Last updated 2026-05-01. Based on NICE NG87, the NHS England ADHD Taskforce Report (2025), House of Commons Library statistics, ADHD UK guidance, peer-reviewed research, and current ICB activity reporting. England-specific. Not legal or medical advice.

TL;DR

The NHS ADHD waiting list is 562,450 people as of December 2025 (House of Commons Library). Many areas average 4 to 8 years; the worst affected reach 10 to 15 years.

Right to Choose lets you bypass that. It is your legal entitlement under the NHS Constitution to pick any approved provider in England that holds an NHS contract for ADHD assessment.

It costs you nothing. The NHS pays the provider directly. You pay only the standard NHS prescription fee, if medication is later recommended.

You ask your GP. The GP letter template is at the bottom of this page. Editable in your browser, sendable via your practice's eConsult, NHS App, email, or post.

Some Integrated Care Boards have paused new Right to Choose referrals as of 2026. The pause is local, not national. The named pauses and how to confirm yours are below.

If your GP says no, you have not done anything wrong. There is a workaround for every reason a GP might give. They are below.

If you are an adult who suspects you have ADHD, or you have been told the NHS waiting list is two to five years and you should "just wait", this page is for you. Right to Choose is real, it is your entitlement, and most GPs have not been told it exists.

1. The scale of the wait

If you are waiting for an ADHD assessment on the NHS, you are part of a system under unprecedented strain.

As of December 2025, there were 562,450 open referrals for ADHD diagnosis in England. When Community Health Services referrals are included, the true waiting list may exceed 2.75 million people (House of Commons Library, FAQ: ADHD Statistics, England).

The human cost is severe:

61.6% of adults and 65.8% of children have been waiting over a year for assessment
Average wait times in many areas span 4 to 8 years
In the worst-affected areas, waits have reached 10 to 15 years
Some Integrated Care Boards (ICBs) have limited new assessments to manage budget deficits, sometimes without notifying patients or GPs (Guardian, 2025; NHS England ADHD Taskforce)
Untreated ADHD costs the UK economy an estimated £17 billion per year through educational underachievement, unemployment, substance misuse, and criminal justice involvement

A global systematic review and meta-analysis (Song et al., 2021) estimated that 2.5% of adults and 5% of children have ADHD: roughly 2.5 million people in England alone. Recognised clinical diagnosis rates fall far short of these figures.

These are not just statistics. Behind every number is someone struggling with undiagnosed ADHD, with work, relationships, finances, and mental health, while waiting for support they are entitled to.

2. What Right to Choose actually is

Under the NHS Constitution, you can choose any approved provider in England that holds an NHS contract for the service you need. The Department of Health and Social Care has confirmed this applies to ADHD assessment specifically.

In practice: instead of waiting on your local NHS Trust's queue, you can ask to be referred to a provider with a shorter wait, or one that specialises in adult ADHD. The cost is the same to you. Zero. The NHS pays the provider directly.

As ADHD UK puts it: "Your GP writes the referral letter, you can write the envelope."

Key points:

These are private companies providing NHS services to NHS standards
Assessments and treatment are entirely NHS-funded
Any subsequent medication incurs only the standard NHS prescription charge
Right to Choose applies in England only. Healthcare is devolved. Wales, Scotland, and Northern Ireland have different arrangements (see section 12)

Why is this not better known? Because the NHS does not advertise it. GPs are not routinely trained on it. Some Integrated Care Boards have responded to budget pressure in 2026 by pausing new Right to Choose referrals, which makes the picture more complicated than it was a year ago.

3. The legal foundation

Patient choice is formally enshrined in the NHS Constitution. The Right to Choose framework for mental health was introduced in 2018, supported by:

The Health Act 2009
The Mental Health Act 2018 amendments
The Health and Social Care Act

This means a GP cannot refuse a Right to Choose referral on administrative or funding grounds. If there is clinical agreement that an ADHD assessment is appropriate, the choice of provider is yours.

