Your Right to Choose: A Research-Based Guide to ADHD Diagnosis in the UK

Research basis: NICE NG87, NHS England ADHD Taskforce Report (2025), House of Commons Library ADHD Statistics, peer-reviewed meta-analysis (Song et al., 2021), and 25+ academic, clinical, and government sources.

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The Scale of the Crisis

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) found that approximately 2.5% of adults and 5% of children have ADHD — meaning 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.

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What Is the Right to Choose?

The NHS Right to Choose (RTC) is a legal right allowing patients in England to choose their mental healthcare provider and clinical team, rather than being restricted to clinics commissioned by their local NHS trust (ADHD UK; NHS England).

Here is what this means in practice:

• If your local NHS waiting list is unacceptably long, you can be referred to an NHS-contracted private provider anywhere in England
• These are private companies providing NHS services to NHS standards
• Assessments and treatment are entirely NHS-funded — no cost to you
• Any subsequent medication incurs only the standard NHS prescription fee
• As ADHD UK explains: "Your GP writes the referral letter, you can write the envelope"

Critical: Right to Choose applies only in England. Healthcare is devolved — Wales, Scotland, and Northern Ireland have different arrangements (see below).

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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
• The Health and Social Care Act

This means your 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.

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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 RTC, 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 & 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 & 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 & 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 & 1.5.18)

• Cognitive Behavioural Therapy (CBT) should be considered if medication is declined, poorly tolerated, or ineffective
• This 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+ months), prescribing and monitoring should transfer to your GP under a Shared Care Protocol
• The specialist remains available for reviews and complex adjustments

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Step-by-Step: How to Exercise Your Right to Choose

Step 1: Check Eligibility

You can use Right to Choose if you:

• Are registered with a GP in England
• Are not already receiving elective mental health care for ADHD
• Are not accessing urgent or crisis care
• Are not detained under the Mental Health Act
• Are not serving in the armed forces

Step 2: Choose Your Provider

Research NHS-contracted providers. Common options include Psychiatry UK, CARE ADHD, and ADHD 360, though availability changes regularly.

Check before choosing:

• Current waiting times (usually several months to a year — still far shorter than local NHS waits of 4-15 years)
• 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 based on whether your GP is willing to accept shared care.

Step 3: Prepare 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 from your chosen provider's website. Complete the patient sections before your GP appointment.

Step 4: See Your GP

Book an appointment (request a longer slot if available). Bring your completed documentation and explain:

1. Your symptoms and how they affect your daily life
2. That you would like a referral for ADHD assessment
3. 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: To decide if a referral is clinically appropriate. They are not making the diagnosis — they are referring you to someone who can.

Step 5: If Your GP Is Reluctant

Common objections and responses:

| GP Says | You Can Say | |---------|-------------| | "I have never heard of Right to Choose" | "It is established in the NHS Constitution. Here is the NHS England guidance." | | "We do not do RTC referrals" | "Right to Choose is a patient right, not a surgery policy. It is the law in England." | | "The ICB will not fund it" | "ICBs are legally required to respect Right to Choose. Refusal would be unlawful." | | "I do not think you have ADHD" | "You do not need to diagnose me — just agree a specialist assessment is appropriate. Could you document your clinical reasoning if you decline?" | | "Go on the NHS list first" | "Right to Choose applies at the point of referral. I can choose my provider from the start." |

Escalation if still refused:

1. Ask for refusal in writing with clinical reasoning
2. Request a second opinion from another GP at the practice
3. Contact the Practice Manager with a formal complaint
4. Contact your local ICB — they must uphold Right to Choose
5. Contact ADHD UK (adhduk.co.uk) for advice and template letters
6. Use our Right to Choose Navigator at neurodivarsity.com/right-to-choose
7. Contact the Parliamentary and Health Service Ombudsman as a last resort

Step 6: After Diagnosis — Shared Care

If diagnosed and medication is recommended:

1. Titration period — the specialist adjusts your dosage (usually 3+ months)
2. Shared Care Agreement — the provider contacts your GP to transfer routine prescribing
3. Your GP handles repeat prescriptions and basic physical health monitoring
4. The specialist remains available for reviews and complex issues

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

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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 — though NHS prescribing rules differ for privately diagnosed patients.

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The ADHD Taskforce: What Is Changing

NHS England's independent ADHD Taskforce (report published 2025) 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.

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Frequently Asked Questions

Q: Does Right to Choose cost me anything? A: No. Assessment and initial treatment are NHS-funded. You pay only standard NHS prescription charges for ongoing medication.

Q: How long does RTC take compared to the NHS? A: RTC providers typically assess within a few weeks to several months. Local NHS waits average 4-8 years, with some areas reaching 10-15 years.

Q: Can my GP refuse? A: A GP can decline if they believe a referral is not clinically appropriate. They cannot refuse on administrative or funding grounds.

Q: I was diagnosed privately. Can I use RTC? A: RTC is for initial assessment referral. If already diagnosed privately, ask your GP about shared care agreements for ongoing NHS prescribing.

Q: What if my provider does not offer shared care? A: 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.

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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.

Use our Right to Choose Navigator for step-by-step guidance tailored to your situation. Free, takes a few minutes, and helps you feel confident when speaking to your GP.

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

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This article is based on NICE NG87, NHS England ADHD Taskforce Report (2025), House of Commons Library statistics, ADHD UK guidance, and peer-reviewed research (Song et al., 2021 — PMC7916320). Information is accurate for England as of March 2026. This does not constitute medical or legal advice — always speak to your GP about your individual circumstances.

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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)
• 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 & Autism Payment Guidance