Information for families about Right to Choose neurodevelopmental assessments

All NHS patients in England have the legal right to choose their preferred healthcare provider for their first planned outpatient appointment. It means that you can ask your GP to refer your child to a provider of your choice for an autism or ADHD assessment. This includes one of the many private providers that have contracts with the NHS.

Even though you have a legal right to ask for a Right to Choose referral, it can only be made if:

• Your GP agrees that the referral is ‘clinically appropriate.’ This means that your child meets the criteria to be referred.
• The provider has a contract with an ICB somewhere in England to deliver autism and ADHD assessments for children and young people. This doesn’t have to be with Cheshire or Merseyside ICB.
• Your child has not been assessed for the same condition before.

The alternative to Right to Choose is a referral to an NHS healthcare provider that does neurodevelopmental assessments. In Cheshire and Merseyside this includes:

• East Cheshire NHS Foundation Trust
• Cheshire and Wirral Partnership NHS Foundation Trust
• Mid Cheshire Hospitals NHS Foundation Trust
• Countess of Chester Hospital NHS Foundation Trust
• Wirral University Teaching Hospital NHS Foundation Trust
• Alder Hey Children’s NHS Foundation Trust
• North Cheshire and Mersey NHS Foundation Trust
• Mersey Care NHS Foundation Trust
• Mersey and West Lancashire Teaching Hospitals NHS Foundation Trust

Your child would usually be referred to an NHS provider by their school/education setting, who knows your child well, rather than by their GP. This would happen following a discussion with you and an assessment of their needs.

1. Speak to your child’s key professional.

Right to Choose referrals can only be made by your GP. However, if you think your child might need an assessment for autism or ADHD, speak to their school/education setting (or similar key professional) first.

They may be able to support you and your child to complete a Knowing Me profile if it’s available in your part of Cheshire or Merseyside (the profiling tool is being rolled out to education settings during 2026-2027).

A Knowing Me profile helps everyone (including your GP) to understand your child’s strengths and needs, including what early support may help. You can complete the profiling tool even without an ADHD or autism assessment.

2. Make a GP appointment.

At your GP appointment, discuss your child’s needs and share the information you’ve gathered. The GP can then decide if a Right to Choose referral for autism or ADHD is ‘clinically appropriate.’ This means your child meets the criteria to be referred.

3. Ask for a Right to Choose referral.

If the GP thinks the referral is appropriate, you can ask to be referred to a Right to Choose provider instead of your local NHS ND service. Let the GP know which provider you’ve chosen. As long as that provider has a contract with an ICB somewhere in England to deliver autism and ADHD assessments for children and young people, your GP can make the referral.

4. Wait for assessment.

Once the referral is sent, the provider reviews it and decides whether to accept it. They might ask you for more information first. Your child then joins their waiting list to be assessed.

Note that Right to Choose providers don’t always offer follow-up care or medication. That means if your child does get an ADHD or autism diagnosis, they might need to get any ongoing care from your local NHS ND service.

See “Are Right to Choose assessments accepted by local NHS services?” for more information about how this might work.

If you think your child might need an assessment for autism or ADHD, the first step is to speak to their school/education setting (or similar key professional). Even though your child can only be referred to a Right to Choose provider by their GP, the GP will need information about how your child is affected at school, at home, etc. Key professionals can help you to gather this information.

See “How do I get a Right to Choose referral?” for more information.

Both NHS and Right to Choose providers should follow the same NICE guidelines (national standards) for autism or ADHD assessments. However, unlike NHS services:

• Some Right to Choose providers only offer virtual assessments. This might mean that they can’t start your child on ADHD medication (known as medication initiation) because this needs a face-to-face assessment.
• Right to Choose providers do not always provide ongoing follow-up support that your child might need. This might include sleep support, specialist nursing, or ADHD medication, for example.

In either case, you might need to be referred into an NHS ND service for ongoing support.

See “Are Right to Choose accepted by local NHS services?” for more information.

In some cases, yes.

Right to Choose is a legal right of every NHS patient in England. However, your GP cannot make a Right to Choose referral if:

• The referral would not be clinically appropriate. This means that your child does not meet the criteria to be referred for that condition. In this case, the GP won’t be able to make a referral to any provider, whether they’re an NHS provider or a Right to Choose provider.
• The provider does not have a contract with an ICB somewhere in England to provide autism or ADHD assessments to children and young people (it doesn’t have to be Cheshire or Merseyside). In this case, the GP could refer you to another Right to Choose provider that does have a contract.
• Your child has been assessed for the same condition before.

Ask your GP to explain why they have refused. It might be because they believe your child doesn’t meet the criteria for a referral for assessment. In this case, the GP would not be able to make a referral to any Right to Choose or NHS provider. If you disagree with this decision, you could ask for this decision to be clinically reviewed by another GP within the practice.

Your GP might refuse to refer you to a specific Right to Choose provider if that provider does not have a contract with an ICB anywhere in England to do autism or ADHD assessments for children and young people. In this case, you could consider being referred to a different provider who meets the requirements.

If you believe your GP has refused your referral without a valid reason, ask to speak to the practice manager in the first instance. They will be able to give you more information about your child’s individual case and let you know what options are available to you.

Many private or Right to Choose assessment providers will say that they are ‘NHS-commissioned’ on their ads and websites. In simple terms, this means they have a contract with an ICB in England to provide a healthcare service.

