Three routes: NHS, Right to Choose or private?

Written by Peter Corkhill MSc, Content Editor, ADHD Junction. Last reviewed September 2026.

N.B. AI tools helped double-check official facts, guidance and terminology, locate primary sources, and reduce the risk of factual errors. The writing itself, I’m afraid, is mine.

I am compiling this in September 2026 when waiting times for ADHD assessments in England haven’t improved and there are still a huge number of people in the queue. Of course the situation can change, as can the assessments themselves, or the way the NHS decides how to allocate them, but for now the pressure on services remains considerable.

If your general practitioner (GP) thinks an ADHD assessment would be an appropriate next step, right now you have a few options available in England. The first is that your local NHS service might offer you an assessment. Secondly, you might be able to use the NHS’ Right to Choose option. The last alternative, or last resort perhaps, is to pay for the assessment yourself.

Recent increases in ADHD-related referrals and the longer waiting lists that follow mean that more people are feeling they have to seek an assessment as soon as possible. This sense of urgency means more people don't want to wait for the local NHS service and prefer to seek an assessment by other means. In the Government’s 2026 independent review into mental health conditions, ADHD and autism, it was reported that around 21,000 children and young people with open referrals were waiting for an ADHD assessment in mental-health services in April 2019. By December 2025, that figure had risen to an eye-watering 270,000 or thereabouts.

It's therefore small wonder that people who, in days gone by, might have waited for the local NHS to do their assessment, are now jostling to seek it by other means.

If you are still not reaching for the kettle out of boredom, I will now try to explain what these pathways are; whom they are available to; what they might cost you; and perhaps most importantly, what will be on offer after you've been to the assessment, assuming ADHD is diagnosed and you want some kind of further treatment.

But before making any sort of decision, this last point is worth pausing on. Why? Well, the ADHD assessments themselves are usually just the first step down the path and, for those who are diagnosed as having ADHD, the multi-faceted issue of medication, its prescribing and its ongoing management sits in a different part of the care pathway which not every assessor or organisation that performs assessments is able to offer.

So let's look at the routes in more detail.

Wales, Scotland and Northern Ireland have their own rules but in England specifically, depending on your age and where you live, once your GP or other appropriate clinician has had the initial discussion with you and given you the green light, you currently have three different gateways to pick from: standard NHS, NHS Right to Choose and fully private.

For adults, standard NHS means a conventional referral is made to the NHS service in that area. This varies considerably for children and young people, where the referral may involve community paediatrics, CAMHS or another neurodevelopmental team, and may to some extent involve the school itself. I would recommend finding out the specifics directly from your child's GP or paediatrician to be certain how this will work for you and your child specifically.

The second route is the ‘Right to Choose’ route.

It's the Right to Choose pathway that causes the most confusion or misinterpretation. Why? Because under Right to Choose, you may be referred to an independent provider rather than your local NHS trust, and it is easy to mistakenly think that because the organisation also operates privately, the assessment itself is chargeable. In this instance, the truth is good news! Right to Choose itself is part of the NHS service and therefore free at the point of use, as is the case with NHS services generally. So, just to emphasise this point, if your GP or other appropriate referrer considers an ADHD assessment clinically appropriate and refers you through Right to Choose, the cost of that NHS-funded assessment will be covered by the NHS.

Okay, we've covered the NHS-funded alternatives so all we've got left is the completely private option. Anyone choosing to opt out of what the NHS can offer and arrange to cover the costs of an assessment themselves as a private patient should discuss the fees with the individual provider before booking. It's worth noting that some providers offer assessments both privately and through Right to Choose, but even if a provider does offer Right to Choose, a direct private booking is not a Right to Choose referral. To benefit from the NHS covering the costs under Right to Choose, you have to reach the provider according to the NHS rules and through an appropriate NHS referral.

In summary:

Who can I use under Right to Choose?

In England, Right to Choose falls within the NHS Choice Framework, which gives people referred for certain outpatient services legal rights over which provider they use. NHS England says some remotely provided mental-health services, including ADHD assessments, may also be subject to those rights.

While choosing an ADHD assessment service is, in theory, an option, the term “any qualified provider” is potentially very misleading.

According to NHS England, in order for a service to qualify under these rights, the provider must have a current NHS Standard Contract with an ICB or NHS England. The service must also be included in the contract, and the contract must specify the location or method of service provision.

Therefore, from a legal perspective, a private clinic can't just become a Right to Choose provider because it carries out ADHD assessment services. On the other hand, it is not possible to choose any provider for your Right to Choose assessment because they may not meet the NHS requirements for that particular service. NHS guidance asks referrers, where practicable and clinically appropriate, to offer patients a choice from a shortlist of around five providers. That shortlist isn't necessarily the only group you're allowed to use under Right to Choose, and if none seem to fit with your preferences, another provider may also be available if it holds the required NHS contract and is clinically appropriate for your referral.

