NHS Right to Choose ADHD Referral Rejected or Delayed: What to Do Next

Published: August 2026

You research the available ADHD services, download the relevant forms and make an appointment with your GP. You may have spent years wondering why concentration, organisation, impulsivity or restlessness seem harder for you than for the people around you.

Then the referral stalls.

Perhaps the surgery says it only refers to the local NHS service. Perhaps you are told that the chosen provider is private, even though it offers NHS-funded care. Sometimes the referral is apparently sent but no confirmation arrives. In other cases, the provider returns it because a questionnaire, medical summary or important piece of information is missing.

These situations can be frustrating, particularly for someone seeking help with a condition that may itself make complicated paperwork, telephone calls and repeated follow-up difficult.

This guide explains what NHS Right to Choose means in England, why an ADHD referral might be delayed or declined and what practical steps you can take next. It does not guarantee that a referral must be made, because a GP still has to decide whether specialist assessment is clinically appropriate and certain legal exceptions apply.

Already choosing between services? Read our companion investigation: NHS Right to Choose ADHD Wait Times in England: August 2026 Audit. It explains why the advertised assessment wait may be very different from the complete wait for diagnosis and medication.

The Right to Choose ADHD referral pathway

The diagram below shows a typical journey. Individual providers and GP practices may use slightly different processes. NHS Right to Choose ADHD referral pathway A visual pathway beginning with preparing for a GP appointment, followed by clinical discussion, choosing an eligible provider, submission and review of the referral, assessment, and possible treatment. Side routes show what to check if the referral is declined, returned or delayed.

What does Right to Choose actually give you?

In England, patients have a legal right in many circumstances to choose the provider and clinical team responsible for their first outpatient appointment when a GP makes an eligible referral.

This includes mental health referrals and can include an independent organisation where it provides the relevant service to the NHS under an appropriate contract.

The official NHS guidance on patient choice explains that many private hospitals and organisations can be chosen where they supply services to the NHS. The fact that an organisation also treats private patients does not automatically make a Right to Choose referral private or self-funded.

However, Right to Choose is not an automatic right to any referral you request. NHS England’s patient choice guidance says that the referring clinician should assess clinical appropriateness before making the referral.

In simple terms, there are two different decisions:

Is a specialist ADHD assessment clinically appropriate? This is a clinical referral decision.
If a referral is appropriate, which eligible provider should receive it? This is where patient choice may apply.

Confusing these two decisions can make discussions at the GP surgery unnecessarily confrontational.

Why might a GP not make the requested referral?

A referral may not proceed for several reasons. Some concern the right to choose a provider, but many are ordinary clinical or administrative problems.

1. The GP does not consider referral clinically appropriate

A GP might decide that there is not currently enough information to support specialist referral. They may want to explore sleep problems, anxiety, depression, medication effects, substance use, thyroid disease or another possible explanation for the symptoms.

This does not necessarily mean that the GP believes your difficulties are unimportant. ADHD symptoms can overlap with several other conditions, and a clinician may need to consider alternative or additional causes.

According to NICE’s quality standard for adults, adults presenting with symptoms suggestive of ADHD should be referred to an ADHD specialist for assessment when the symptoms began during childhood, are not explained by another psychiatric diagnosis and cause at least moderate impairment.

The GP is not expected to make the final ADHD diagnosis, but they do need enough information to judge whether specialist assessment is reasonable.

2. The selected organisation is not eligible for that service

Not every private ADHD clinic can accept NHS Right to Choose referrals. The selected organisation must provide the relevant service under a qualifying NHS contract.

A clinic might offer private ADHD assessments but not an NHS-funded Right to Choose pathway. Another organisation may hold an NHS contract for adult ADHD but not for children, autism or medication-only referrals.

Before speaking to your GP, use the provider’s dedicated NHS Right to Choose page rather than its general private-services page.

3. The provider does not cover your age group

This is a common source of returned referrals. Some services assess adults only. Others see children from a particular age, such as seven or eight, and may maintain separate referral forms for adults and younger patients.

A 17-year-old approaching their eighteenth birthday can fall into an awkward gap if the service’s age rules are not checked carefully.

4. Required documents are missing

A provider may require:

a GP referral letter;
an ADHD screening questionnaire;
a summary care record;
details of current medicines and physical health;
school information for a child;
an informant questionnaire from somebody who knows the patient well; or
evidence about symptoms and their effect on daily life.

If one of these items is absent, the provider may return the referral or wait for further information before adding the patient to its assessment list.