4. Who can use it

You can use Right to Choose if all of these are true:

You are an adult registered with an NHS GP in England
Your GP has agreed (or will agree) that an ADHD assessment is appropriate for you
You are not already receiving elective mental health care for ADHD via another route
You are not accessing urgent or crisis care for ADHD
You are not detained under the Mental Health Act
You are not serving in the armed forces (separate pathway applies)

The eligibility test is simple. Most adults in England seeking an ADHD assessment qualify.

5. How long it actually takes

Standard NHS ADHD assessment wait in England: 24 to 60 months in most areas. Some ICBs report 10 to 15 year waits in 2025-2026.

Right to Choose providers in 2026: typically 6 to 16 weeks for assessment, depending on provider and demand.

The variance is large because providers and ICB pauses change. ADHD UK and ADHD 360 both publish current wait times by region. See section 11 for sources.

Total realistic timeline from "I want to do this" to "I have a diagnosis":

| Step | Time | |---|---| | Decide and prepare paperwork | 1 to 7 days | | GP appointment booked | 5 to 10 working days | | GP referral processed (e-Referral System) | 1 to 5 working days | | Provider triage acknowledgement | 1 to 4 weeks | | Assessment appointment | 6 to 16 weeks from triage | | Diagnosis communicated | At appointment, or within 2 weeks | | Titration begins (if medication recommended) | 4 to 8 weeks after assessment | | Shared Care transfer to GP | 3 to 6 months from titration start |

Total: 3 to 6 months from first GP appointment to a settled diagnosis and medication plan, in most cases. Compared to 24 to 60 months on a standard NHS waiting list, that difference is what makes Right to Choose worth doing.

6. Step-by-step: how to ask your GP

Step 1. Check eligibility

See section 4. Most adults in England qualify.

Step 2. Choose your provider

Common Right to Choose providers in England include:

Psychiatry-UK
ADHD 360
Clinical Partners
CARE ADHD

Availability changes regularly. Before choosing, check:

Current waiting times (from the provider's site, ADHD UK, or ADHD 360's tracker)
Whether they require a Shared Care Agreement with your GP for ongoing medication
Their specific referral process and required forms

ADHD UK maintains an up-to-date provider list at adhduk.co.uk/right-to-choose. You can filter by whether your GP is willing to accept shared care.

Step 3. Prepare your documentation

Most providers supply a Right to Choose information pack including:

A GP referral letter template
An Adult ADHD Self-Report Scale (ASRS) screening tool
NHS Choice framework documentation

Download these from your chosen provider's website. We have also written a generic GP letter at the bottom of this page (section 14) that you can use directly.

Step 4. Book the GP appointment

Request a longer slot if available. Bring your completed documentation and a clear summary of how your symptoms affect your daily life.

Step 5. The conversation

Explain three things, in this order:

Your symptoms and how they affect your daily life
That you would like a referral for ADHD assessment
That you wish to exercise your Right to Choose and be referred to [provider name]

A helpful script:

"I have been experiencing symptoms consistent with ADHD that significantly affect my work and daily life. I would like to be referred for an ADHD assessment. Under my NHS Right to Choose, I would like this referral to go to [provider name], who accepts NHS-funded Right to Choose referrals."

The GP's role is to decide if a referral is clinically appropriate. They are not making the diagnosis. They are referring you to someone who can.

Step 6. After diagnosis: shared care

If you are diagnosed and medication is recommended:

Titration period with the specialist (usually 3 or more months)
Shared Care Agreement between specialist and GP
Your GP then handles repeat prescriptions and basic physical health monitoring
The specialist remains available for reviews and complex issues

Note: the NHS England ADHD Taskforce has specifically addressed GP reluctance to accept Shared Care from RTC providers. Guidance now supports GPs accepting shared care, and this is increasingly standard practice.

