Adult ADHD on the NHS: how Right-to-Choose actually works, what the wait looks like, and what to do when your GP refuses

An adult who suspects they have ADHD, goes to their GP, and asks to be assessed on the NHS is being told, in 2026, that the local wait is somewhere between two and eight years. In some parts of England the local NHS adult ADHD service has simply closed its referral list.

This is not new, and it is not getting better on its own. What has changed is that more patients now know there is a second route — the NHS Right to Choose — and most of them are getting refused or fobbed off by their GP the first time they ask.

This article is about why that gap exists, what Right to Choose actually says, and the specific steps that work when a GP says no.

What the data says (and doesn't)

NHS England publishes most secondary-care waits in a single open dataset called RTT — Referral to Treatment. That is the source HospitalWaits.co.uk uses today for the 18 specialties we cover.

Adult ADHD is not in RTT.

It is published separately, in an experimental statistic called the ADHD Management Information, first released by NHS England in May 2025. Experimental means exactly what it sounds like: the methodology is still being agreed, the coverage is incomplete, and the trust-level comparisons that work for hip replacement do not work yet for ADHD. NHS England has been honest about this in the bulletin itself.

What the experimental data does show is that across the providers reporting, the median wait from referral to first appointment for an adult ADHD assessment is measured in years, not weeks, and that the spread between providers is wide enough that the national median is not a useful number for any individual patient. Royal College of Psychiatrists analysis of the same period estimates roughly 196,000 adults waiting for an ADHD assessment in England at the point the data was published, against an NHS adult mental-health service that was not designed for that volume.

That is the background. Now the part that matters.

Why Right to Choose changes the maths

Under the NHS Constitution and the legal regulations that sit underneath it, an adult patient referred for a non-urgent consultant-led service in England can choose any qualified provider that holds an NHS contract for that service. They do not have to accept the referral their local NHS Integrated Care Board defaults to.

In practice this means a patient referred for adult ADHD assessment can ask their GP to refer them to a specialist provider with a national Right-to-Choose contract — providers like Psychiatry-UK, ADHD 360, Clinical Partners, ProblemShared and several others — instead of the local NHS adult mental health trust.

The waits at those providers are not zero. They have grown sharply since 2023. But at the time of writing they are typically quoted in months rather than years — somewhere between three and twelve, depending on the provider and the route. That is the difference Right to Choose buys: not a queue jump, but a different queue, on a different contract, for the same NHS-funded assessment.

The thing every reader needs to understand is that this is a statutory entitlement, not a favour. It does not depend on the GP's view of whether the local pathway is "adequate". It does not depend on the patient already being on the local list. It is the patient's right, set out in the NHS Constitution and the NHS Choice Framework that NHS England re-published most recently in 2024.

The patient script: how to actually do it

The mechanics are simpler than most blog posts make them sound.

1. Pick the provider. Check the provider's website yourself to confirm they hold a Right-to-Choose contract for adult ADHD assessment in your part of England — most list this explicitly on a page titled "Right to Choose" or "NHS referrals". Note the exact provider name and the address they want on the referral.
2. Write to the GP. Either book a routine appointment to discuss it, or — and this is faster — send a written request via the practice's online consultation system or by letter. The request should say that you would like to be referred for an adult ADHD assessment under your NHS Right to Choose to a named provider, and ask the practice to send the referral via NHS e-Referral Service (e-RS) or, where the provider asks for it, by direct letter.
3. Be specific. A request that names the provider, the service, and the legal basis (NHS Constitution / Right to Choose) is much harder to deflect than a vague "can I be seen somewhere quicker".
4. If the GP refuses, ask for the refusal in writing. This is the single most useful step. Most refusals quietly disappear when a patient asks the practice to put the reason on record.
5. Escalate to the ICB. If the practice still refuses, the next stop is the Integrated Care Board's Patient Advice and Liaison Service (PALS) — every ICB has one — and the national NHS England Right-to-Choose patient guidance, which the ICB is required to operate within.

NHS England's own patient-facing guidance — Your choices in the NHS (last updated 2024) — sets out the same path in plainer language and is worth printing and taking to the appointment.

Why GPs sometimes refuse — and why the refusal is usually wrong

It is worth being fair to GPs here, because the refusal is rarely malicious.

The real reasons a GP says no to a Right-to-Choose ADHD referral usually fall into three buckets:

• Local-pathway concern. Some ICBs have asked GPs to default to the local NHS service first. That is a local preference, not a legal override of Right to Choose.
• Shared-care worry. GPs are anxious about agreeing to take over ADHD medication prescribing after a Right-to-Choose assessment, because of the controlled-drug monitoring involved. That is a real concern — see the next section — but it is not a reason to refuse the assessment referral.
• ICB or LMC pressure. A small number of ICBs have issued notes asking GPs to limit non-local referrals. Where these notes conflict with the NHS Constitution they do not override it; the Royal College of GPs and NHS England guidance are both clear on this point.