5. The referral was sent to the wrong place

Some organisations accept referrals through the NHS e-Referral Service, while others supply a dedicated secure email address or online professional form.

A referral sent to a general enquiries inbox may not enter the clinical pathway. The surgery may believe it has completed the task while the provider has no valid referral on its system.

6. Local NHS arrangements affect capacity

During our August 2026 waiting-time review, several providers warned that their ability to accept or process referrals differed between Integrated Care Board areas.

This can be especially confusing because a provider may advertise a standard national waiting time while also publishing a separate list of areas affected by funding or activity limits.

For the latest explanation of these regional differences, see our August 2026 Right to Choose ADHD waiting-times audit.

7. Right to Choose does not apply to the situation

The legal right has exceptions. The NHS mental health access guidance explains that a legal right to choose does not apply in some circumstances, including urgent or crisis treatment and certain situations where a person is already receiving care for the condition.

Other exclusions can apply to prisoners, some people detained in secure accommodation and serving members of the armed forces.

“My GP says we only use the local ADHD service”

This is one of the most frequently reported points of confusion.

A GP practice may have a familiar local referral pathway, a preferred form or a list of services commonly used by its clinicians. That administrative familiarity does not necessarily determine the full extent of a patient’s legal choices.

At the same time, it is better to approach the conversation as a request for clarification rather than telling the GP that they are breaking the law.

You could say:

I understand that the local ADHD service is the usual pathway. I have been reading the NHS Choice Framework and would like to ask whether an eligible Right to Choose provider could be considered if you agree that a specialist referral is clinically appropriate. I have brought the provider’s NHS referral information and forms.

This keeps the clinical decision separate from the provider-choice question and gives the GP something concrete to review.

What to bring to the GP appointment

You do not need to arrive with a perfectly prepared legal argument or a folder several inches thick. A clear page of notes is often more useful.

Include examples from several areas of life:

Work or education: missed deadlines, unfinished tasks, forgotten instructions or difficulty starting work.
Home: unpaid bills, lost keys, forgotten appointments or household tasks repeatedly left incomplete.
Relationships: interrupting, forgetting conversations, emotional impulsivity or difficulty sharing responsibilities.
Childhood: school reports, comments about daydreaming, restlessness, disorganisation or underachievement.
Safety: impulsive decisions, driving difficulties, accidents or medication errors.

Try to explain not only that a symptom exists, but how often it happens and what effect it has.

“I sometimes lose things” is vague. “I have replaced my door key three times this year and missed two placement mornings after being unable to find my travel pass” gives the clinician a clearer picture of functional impairment.

What to do if the GP declines the referral

First, ask why. The next step depends on the reason.

You might ask:

Do you feel that specialist ADHD assessment is not clinically indicated?
Is the concern about this particular provider?
Is additional information required before you can decide?
Does the practice believe Right to Choose does not apply in my circumstances?
What alternative assessment or support are you recommending?

If more information is needed, ask exactly what would be useful. For a child, that might include school observations. For an adult, it might involve examples of symptoms during childhood or evidence of current impairment.

You can request another appointment or ask whether another GP at the practice can review the situation. A second clinician may have more experience with ADHD or patient-choice referrals, although there is no guarantee that they will reach a different clinical decision.

Keep the tone factual. Write down the date, the reason given and any agreed next steps. This is helpful if the issue later needs to be reviewed.

What to do when a referral was sent but nothing happens

Silence does not always mean refusal. Referral processing can take weeks, and some providers ask patients not to contact them during an initial processing period.

Use this checklist:

Ask the GP surgery for the date the referral was sent.
Confirm the exact destination used.
Ask whether the provider’s required forms were attached.
Request the NHS e-Referral reference number if one exists.
Check the provider’s published processing time.
After that period has passed, ask whether the provider can confirm receipt.

A short email from the surgery confirming that a referral was “done” does not necessarily establish that it was complete, accepted or placed on the correct waiting list.

What if the provider returns the referral?

A returned referral is not always a final rejection. It may mean that information is missing or that the wrong form was used.

Ask the surgery or provider for the precise reason. Common correctable problems include:

an incomplete screening questionnaire;
missing medical history;
no summary care record;
incorrect age pathway;
missing parent or school information;
an unreadable attachment; or
the referral being sent to the private rather than NHS service.

Correcting the original referral may be quicker than beginning again with a different service.

When and how to make a complaint

A formal complaint is usually more effective after you have tried to establish what happened and given the practice an opportunity to resolve an administrative misunderstanding.

