What to do if your GP refuses a Right to Choose referral

Common reasons GPs give for refusing a Right to Choose referral.

"We do not do Right to Choose referrals." This is incorrect. The Right to Choose is a legal right, not a service the practice chooses to offer.

"You need to go through the NHS pathway first." This is incorrect. Right to Choose applies to your first outpatient appointment. There is no requirement to exhaust the NHS pathway first.

"That provider is not on our system." This is irrelevant. You choose the provider, not the practice. The practice refers to the provider you name, provided that provider holds an NHS contract.

"The CCG or ICB has told us not to." ICB guidance does not override your legal right. Some ICBs have issued guidance discouraging Right to Choose referrals for ADHD. This guidance is not legally binding and has been challenged successfully.

"I do not think you have ADHD." The GP does not diagnose ADHD. That is the specialist's role. The GP's job is to refer you for assessment if you present with symptoms consistent with ADHD. They do not need to agree that you have it.

None of these are valid reasons to refuse.

Before going back to your GP or escalating, gather the following.

A completed ADHD screening. The ASRS-v1.1 is the standard GP screener. If you score 4 or more out of 6, you have clinical evidence that assessment is warranted. We have a free screening tool on this site.

The name of your chosen provider. Confirm they currently accept Right to Choose referrals and hold an NHS contract. Psychiatry-UK, Clinical Partners, and ADHD 360 are common choices. Check their website for current availability.

The legal references. The NHS Constitution confirms your right to choose your provider for a first outpatient appointment. Section 75 of the National Health Service Act 2006 provides the statutory basis. NHS England's patient choice guidance explains the operational detail.

Written examples of how ADHD affects your daily life. Specifics are more persuasive than generalities. "I missed three deadlines last month and lost my car keys four times this week" is stronger than "I struggle with focus."

Ask your GP to record their refusal and their reason in your medical records. Say: "I understand you are declining my request. Please document your refusal and the reason for it in my notes."

This serves two purposes. First, it creates a paper trail for any future complaint. Second, it often prompts the GP to reconsider. Documenting an unlawful refusal is different from verbally declining. Most GPs understand the implications.

If the GP is unfamiliar with the Right to Choose, provide the following references.

The NHS Constitution, Section 3a, confirms your right to choose any clinically appropriate provider for your first outpatient appointment.

Section 75 of the National Health Service Act 2006 establishes the statutory basis for patient choice.

NHS England guidance on patient choice of provider explains the operational requirements for GP practices.

You can print these and bring them to your appointment, or send them by email to the practice in advance. A calm, factual approach works better than confrontation. You are not accusing anyone of wrongdoing. You are helping your GP understand a legal right they may not have encountered before.

Some providers, such as Psychiatry-UK, offer template letters you can give to your GP. These explain the Right to Choose and provide the referral details the GP needs.

If the GP still refuses after seeing the legal basis, submit a written complaint to the practice manager. Keep it factual and brief.

State that you requested a Right to Choose referral for an ADHD assessment. Name the date of the appointment and the GP you saw. State that the referral was refused and give the reason provided. Explain that the Right to Choose is established in the NHS Constitution and Section 75 of the National Health Service Act 2006. Name the specific provider you wish to be referred to and confirm they hold an NHS contract. Request that the referral is processed.

Most complaints are resolved at this stage. Practice managers understand the legal and reputational implications of denying patient rights. Keep a copy of your complaint and any response.

If the practice manager does not resolve the issue, you have several escalation routes.

Contact your local Integrated Care Board. Report a breach of patient choice. ICBs have a legal duty to ensure providers in their area comply with patient choice regulations.

Contact NHS England directly via their complaints process. You can do this online or by phone.

Contact your local Healthwatch organisation. They provide free, independent advocacy and can support you through the complaints process.

Contact your MP. If systemic issues with Right to Choose are affecting patients in your area, your MP can raise this formally.

Consider changing GP practice. This is your right and can be done at any time without giving a reason. Register with a new practice and request the referral there.

In the vast majority of cases, the referral is processed before you reach the ICB stage. The escalation path exists to ensure you are not left without options.

The Right to Choose as described here applies in England only. Scotland, Wales, and Northern Ireland have different NHS structures and patient choice frameworks.

In Scotland, you can request a referral to a specific provider, but there is no equivalent statutory right. In Wales, patient choice provisions are limited. In Northern Ireland, patient choice options are more restricted.

In all four nations, you can pursue a fully private assessment without a GP referral. Costs are typically 500 to 1,500 pounds. If you receive a private diagnosis, you can ask your GP to accept a shared care agreement for ongoing medication prescribing.