How to get an NHS Assessment via ‘Right to Choose’
Step 1- Check if you are eligible for ‘Right to Choose’
To go through the ‘Right to Choose’ pathway, you must be based in England and be eligible to access an assessment through the NHS. You can read more about eligibility here.
Patients cannot use Right to Choose if they are:
- Already receiving mental health care following an elective referral for the same condition.
- Referred to a service that is commissioned by a local authority e.g. a drug and alcohol service (unless commissioned under a Section 75 agreement).
- Accessing urgent or emergency (crisis) care.
- Accessing services delivered through a primary care contract.
- In high secure psychiatric services.
- Detained under the Mental Health Act 1983.
- Detained in a secure setting. This includes people in or on temporary release from prisons, courts, secure children’s homes, certain secure training centres, immigration removal centres or young offender institutions.
- Serving as a member of the armed forces (family members in England have the same rights as other residents of England.
If you are eligible, this means that you have the legal right to choose which mental healthcare provider you want to be referred to for assessment and treatment. This means that if you decide the waiting time for your ADHD assessment is too long, then you can choose another provider.
Step 2- Will your GP make a referral and accept a ‘Shared Care Agreement’?
The Right to Choose pathway has only been available since 2018, so some GPs and other medical professionals are not aware that it’s even an option, even though hundreds of people have been referred for ADHD assessment through Right to Choose. You can read more about this on the NHS website.
Referral
To go through the Right to Choose pathway, your GP needs to agree to make a referral to the provider of your choice. You will first need to go and speak to your GP about why you think that you have ADHD. Your GP should take you seriously, and ask why you think you might have ADHD. Following this conversation, they may ask you to fill a diagnostic screening tool called an ‘ASRS form’, which you must complete before you can be referred for an assessment. The GP should then refer you for assessment to the provider you have requested. If you are having trouble getting referred by your GP, there is some advice on our Getting an ADHD Asessment page about what you can do.
When you ask for a referral, your GP may ask you:
-“Does an IFR (Individual Funding Request) need to be in place?”
It does not.
-“Does the CCG (now called the ICS/ICB) need to give permission?”
It does not.
Shared Care Agreement
You also need to think about whether you want to access ADHD treatment through the NHS, or if you are willing to pay for it privately. This applies to both medication and CBT therapy. If you do want treatment on the NHS, you need to check that your GP will accept full care or something called a ‘Shared Care Agreement’, after your chosen provider discharges you. Ideally, you should make sure that your GP will accept one of these BEFORE you get referred for an assessment, so that you don’t end up without follow up treatment.
If your GP is unwilling to accept full care or shared care, it is up to you to convince the GP. It is possible to change GP if you are having difficulties with them, though it is important to make sure that a new GP will refer you and accept shared care or discharged care.
Step 3- How to choose an ADHD Assessor
While you do have the right to choose which provider you want, you might be unable to be referred outside of your ICS (Integrated Care System, formerly CCG) catchment area. You can find out more and check your catchment area here. You can only be referred to providers your ICS has an NHS contact with. However, some of these may be online such as Psychiatry UK.
Some providers might have longer waiting lists than others, so you should ask about that when choosing a provider. You can ask your GP to find out for you, but it might be quicker to call the provider yourself and ask what their waiting time is.
Before booking an assessment, you should ask your provider:
-Their current waiting times for diagnosis.
-If they have a contract with your ICS.
-If they offer treatment following an ADHD assessment.
-What their treatments are (usually medication or CBT therapy).
-If you will be able to access their treatment through the NHS.
Right to Choose Providers
The largest provider of Right to Choose ADHD assessments. Their assessments are mostly done by video call and titration for medication is also done remotely. Psychiatry UK provides details on Right To Choose, including a downloadable letter to give your GP.
May 2023: Assessment wait time: 6 months. Medication wait time following assessment: 3-6 months.
Provide both Right to Choose and Private ADHD Assessments. They do not currently have capacity to meet the demand for their services, and they discuss this in a video on their site here.
May 2023 Update: Currently taking bookings for Winter 2024.
Provide both Right to Choose and Private ADHD Assessments for adults and children, although Right To Choose is not currently signposted on their website. It is recommended that you call and ask whether they provide treatment on the NHS following assessment.
May 2023: Not currently accepting new NHS referrals.
Provides ADHD assessments through Right to Choose in only 4 areas: Kent and Medway (adults), Isle of Wight and North East Hampshire (children aged 6-18 only). They offer diagnosis only through RTC, they don’t provide titration services for medication through the NHS.
May 2023: Current wait time for an Adult assessment (adult): 2-3 months. Wait time for children aged 6-11: 10-12 months.
Provide ADHD, Autism and combined assessment through Right to Choose for children and young people in education, up to age 19. They do not have a Right to Choose service for adults, although they do have a private service. They accept referrals for people throughout England. In person appointments are preferred, but they may offer online assessments depending on individual circumstances.
May 2023: Due to high demand, they are only able to take referrals for 0-19 years olds.
Step 3- What to expect at an ADHD Assessment
Once you have chosen a assessor and completed any necessary paperwork, your provider will book an assessment for you. Your assessment may be in person, but it is not unusual to have one conducted via video call.