7. If your GP says no, you have not done anything wrong

There are three common reasons a GP refuses, and a workaround for each.

| GP says | What it really means | What you can say | |---|---|---| | "I have never heard of Right to Choose" | They have not been trained on it | "It is established in the NHS Constitution and confirmed in NHS England guidance. I have brought a copy of the relevant NHS England Choice document. May we look at it together?" | | "We do not do RTC referrals at this practice" | The practice has an internal policy that does not align with the law | "Right to Choose is a patient right under the NHS Constitution, not a surgery policy. It is the law in England. Could we treat my request as the legally protected referral it is?" | | "The ICB will not fund it" | The ICB has paused, or the GP believes they have | "ICBs are required to respect Right to Choose. If your specific ICB has paused and Right to Choose is unavailable for new referrals, could you confirm that in writing so I can ask the ICB directly?" | | "I do not think you have ADHD" | The GP is conflating screening with diagnosis | "You do not need to diagnose me. You need to agree that a specialist assessment is appropriate. Could you document your clinical reasoning if you are declining the referral?" | | "Go on the NHS list first" | The GP misunderstands when Right to Choose applies | "Right to Choose applies at the point of referral. I am entitled to choose my provider from the start. There is no requirement to be on a local list first." | | "We do not have the form" | The form is provider-specific | "I have brought the provider's referral form, complete except for the clinical sections. Could we go through it together?" |

If your GP still refuses after this conversation, your escalation path is:

Ask for the refusal in writing, with the GP's clinical reasoning
Request a second opinion from another GP at the practice
Contact the Practice Manager with a formal complaint
Contact your local ICB directly (the GP's ICB is on your registration paperwork; the ICB lookup is at nhs.uk/service-search/find-an-integrated-care-board)
Contact ADHD UK (adhduk.co.uk) for advice and template letters
As a last resort, the Parliamentary and Health Service Ombudsman

You can also move GP practice. Some practices in neighbouring areas have not had Right to Choose paused. Or write to your ICB directly asking for a written explanation of any pause and its review timetable. ICBs are public bodies and obliged to respond.

8. What NICE says (the clinical standard, NG87)

The National Institute for Health and Care Excellence guideline NG87, "Attention Deficit Hyperactivity Disorder: Diagnosis and Management", sets the national clinical standard. Any provider assessing you, whether NHS or Right to Choose, must follow these guidelines.

Diagnosis requirements

| NICE Reference | Requirement | |---|---| | 1.3.1 | Diagnosis by a specialist psychiatrist, paediatrician, or appropriately qualified healthcare professional only | | 1.3.1 | Full clinical and psychosocial assessment, developmental and psychiatric history, plus observer reports | | 1.3.2 | Must not rely solely on rating scales or observational data (tools like Conners' scales are adjuncts only) | | 1.3.3 and 1.3.4 | Symptoms must meet DSM-5 or ICD-11 criteria, cause at least moderate impairment, and be pervasive across two or more settings |

Treatment pathway (NICE NG87)

NICE recommends a staged approach:

1. Environmental modifications first (Guidelines 1.5.13 and 1.5.15). Workplace adjustments, study strategies, routine and environmental management. Medication is offered only if symptoms continue to cause significant impairment after these have been tried.

2. First-line medication (Guidelines 1.7.7 and 1.7.11). Methylphenidate (e.g., Concerta XL, Medikinet) and lisdexamfetamine (Elvanse) are the recommended first-line treatments. Both have strong evidence bases for efficacy and safety.

3. Non-pharmacological treatments (Guidelines 1.5.14 and 1.5.18). Cognitive Behavioural Therapy (CBT) should be considered if medication is declined, poorly tolerated, or ineffective. CBT can be combined with or used instead of medication.

4. Shared Care transfer (Guideline 1.7.29). Following titration and dose stabilisation (usually after 3 or more months), prescribing and monitoring should transfer to your GP under a Shared Care Protocol. The specialist remains available for reviews and complex adjustments.

9. What changed in 2026: the ICB pause situation

The picture has been moving fast through 2025 and 2026. Some Integrated Care Boards have responded to budget pressure by pausing new Right to Choose referrals. The pause is local, not national.