If you remain concerned, you can use the GP practice’s complaints procedure. Keep the complaint focused on the specific decision or process:

what you requested;
when you requested it;
what response you received;
why you believe the decision or handling should be reviewed;
the relevant NHS guidance; and
what outcome you are requesting.

For example, you might request a written explanation of why the provider was considered ineligible, confirmation that the applicable patient-choice rules were considered or correction of an incomplete referral.

The official NHS Choice Framework explains the routes available when someone believes their right to choice has not been respected. Depending on the circumstances, concerns may be raised with the GP practice, the relevant ICB or NHS England.

NHS England’s complaints guidance also explains that unresolved NHS complaints may ultimately be taken to the Parliamentary and Health Service Ombudsman after the relevant complaints process has been completed.

A complaint is not a shortcut to obtaining a diagnosis. Its purpose is to examine whether the referral request and patient-choice rights were handled correctly.

What happens after the referral is accepted?

Acceptance is an important milestone, but it is not the end of the process.

The provider may ask you, a family member or a school to complete additional questionnaires. It may request childhood evidence, medical observations or details of other mental health conditions. Some services will not begin the quoted assessment wait until this information has been returned.

An ADHD assessment should be more than a brief screening questionnaire. NICE guidance states that diagnosis should be made by a specialist psychiatrist, paediatrician or another appropriately qualified healthcare professional with training and expertise in ADHD.

The assessment commonly considers:

current symptoms and impairment;
childhood and developmental history;
education and employment;
family and relationship functioning;
physical and mental health;
alternative explanations for the symptoms; and
information from someone who knows the patient well, where available.

If ADHD is diagnosed, the clinician should discuss support and treatment options. These may include information about ADHD, environmental adjustments, psychological support and medication where appropriate.

Shared care is another decision—not an automatic handover

People sometimes assume that their GP will automatically prescribe ADHD medication after a specialist has adjusted the dose. In reality, the specialist may propose a shared-care arrangement, but the GP must be satisfied that it is appropriate and safe to accept responsibility.

Before choosing a provider, ask:

Who issues prescriptions during titration?
Who monitors blood pressure, pulse, weight and adverse effects?
What happens if the GP does not accept shared care?
Will the provider continue NHS prescribing?
Who completes annual specialist reviews?

A fast diagnosis is of limited practical value if the longer-term treatment arrangements are unclear.

Common myths about a delayed referral

“If my GP says no, they are definitely breaking the law.”

Not necessarily. The GP still has to decide whether the referral is clinically appropriate, and Right to Choose has exceptions. Ask whether the concern is the clinical need for referral or the choice of provider.

“Any private ADHD clinic can be used.”

No. The organisation must provide the relevant service under an appropriate NHS contract. Private availability alone is not enough.

“Once the email is sent, I am on the waiting list.”

Not always. The provider may need to check the referral, confirm eligibility and obtain missing information before adding you to its assessment queue.

“The published assessment wait includes medication.”

Often it does not. Medication titration may have a separate waiting list lasting several additional months.

“Right to Choose applies everywhere in the UK.”

No. The pathway discussed here applies principally to eligible patients registered with a GP in England. Wales, Scotland and Northern Ireland use different healthcare arrangements.

A calm, practical way forward

A stalled ADHD referral can feel personal, especially after somebody has gathered the confidence to ask for help. Most difficulties, however, become easier to address once the reason is identified.

Find out whether the problem concerns clinical appropriateness, provider eligibility, local arrangements or missing paperwork. Bring the official referral information to the GP appointment. Ask for decisions and next steps to be explained clearly. If an administrative error has occurred, give the practice an opportunity to correct it.

If the matter remains unresolved, use the appropriate complaints process and keep a written record of what happened.

Most importantly, do not choose a provider solely because one attractive number appears beside its name. Consider the complete pathway from GP referral to assessment, treatment and continuing care.

Compare the pathway before requesting a referral:

Our NHS Right to Choose ADHD Wait Times in England audit examines assessment waits, medication delays, regional differences and the questions patients should ask before choosing a service.

Sources and further information

Medical and legal disclaimer: This article provides general educational information and is not personal medical or legal advice. Right to Choose eligibility depends on individual circumstances, clinical appropriateness and current NHS arrangements. Speak to your GP and consult the current NHS Choice Framework for advice relevant to your situation. If you are in immediate danger or experiencing a mental health emergency, call 999 or attend A&E. For urgent medical help when it is not an emergency, contact NHS 111.

Corrections and updates

NHS guidance and referral arrangements may change. If you believe this article contains a material error or requires an update, please email pryhelmuk@gmail.com. Verifiable corrections will be reviewed promptly.