Right to Choose ASD & ADHD Pathways
Information on alternative referral options for ADHD & ASD assessment
If you are based in England under the NHS you now have a legal right to choose your mental healthcare provider and your choice of mental healthcare team, this includes for referrals relating to Autism and ADHD assessment. This applies to adults and children.
This important right means that, for instance, should you decide the waiting time for your ADHD or ASD assessment is too long, then you can choose an alternative provider to suit you.
Right to Choose within mental health is a relatively new scheme (since 2018) and as such, many patients are not aware of the options.
Who can offer Right to Choose assessments?
There are a number of clinics throughout the UK that can offer Right to Choose ADHD and/or ASD assessments. To become a’ Right to Choose’ clinic provider, the clinic must supply the same service to the NHS somewhere in England, they cannot be a private only clinic.
The provider’s website is usually a good place to start to find out if they offer the service you need as most will have a right to choose page if they offer an NHS service.
Which providers offer Right to Choose assessments?
This list of providers is constantly changing and there may be other clinics you may want to research too. The ADHD UK and the National Autistic Society websites have useful information
Things to consider about Right to Choose
It is important to note that many of the clinics mentioned in this leaflet can offer diagnosis but for ADHD some do not offer medication titration.
If they do not prescribe then you may be able to obtain a diagnosis but will need a local NHS referral should they find that you need to start medication to control your symptoms then you will need a further referral for post-diagnostic support. There is a waiting list for this service. Your GP cannot initiate or titrate medications used to treat ADHD.
When can you not use Right to Choose?
There are some restrictions on which patients are eligible for a Right to Choose assessment so you should read the NHS Right to Choose page carefully.
Process for requesting a Right to Choose referral from your GP
Talk to your GP, have an open and frank conversation about why you think you have ADHD and/or ASD. Talk about any and all mental health concerns you might have. The goal is to help you with your issues and the conversation often will be wider than just the query of ADHD / ASD.
Following that conversation your GP may suggest a referral for an official assessment. There are long waiting lists locally for an ADHD or ASD assessment in both adults and children’s services. You may wish to have a look at the websites mentioned above to see what your options and choices are.
What happens when I have chosen my clinic?
For all Right to Choose referrals, the patient, or their family if a child, will need to research and select a clinic themselves, it is not something the GP can advise on.
Once you have chosen which clinic you would like to have your assessment with and obtained the relevant forms, please send an email to us at Lordswood Medical Centre confirming who you have chosen and forward any forms. Please ensure any forms that are required to be completed by/for the patient are enclosed with this email together with the GP forms. This will enable us to process the referral efficiently. Send your email to admin.lordswood@nhs.net
How much quicker will Right to Choose be?
That depends on which clinic you choose and whether they can offer medication titration, should you need it. Each clinic has different waiting times which they should have on their websites. Generally they are shorter than NHS waiting times.
Some patients feel a diagnosis is enough to request further support / considerations from school or employers and some patients may not require medication for these conditions at all.
If I am prescribed medication which has been initiated and titrated by the provider, will my GP take over prescribing?
GPs are not specialists in these medications which is why we do not initiate or titrate them. However, once you are on a stable dose of medication we are happy to take over prescribing as long as the provider has a ‘shared care agreement’ in place.
A shared care agreement (or SCA) is a written agreement between a patient, their general practitioner (GP), and a hospital or clinic consultant that allows for the sharing of care for a specific health condition. The agreement details the responsibilities of each party, including who is responsible for prescribing, monitoring, and early referrals back to the Consultant where necessary.
A shared care agreement is usually made when a patient’s condition is stable or predictable, and with the patient’s agreement. The agreement allows the patient to continue taking their medicine from their GP, rather than having to visit the hospital.
Shared care agreements are voluntary for GPs, and they are not required to enter into them.
Generally we will accept shared care agreements to take over prescribing with NHS organisations as they meet the criteria laid out in the SCA proforma. However some remote organisations (providing digital or online only services) and private providers do not meet all of these criteria. Often the main problem is with initial tests needed for initiation of medications especially for children and ongoing monitoring requirements.
To start ADHD medications, NHS organisations will carry out some basic blood tests, patient’s height, weight, blood pressure and an ECG. Ongoing monitoring often requires blood pressure monitoring, height and weight measurements and a six monthly review in children and at least annual review in adults. This shared care agreement shows the investigations and monitoring required.
GPs cannot carry out private organisation requests for blood tests, ECGs or blood pressure monitoring as we do not have the requisite skills or equipment to do this safely in primary care in children. We are often asked to refer children for ECGs but many paediatricians do not have the capacity to carry this out at the hospital and we cannot refer to any other services for children so if the request is denied then it is up to the original requester to arrange this service (which may mean additional costs and referrals if you have gone privately).
In this situation if we are unable to provide shared care, you will need to continue accessing prescriptions from your private provider.