The assessment usually takes 45-90 minutes, during which time you will discuss your overall mental health, mental health history, and any family mental health issues that you are aware of. If you have a family history of ADHD, it can be helpful to mention that during your assessment, as ADHD is genetic.
You will also be asked questions relating to Hyperactivity and Inattention, and assessed according to the DSM V criteria for ADHD. You will be asked a number of questions that relate to this criteria, and you need to answer with examples that demonstrate the trait (symptom) that is being assessed. To receive a diagnosis, you must have at least 6 traits (symptoms) which are present now, and when you were a child.
For example, you may be asked if you often lose things. To answer this, you need to give a general description of how often you lose things (e.g. “I lose things all the time”), and give several examples of times that you lost things that were necessary for a task. You will also need to give examples of times that you lost things when you were a child e.g. “When I was in school, I always used to forget my homework.”
We recommend that you familiarise yourself with the different traits (symptoms) of ADHD that will be assessed during your appointment. Many people with ADHD find that their mind goes blank in such situations, so it is important to think about which traits (symptoms) of ADHD you can identify in your own life, and write down examples before your assessment.
After the clinician has finished asking you questions, they will let you know what happens next. If you are given a diagnosis of ADHD, your clinician should discuss treatment options with you. If not, they will tell you why they think that you do not meet the criteria for an ADHD diagnosis. It may be that you did not give enough detail about the difficulties you experience, or that another diagnosis explains your traits (symptoms) better than ADHD. You do not have to accept this diagnosis if you disagree with it, and you are entitled to seek out another provider for assessment if you still think you have ADHD.
Many adults who receive a diagnosis find that it comes as a huge relief to know that they are neurodivergent, because it explains a lot about why they have struggled in life, but the feelings that it brings up can also be difficult to deal with. If you would like support, to share your experiences, or meet other adults with ADHD, you can sign up for the ADHD Aware newsletters here and come to one of our (free) monthly meetings.
Step 4- What Kind of Treatments Are There For ADHD?
If you are given an ADHD diagnosis, your clinician will discuss whether you want to consider medication or another form of therapy, such as CBT. You should then decide together on what your treatment plan will be.
Medication
The first-line treatment for ADHD is stimulant medication, because that is what has shown to be the most effective treatment for ADHD. If you want to try medication, it is likely that you will be offered a brand of methylphenidate, lisdexamfetamine or dexamfetamine. These are not the same as illegal drugs you may have heard of, and it is important to be aware of any misconceptions you may have about ADHD medication, due to misinformation and stigma.
If you are not able to take stimulant medication for medical reasons e.g. a heart condition, or untreated high blood pressure, then you should ask to try a nonstimulant medication instead.
Atomoxetine is an example of a non-stimulant that you may be offered, but some clinicians will also prescribe Modafinil, Venlafaxine, bupropion hydrochloride or tricyclic antidepressants.
It is likely that you will need to try different medications and doses before you find the right one for you. This process is known as titration.
If you would like more information about the different kinds of ADHD medication, you can find it here.
CBT Therapy
CBT stands for ‘Cognitive Behavioural Therapy’, which is a type of talking therapy. CBT for ADHD is very different to the way that CBT is used to treat other conditions such as anxiety. CBT therapy for ADHD specifically deals with the difficulties caused by executive function, and other traits (symptoms).
For this therapy to be effective, the therapist should have experience of treating adults with ADHD. If the clinician who diagnosed you does not provide CBT Therapy and you would like to try it, they may be able to give you recommendations for another therapist.
Most people find that a combination of medication and CBT therapy is most effective, but everyone is different. It’s about finding out what works best for you!
Step 5- What happens after you have a treatment plan for ADHD?
Shared Care Agreement
If you are planning on returning to the NHS for treatment, the clinician who diagnosed you will write to your GP with paperwork for a ‘Shared Care Agreement’.
This means that your care and treatment will be shared by your clinician and your GP. If your GP has previously said that they will accept this agreement, you need to wait for this paperwork to go through.
Once the GP has accepted the agreement, you will be able to get treatment via the NHS. For medication, this means that the clinician you saw is still the one writing the prescription, but you get the prescription filled through your GP. You will pay the usual NHS prescription charge.
However, you may still need to go to the clinician you saw for an appointment if you need to adjust your prescription, as well as for your annual check up.
For CBT, you will be referred to a therapist on the NHS. There is more information about CBT on the NHS here. You should be aware that CBT is only available short term on the NHS, and that if you want to access it long term you will have to pay for it privately.
Full Discharge to GP
If you are fully discharged to your GP, it means that it is not a requirement for you to continue to see the clinician who diagnosed you for follow up appointments. However, you can return to them should the need arise.
Prescriptions will be renewed by your GP and your ongoing treatment plan will be decided between you and your GP. GPs are not able to prescribe you a new type of ADHD medication, so they may refer you back to your private clinician if that is what’s needed.
For CBT, you will be referred to a therapist on the NHS. There is more information about CBT on the NHS here. You should be aware that CBT is only available short term on the NHS, and that if you want to access it long term you will have to pay for it privately.