We do not maintain a definitive nationwide list ourselves yet (it is on our build list). Until that tracker is live, the two sources we cross-reference are:

ADHD UK. Patient-side charity. Tracks ICB status changes and publishes practical guidance for people navigating Right to Choose. Read this first if your ICB has paused.
ADHD 360 wait times and ICB allowances. A provider that publishes region-by-region wait times and which ICBs have placed activity caps. Provider-side, so it has commercial framing, but the granular regional data is useful.

For the journalistic backstory of how the pauses started and which areas were named in 2025, Special Needs Jungle's coverage is the most thorough.

Confirmed paused or restricted at the time of writing (this changes month to month):

North Central London ICB area (Barnet, Camden, Enfield, Haringey, Islington). Paused until at least April 2027 unless new funding is agreed.
Greater Manchester area. Referrals paused.
Kent and Medway. New referrals on hold pending an Indicative Activity Plan.
At least nine NHS areas overall, per Special Needs Jungle's reporting.

Confirmed pauses change frequently. Always check with your GP practice on which ICB they sit in before assuming Right to Choose is available, and cross-check on ADHD UK for the most current status.

If your ICB has paused, the rebuttal table in section 7 ("Our ICB has paused new Right to Choose referrals") covers your options: wait for the quarterly review, ask for the pause and its review timetable in writing, or move GP practice into a neighbouring ICB that has not paused.

10. After diagnosis: medication and Shared Care

If you are diagnosed and medication is recommended, what follows:

Titration period with the specialist. The specialist adjusts your dose over 3 or more months until you are on a stable, effective dose with manageable side effects.
Shared Care Agreement. Once stable, the provider contacts your GP to formally transfer routine prescribing and monitoring.
Your GP then handles repeat prescriptions and basic physical health monitoring (blood pressure, weight, height for younger patients).
The specialist remains available for medication reviews, dose adjustments, and complex issues.

Some providers cannot offer long-term medication without a GP Shared Care Agreement. ADHD UK's provider list lets you filter by shared care availability, so you can pick a provider whose policy aligns with what your GP is willing to accept.

11. Where to find current information

Three sources, in order of usefulness:

ADHD UK. The patient-side charity. Provider list, wait times, ICB status, template letters, escalation guidance.
ADHD 360 ICB allowances tracker. Provider-side; granular regional wait time data.
NHS England ADHD Taskforce reports. Government-side; the policy and funding picture.

12. Scotland, Wales, and Northern Ireland

Right to Choose as described above applies in England only.

Scotland. No direct RTC equivalent. Ask your GP for referral to any NHS Scotland service. Contact your local Health Board for ADHD pathways.
Wales. No direct RTC equivalent. Welsh Government has separate ADHD pathway guidance. Contact your local Health Board.
Northern Ireland. The November 2025 Department of Health Needs Assessment Report specifically examined ADHD service gaps. Assessment is available through HSC trusts but with significant waiting times. No RTC equivalent.

If you are outside England with very long waits, explore Individual Funding Requests (IFRs) or private assessment. NHS prescribing rules differ for privately diagnosed patients across the UK; check with your GP.

13. What the ADHD Taskforce is doing

NHS England's independent ADHD Taskforce (report published 2025) has acknowledged the crisis:

2.5 million estimated affected people in England
Some ICBs limiting new assessments to manage multi-million-pound budget deficits
Patients and GPs sometimes not notified of these restrictions
Recommendations for standardised pathways and improved access
New Payment Guidance for ADHD and Autism services

The landscape is actively evolving. Stay informed through ADHD UK and NHS England publications.

14. The GP letter template

The letter is at neurodivarsity.com/downloads/gp-letter.html. Fill it in your browser, then pick whichever sending method matches your GP practice. No signup. No PDF editor. No envelope.

The page gives you three options:

Copy the finished letter to your clipboard, then paste it into your practice's eConsult form, NHS App message, or whatever online contact your GP uses. Most practices have one of these.
Open in email to launch your mail app with the letter pre-written. Add your GP's email, click send.
Print or save as PDF if you prefer paper or want a copy for your records. The same page also lives at neurodivarsity.com/downloads/gp-letter.pdf as a static PDF if your browser cannot render the editable version.

