requires a confirmed diagnosis.
NHS locally funded assessment service pathways
While the Right to Choose pathway may seem appealing, there are benefits to using local NHS services:
Using the NHS locally funded pathway service often means smoother coordination of care, and better use of community resources such as:
- Coordinated Care: Local services often provide smoother follow-ups and integrated support.
- Access to additional services: Local pathways may signpost to local holistic resources like occupational therapy or counselling.
- Community Insight: Local providers are familiar with area-specific resources, such as employment support or adult social care services.
Considerations
- Waiting times: private providers under the Right to Choose scheme may still have long waiting lists due to high demand.
- Communication gaps: using external providers may result in coordination challenges with local health or support services.
For more information about locally funded service pathways, contact your local NHS Trust or visit their website here: Neurodevelopmental Specialist Service (NeSS) | Nottinghamshire Healthcare NHS Foundation Trust
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