Patient choice is at the heart of the NHS. The significant increase in waiting lists for autism and ADHD assessments means that many more people are selecting a provider under their legal Right to Choose (RTC). This means they are opting to be referred to independent providers, contracted and paid for by the NHS.
RTC allows you to select an NHS-funded healthcare provider when receiving a referral from a GP or another designated professional for your initial appointment.
There is more information about Right to Choose on the NHS website.
Information will differ slightly depending on whether you are seeking a referral or treatment for an adult or a child or young person.
Children and young people
NHS Kent and Medway has commissioned local services for autism and ADHD but we recognise people may wish to choose an alternative provider through Right to Choose.
Adults
From 1 April 2025, all referrals for adult ADHD assessments, diagnosis, prescribing and titration (the process that introduces your body to medication safely and establishes an effective dosage), as well as autism assessments, will fall under RTC, in line with new procurement legislation.
NHS Kent and Medway has a list of preferred accredited providers for patients seeking an autism or ADHD assessment. Your GP can help you choose the most appropriate provider.
The first step is to talk to your GP as they will be able to advise you.
As different providers provide different services, your GP will determine which provider is the most appropriate to refer to.
RTC may not be the best choice for you. For example, if you have complex needs and selecting RTC would mean your care would be split between too many providers. For those individuals, we have commissioned services from local NHS providers which your GP will be able to advise you of.
You can select any appropriate qualified provider across England, as long as the provider is commissioned by an Integrated Care Board to provide the service needed for you.
This includes NHS organisations as well as independent providers that are commissioned to provide a service to the NHS.
For adults, NHS Kent and Medway has a preferred list of accredited providers that meet our quality checks and service requirements.
Your GP can help you decide which provider is most appropriate for you, based on the service they offer.
There is no guarantee that your chosen provider will prescribe the treatment that you may need, and some providers will only diagnose.
However, all RTC providers accredited by NHS Kent and Medway will prescribe the treatment may you need.
As GP practices in Kent and Medway will not be able to start treatment for patients with ADHD, it is important to check the provider can start the medication, should it be needed. If the provider can prescribe, they should do so until your dose is stable.
After that period, the provider sends a Shared Care Agreement (SCA) to your GP to consider taking over regular prescribing. Your GP is not under any obligation to undertake shared care so we would advise discussing this with your GP before a referral is made.
For your GP to prescribe ADHD medicines, the provider will also need to support your GP with advice and guidance should there be a change in your condition or your response to the medication. The provider will also need to be able to provide ongoing monitoring as needed.
If you normally pay a prescription charge for medication, it will still apply with Right to Choose providers.
If the GP believes the referral to be clinically appropriate, patients can be referred more than once. However, it is not generally clinically appropriate to make more than one referral to different providers at any given time for the same condition.
It would not be a good use of NHS resources and being on duplicate waiting lists has the potential to delay or disadvantage other patients.
The full statement from NHS England is below.
Can patients exercise the legal right to choose the organisation and team who provides their elective care on more than one occasion for the same condition?
Yes, as described in Section 3 of the DHSC guidance the NHS Choice Framework provided the patient is not currently in treatment for the condition; or subject to one of the other exclusions, and the referrer (GP in this case) believes the referral to be clinically appropriate they can be referred. This applies to Physical & Mental Health, ADHD, Learning Disabilities and Autism which are all in scope of the choice regulations.
However, it is not expected clinical/operational practice to make more than one referral at any given time for the same condition. Regardless of the underpinning policy/regulation, it is hard to see how multiple referrals for one person to different providers is clinically appropriate, nor would it be a good use of NHS resources and being on duplicate waiting lists also has the potential to delay or disadvantage other patients.
The GP will decide if a referral is clinically appropriate. Second referrals after a previous NHS-referred diagnosis would need to be prompted by additional evidence or symptoms that were not previously considered.
We know there are concerns around the national consultation on the NHS Payment Scheme, and what this could mean for patient choice with regards to ADHD assessment and treatment.
The consultation does not affect a patient’s right to choose a provider for ADHD or autism services. The proposal does not introduce a cap of £100k, as has been rumoured.
Payment limits will not be set for provider-commissioner relationships expected to have a value of less than £100k. For relationships over that level, a limit may be calculated by NHS Kent and Medway based on need and priorities.