Don't forget what we mentioned earlier though: if you might want follow-up treatment such as medication, take into account that not every provider offers the same onward care. Some just provide an assessment, whilst others may also offer titration, prescribing and, later on, regular medical reviews of your progress and medication, so it is worth checking everything carefully.

'Right to Choose' is an English-only policy

The entire NHS Choice Framework we've discussed, including Right to Choose, is actually only available in the English NHS and not in Scotland, Wales or Northern Ireland, so people elsewhere in the UK should check their own local guidance.

When a GP won't refer you for an assessment

Getting assessed for ADHD through the NHS is not an automatic right and the referrer has to decide whether an assessment would be an appropriate next step. If your GP doesn't agree that a referral is appropriate, ask them to explain why. You can discuss the decision further and, if necessary, ask about obtaining another clinical opinion, although there is no automatic legal right to a second opinion.

If, however, your GP agrees that you should be referred but refuses to refer you to the provider you have requested, it is possible to ask why. There may well be a legitimate reason such as the provider not holding a qualifying NHS contract, but if you believe your legal right to patient choice has not been respected, you can raise the issue first with the practice and, as a last resort, contact your ICB or NHS England.

Switching from a local NHS waiting list to Right to Choose

If you haven't been referred for an assessment yet, or if you've only recently been referred, this part won't apply, but people who've been on the conventional NHS waiting list for what feels like a long time and then discover Right to Choose might understandably want to change providers.

While this is, in principle, possible, it is worth checking the waiting time with the replacement provider and finding out what will happen to your existing place before you switch.

Do not assume you can simply remain on both pathways. Local arrangements can differ. Leeds and York Partnership NHS Foundation Trust, for example, states explicitly that an assessment or treatment through Right to Choose replaces its local NHS pathway and that the patient is removed from its waiting list. That doesn't establish a national rule, so check what happens with your own service before changing provider.

What if I contact a Right to Choose provider directly?

Right to Choose is a pathway, not a provider or a trust, so a private provider may operate both Right to Choose and private services at the same time.

If you know someone who was assessed by a particular provider under Right to Choose and decide to contact that provider directly yourself, that does not make your booking NHS-funded. A direct private booking is not a Right to Choose referral and, if the provider accepts you privately, its private fees will apply.

If you want to use that same provider under Right to Choose, you need to discuss an appropriate NHS referral with your GP.

For private patients who choose to pay, a private clinic decides its own fees and charges and whether those charges cover things like a report, a follow-up appointment, medication, titration, private prescriptions and ongoing medical reviews, so it's important when comparing prices between providers to make sure you're comparing like-for-like.

Now, there is another potential source of confusion: the newly published NHS guide prices.

Why you can forget the NHS guide prices

Like me, you may well have seen the new NHS England guide prices for ADHD services for 2026/27 bandied about the internet. In fact, I've come across more than one interpretation of these figures that treats them as though they're an indication of what a private ADHD assessment should cost. This is misleading. These figures are not private-market prices or going rates at all. NHS England describes its guide prices as non-mandatory and intended to support local payment arrangements.

So what figures am I talking about? Maybe the best way to clarify them is via a few bullet points. NHS England states that for 2026/27, the final guide prices include:

• £850 for an adult face-to-face ADHD assessment
• £700 for an adult virtual assessment
• £950 for a face-to-face assessment for a child or young person; virtual assessment sits outside the national guide-price scope
• £400 for titration for both adults and children and young people
• £150 for an annual adult review where shared care has been accepted
• £265 for an annual adult review where shared care has not been accepted and the specialist provider continues the medication pathway
• for children and young people, £100 per three-monthly review with shared care and £130 per three-monthly review without shared care

This might sound all very well, but in August 2026 the NHS Alliance reported large variations in what integrated care boards (ICBs) were paying for ADHD and autism services, with one ICB reporting similarly specified services across different providers costing between £300 and £3,000.

The published coverage does not tell us when all of those prices were agreed, so the £300 to £3,000 range can't safely be treated as evidence that providers were ignoring the new 2026/27 guide prices. What it does show is that wide variation in NHS-funded prices was still being reported as a live problem in August 2026. The NHS Alliance's proposed answer was a mandatory national price, alongside a national service specification.

This issue with shared care

Once your medication has been fine-tuned and is stable, you will probably become familiar with the term shared care.

NHS guidance for adults with ADHD states that under a shared-care arrangement, a GP may be able to take on responsibility for medication management if the GP and ADHD specialist are in agreement. However, as the NHS service Oxleas tells patients, either the GP or the patient can decline the arrangement.

