ADHD & ASD Right To Choose Process
This information is for patients who have asked their GP to refer them to a specialist service for an attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) assessment and/or treatment, under the NHS scheme ‘Right to Choose’ (RTC).
If the GP considers a referral to be appropriate, they will either write the referral letter and give it to you, or they will send it directly to your nominated service at your request. If you have any queries about the appointment, please contact the provider directly.
Whist services available are offered via the NHS and are free for patients, RTC services are often private companies who are contracted to deliver services to the NHS. When choosing a RTC service, it is important to consider the following points, relating to what you should expect from this process and your preferred service:
Choice
Your GP cannot choose for you. You need to research the options and make the choice yourself, then contact your GP to inform them of your chosen provider, and they will advise you on how to proceed. The list of providers is constantly changing, and the services’ websites are usually a good place to find out if they offer the service you need.
Referral
The number of RTC services is ever-growing and each service may have its own referral process. It can be difficult for your GP to complete multiple, and often lengthy referral processes. Most providers need a core set of information, so your GP may ask you to complete a questionnaire and a self-assessment score as part of a standardised referral. If the service needs additional information, they can request it from the practice or ask you directly.
Diagnosis, medication and follow-up
Some ADHD/ ASD clinics may ask your GP to perform tests like blood tests, ECGs (heart tracings), or weight and height measurements. However, these tests are the responsibility of the service and should be arranged by them to support their own assessment. Your GP is likely to decline such requests and advise the service to carry out any necessary tests they require themselves.
It is important to understand that many of the RTC services can offer diagnosis but are rarely able to prescribe medication on an ongoing basis, even if deemed appropriate. This means that you may be able to obtain a diagnosis, but often you will need a further referral to a local NHS service should they recommend you need to start medication to control your symptoms.
Before a local service will take over your care, they may require you to complete their own assessment, as not all assessments carried out by RTC services are universally accepted, and this may delay further treatment and follow up. Unfortunately, this is not something which can be easily avoided, as most medications suggested for these conditions are ones that GPs are not allowed to prescribe without the support of a specialist clinic under a ‘Shared Care Agreement’.
Your GP has no control over the waiting times for local NHS assessments, but we are aware that some waiting times nationally have been stated to be as long as 7 years. Some people still opt for a RTC service as they feel a diagnosis would be enough to request further support from school or employers, and many do not require medication.
Other things to consider
It is important to recognise that as many RTC ADHD/ ASD services operate as independent businesses, their ability to provide you with specialist care may suddenly cease if they stop trading or lose their NHS contract. This is one of the reasons your GP may consider it unsafe to prescribe on their behalf, given the requirement for ongoing review and monitoring of both your condition and specialist medication.
When you are choosing your RTC provider, you may find it useful to use this information to support your decision making, and to share these details with your chosen provider so that they are aware that their duty in performing tests and prescribing is unlikely to be taken over by your GP.