None of those reasons override the statutory right. A GP who says "we don't do Right-to-Choose referrals" is, in NHS England's own framing, incorrect. A GP who says "I have concerns about shared care after diagnosis" is raising a legitimate but separate question — and one the patient can address up front.

The shared-care problem (the bit most articles skip)

This is the part that needs honesty.

Right to Choose gets you the assessment. It does not automatically get you long-term medication on the NHS. Once a patient is diagnosed and titrated on stimulant or non-stimulant medication by a Right-to-Choose provider, that provider typically asks the GP to enter a shared-care agreement — the GP prescribes routine repeats on the NHS, the specialist remains responsible for review.

Shared care is voluntary. Some GP practices accept these agreements without difficulty. A growing number — citing controlled-drug monitoring workload, ICB pressure, and unfunded prescribing burden — are declining them. When the GP declines shared care, the patient is left either paying privately for medication on an ongoing basis (often £100–£300+ per month) or going back to the Right-to-Choose provider to keep prescribing privately on a long-term basis.

There is no clean answer to this in 2026. NHS England and NICE both recognise the problem; the British Medical Association has called it out; the Royal College of Psychiatrists has published guidance asking GPs to engage with shared care wherever clinically appropriate. None of that changes the day-to-day reality that the shared-care fight is a real fight, and the people who need to know about it most are the ones being told Right to Choose is a clean shortcut. It isn't. It is a much better starting point than the local 5-year wait, but the medication leg is a separate negotiation, and a reader thinking about Right to Choose should plan for it from day one — including asking the prospective provider, in writing, what their shared-care success rate is in your area.

What HospitalWaits does and doesn't cover

HospitalWaits.co.uk launched on the open NHS England RTT dataset, which covers 18 elective specialties. Adult ADHD waits are not in RTT — they are in the experimental ADHD Management Information dataset, which has a different structure, a different update cadence, and a different list of reporting providers.

V1 of HospitalWaits does not cover adult ADHD waits. We are not going to pretend otherwise.

It is the single most-requested expansion since launch — from working NHS GPs, from ADHD charities, and from patients themselves — and it is on the V2 roadmap. When the ADHD Management Information moves out of experimental status and onto a stable trust-level structure, we will add it to the site with the same rules we apply to RTT: source-linked, methodology-documented, no estimates, no commercial relationships with providers.

In the meantime, this article exists so that the people searching for "adult ADHD Right to Choose" find a credentialed, source-linked walkthrough that is not trying to sell them an assessment.

What this article is not

It is not medical advice. Whether ADHD assessment and treatment is right for you is a clinical conversation, and the GP and the assessing specialist are the right people to have it with.

It is not a guarantee that a specific Right-to-Choose provider will be the fastest for you in 2026 — provider waits have moved sharply over the last 18 months, and the only honest way to compare is to check each provider's current quoted wait at the moment you are referred.

It is also not a claim that Right to Choose solves NHS adult ADHD care. It does not. It is a workaround that exists because the local NHS pathway is structurally under-resourced. Fixing that is a different, longer, much harder argument — one that ADHD UK, the Royal College of Psychiatrists and NHS England's own ADHD Taskforce are leading.

Why we published this

Because the gap between "the NHS wait is 5 years" and "you have a legal right to choose a different provider whose wait is 6 months" is a gap a patient should not have to discover through luck.

The data is patchy, the route is statutory, the refusals are common, and the shared-care problem is real. Each of those four facts deserves to be in one place, written down honestly, by someone who is not selling the assessment.

If you are a patient on the local list, the route above is yours by right. If you are a GP, the NHS England guidance is on your side. If you are an ICB or a commissioner reading this — the data we will need from you in V2 is the experimental ADHD Management Information, broken down by provider, with methodology you are willing to stand behind.

— Mustafa

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Sources referenced in this article (please verify links before relying on any figure):

• NHS England, ADHD Management Information — experimental statistic, first published May 2025.
• NHS England, Your choices in the NHS — Right-to-Choose patient guidance, 2024 update.
• NHS Constitution for England, updated 2021 (sections on patient choice).
• Royal College of Psychiatrists analysis of adult ADHD waits, 2025.
• NICE NG87, Attention deficit hyperactivity disorder: diagnosis and management (shared-care guidance).
• British Medical Association statements on ADHD shared-care prescribing, 2024–2025.