So discussing it early on with a GP is a good idea. If, for example, the GP is not willing to take on shared care, other care and treatment arrangements must be made.

For private patients, the potential financial consequences of a particular shared-care outcome should be examined carefully. Otherwise people might find themselves continuing to pay privately for prescriptions, specialist reviews and medication management, and an assessment which looked inexpensive can become considerably less so later on.

Transferring a private diagnosis to the NHS

If this is what you intend to do, it's critical to get to the bottom of whether it's possible and, if so, what's involved before getting a private assessment.

Generally speaking, after receiving a private ADHD diagnosis, undergoing titration and reaching a stable point with your medication, your GP may agree to enter shared care, but there are no guarantees.

Your local NHS ADHD service may also accept your private assessment, although it may wish to review the evidence. In some places, patients who wish to get treated by the NHS will still have to enter the NHS pathway and, in some cases, may still need to undergo the full NHS assessment process to be eligible for treatment.

So having a private ADHD diagnosis, I'm afraid, doesn't mean that you will automatically receive NHS prescribing for ADHD medication.

As a precaution, NHS guidance in Scotland makes it very clear that patients should check with their health board and GP practice before privately funding their assessment. They may refuse to provide treatment based on the private assessment.

The underlying advice here is to ask before you commit to a private assessment: if I obtain a private assessment and ADHD diagnosis, what will my local NHS ADHD service and GP do with that diagnosis?

Diagnosis-only providers and CQC registration

Care Quality Commission (CQC) status and unregistered providers can cause another kind of misunderstanding, in this case potentially harmful to good practitioners.

In March 2026, the CQC clarified that a service offering only ADHD or autism diagnosis, with no treatment, does not need to register with CQC merely to carry out that diagnostic work.

That of course does not mean that CQC registration is unimportant. It means that diagnosis alone, in those circumstances, is not a regulated activity requiring registration. A provider carrying out treatment or other regulated activities may still need to register, depending on what it actually provides.

Nor does the absence of CQC registration, by itself, mean that a diagnosis-only assessment service is sub-par if that service is not required to register. The more useful questions are what the provider actually does, who carries out the assessment and what happens after diagnosis.

What about 16 to 18 year olds?

Something worth taking into account if you’re booking for a child or if you’re a 16 to 18 year old is that the boundary between children's and adult services is not necessarily something which changes overnight on the 18th birthday.

In fact, NHS England's own ADHD payment guidance says the age at which someone is supported within children and young people's services can vary depending on where in England you live, and on needs and other clinical factors.

The National Institute for Health and Care Excellence (NICE) also recommends that transition from children's services to adult services should be planned according to the young person's development and circumstances rather than treated simply as a fixed-age event.

So if you’re 16 or 17, if I were you, I’d find out from my GP who will assess me, what happens after the assessment, and what happens if I turn 18 while waiting or during treatment. With waiting lists that can last years, this is important information.

Summing up

A lot of what follows is covered in depth on the website, in particular on the interactive “assessment comparison checklist”, but as you’re here, I thought it worth giving a quick mention. Feel free to ignore the rest of this article if you’ve already sussed these points out, but please don’t go before I tell you how impressed I am that you’ve stuck with me this far. Thank you.

So in summary, before I chose an NHS, Right to Choose or private provider, I would want clear answers to these points:

• Does the service assess adults, children and young people, or both?
• Who will actually carry out the assessment?
• If this is Right to Choose, does the provider hold the qualifying NHS contract for the service I need? Remember, a direct private booking is not a Right to Choose referral.
• What information will the assessor want from childhood, school records or somebody who knows me well?
• If ADHD is diagnosed, does the provider offer medication?
• Does it carry out titration itself?
• Who prescribes while titration is taking place?
• What happens once medication is stable?
• Will the provider ask my GP to accept shared care?
• What happens if my GP says no?
• Who provides the later specialist review?
• If I am paying privately, what is included in the quoted assessment price and what costs extra?
• If I later want NHS treatment, what happens to my private diagnosis?
• If I am already on an NHS waiting list, will choosing another NHS-funded provider remove me from it?

A provider should be able to explain those things without making you feel unreasonable for asking.

Making the decision

There is no single route that will suit everybody, but everyone should resist choosing an ADHD assessment simply by looking at the first available appointment or the number printed beside the word assessment. And everyone should also ask what happens afterwards.

Finally, if you decide to go ahead, the ADHD Junction resource Preparing for an ADHD Assessment looks at the sort of real-life examples and background information that may be useful to collect beforehand. The ADHD Junction Interactive Reflection Record can also help you make a note of experiences you may want to discuss with an assessor.