We designed it this way because the standard "download a PDF, find an editor, print it, find an envelope" flow has too many drop-off points for an ADHD brain. One page, one decision, one click.

15. Frequently asked questions

Q: Does Right to Choose cost me anything?

No. Assessment and initial treatment are entirely NHS-funded. You pay only standard NHS prescription charges for ongoing medication.

Q: How long does Right to Choose take compared to the NHS standard route?

Right to Choose providers typically assess within a few weeks to several months. Local NHS waits average 4 to 8 years, with some areas reaching 10 to 15 years.

Q: Can my GP refuse?

A GP can decline if they believe a referral is not clinically appropriate. They cannot refuse on administrative or funding grounds. The rebuttal table in section 7 covers the most common reasons given.

Q: I was diagnosed privately. Can I use Right to Choose?

Right to Choose is for the initial assessment referral. If you are already diagnosed privately, ask your GP about Shared Care Agreements for ongoing NHS prescribing. The terms vary by provider and ICB.

Q: What if my chosen provider does not offer Shared Care?

Some providers cannot provide long-term medication without a GP Shared Care Agreement. ADHD UK's provider list lets you filter by Shared Care availability. Pick a provider whose Shared Care policy aligns with what your GP is willing to accept.

Q: Is the GP letter on this page legally binding?

The letter is a request, not a binding instrument. Your GP makes the clinical referral decision based on assessment of appropriateness. The letter exists to make the request clear, complete, and aligned with NHS Choice framework expectations.

Q: What about sending children for assessment?

This guide is written for adults. Children's ADHD assessment pathways differ; talk to your child's GP or paediatrician. ADHD UK has specific guidance for children.

About this guide

This guide is by Neurodivarsity, a UK company designing ASTI: a calm AI companion for adults with ADHD.

The company: Neurodivarsity Ltd. The publisher. We make guides like this, run the newsletter, and do the slow architecture work behind the scenes.

The product: ASTI. In pre-build, designing to ISO 42001 (AI management), the MHRA Digital Mental Health Technology Standard, and GDPR Article 9 (special category data). Named after our founder's late cat. Named after Asteria, a goddess of falling stars and the patient watch of the night sky.

When ASTI is ready (3 to 6 months from now), we will email everyone who signed up at the contributor opt-in below. Nothing else. No surveys. No data collection beyond your email and your yes-or-no on whether you want to be early.

Until then we publish guides like this one to make the path through NHS systems a bit clearer for people who are tired of being told to wait.

Take the next step

If you are in England and suspect you may have ADHD, you have a legal right to choose who assesses you. You do not need to accept a years-long wait.

The GP letter is at neurodivarsity.com/downloads/gp-letter.html. Free, no signup, fill it in your browser, and send it via whichever method matches your GP practice.

You are not asking for special treatment. You are exercising your legal rights.

Companion reading

The Neurodivergent Advantage: peer-reviewed research on ADHD, autism, and dyslexia in the workplace.
Women and Girls: ADHD Diagnosis: what gets missed and why.
Workplace Rights: reasonable adjustments under the Equality Act 2010.
What Is ADHD?: the foundational explainer.

Sources: NICE NG87 (Attention Deficit Hyperactivity Disorder: Diagnosis and Management, nice.org.uk/guidance/ng87); NHS England ADHD Taskforce Report Part 1 (2025); House of Commons Library FAQ ADHD Statistics (England); ADHD UK Right to Choose Guide (adhduk.co.uk/right-to-choose); ADHD 360 wait times and ICB allowances tracker (adhd-360.com); NHS Constitution for England; Song et al. (2021) "The prevalence of adult ADHD: A global systematic review and meta-analysis" (PMC7916320); Northern Ireland ADHD Needs Assessment Report (November 2025); NHS England ADHD and Autism Payment Guidance; Special Needs Jungle 2025 reporting on the nine NHS areas; The Guardian 2025 reporting on ICB activity restrictions.

This article is accurate for England as of May 2026. It does not constitute medical or legal advice. Always speak to your GP about your individual circumstances.

NHS Right to Choose for ADHD: A Plain English Guide

TL;DR