But keep in mind:

• This does not mean they are NHS providers.
• Their quality and safety standards may not have been checked by Cheshire and Merseyside ICB.
• Cheshire and Merseyside NHS ND providers might need to do extra quality and safety checks before they accept the assessment.

See “What are the risks of using Right to Choose providers?” for more information.

This depends on the provider. For the most accurate waiting times, you would need to contact individual providers directly.

Waiting time is one of the main reasons families ask for a Right to Choose referral.

Right to Choose providers can sometimes offer faster assessments. However, this is not always the case. There is now very high demand for Right to Choose assessments. This means that even with Right to Choose providers, waiting lists can be long.

It is also important to know that:

• Right to Choose providers do not always offer follow-up care. This means that even if your child is assessed quickly, they may still need to wait for NHS follow-up care (e.g., sleep support, specialist nursing, ADHD medication).
• Local NHS ND services might need to do extra checks following a Right to Choose assessment. This can mean follow-up care is delayed.

See “What are the risks of using Right to Choose providers?” for more information.

After a Right to Choose assessment (or self-funded/private assessment), you might ask for ongoing support or medication from your local NHS ND service. To provide this support, they will need to check that the Right to Choose assessment meets high safety and quality standards.

If the assessment doesn’t meet these standards, the ND service will need to do extra checks before they can offer ongoing support. This means:

• Your child may have to wait longer for support or medication.
• You might need to pay for support or medication privately while you wait.
• You might need to go through some or all of the assessment process again.

See “What are the risks of using Right to Choose providers?” for more information.

It depends.

Right to Choose providers do not always offer follow-up care or medication management. Your child might need to be prescribed medication by your local NHS ND service, but they may need to wait for this.

Some Right to Choose providers might want to work with your child’s GP to provide ongoing monitoring/prescriptions (known as ‘shared care’). However, it’s up to your GP to decide whether to provide shared care with any Right to Choose provider. Some GPs may not be comfortable working with a clinical provider they don’t know.

See “What are the risks of using Right to Choose providers?” for more information.

Yes, if you are wanting the medication to be prescribed under the NHS. Local NHS ND services are not able to expedite (fast-track) requests for medication after a private ADHD diagnosis. 

There are some possible risks or drawbacks to keep in mind if you’re thinking of using a Right to Choose provider. (These also apply to self-funded/private providers.)

Risk 1: Follow-up care

Right to Choose providers do not always offer follow-up care or ADHD medication after a diagnosis. This means that if your child needs ongoing support, you may need to get this from your local NHS ND service. There may be a wait for this support.

Risk 2: Quality and safety

Before your local ND service can take over your child’s ongoing care, they need to make sure that the Right to Choose assessment meets required safety and quality standards. These include NICE guidance, which is a set of national NHS rules for how assessment and diagnosis should be carried out.

Unfortunately, we have found that some Right to Choose assessments do not meet these quality or safety standards. That might be because:

• The assessment does not follow NICE guidelines.
• The report does not have enough details or evidence to support the diagnosis.
• The report is missing information from key professionals like school staff.

Risk 3: Delays to NHS follow-up care

If the assessment does not meet safety and quality standards, the local ND service will need to do extra checks before they provide ongoing support (e.g., follow-up care, ADHD medication).

These checks can take longer for some Right to Choose providers. Even though they have a contract with an ICB somewhere in the country, this might not be your own local ICB. This means that the provider will not have been quality-checked by Cheshire and Merseyside ICB, so we wouldn’t have information on the quality or safety of their service.

This can be frustrating for families because:

• Ongoing support might be delayed.
• They may have already been waiting a long time, even with a Right to Choose provider.
• If they want ongoing support or ADHD medication quickly, they may need to pay for it themselves.

Risk 4: No access to ADHD medication

Many Right to Choose providers operate virtually (online or by telephone). This might mean that they can’t start your child on ADHD medication (known as medication initiation) because this needs a face-to-face assessment. Your child might have to wait until an NHS ND service can do that assessment.

Some Right to Choose providers might want to work with your child’s own GP to provide ongoing monitoring/prescriptions (known as ‘shared care’). However, it’s up to each GP to decide whether to enter into a shared care arrangement. Some GPs may not be comfortable working with a provider they don’t know.

If you’re thinking about asking for a Right to Choose referral, speak to your child’s school or other key professional first.

There is a wide range of support available for children and young people through schools, education settings and other services. For example, you and your child may be able to complete a Knowing Me neurodiversity profiling tool with key professionals, e.g., school SENCo.

The Knowing Me tool can help everyone to better understand your child’s needs and put early support in place. You don’t need to have had an assessment or diagnosis to complete the tool, so your child can start getting support right away.

If you choose to ask for a Right to Choose referral, it’s important to know that:

• A Right to Choose referral can sometimes lead to faster assessment, but it doesn’t always lead to faster treatment or support.
• Right to Choose providers might not have been checked locally for their quality and safety standards. This might mean that NHS ND services can’t accept the assessment without doing extra checks.  
• If the NHS service needs to do extra checks, this may delay ongoing support. You may also need to go through parts of the assessment process again.

See “What are the risks of using Right to Choose providers?” for more information.

National guidance recommends that children are only assessed for ADHD from five years old. The minimum age for NHS ADHD services in Cheshire and Merseyside varies from five to six years old depending on their local policies. Even if a Right to Choose provider assesses your child, your local NHS ND service may not be able to offer follow-up care (e.g. medication) if your child is under their minimum age.

For children under five, speak to your health visitor and any other key professionals, e.g. nursery staff. They will be able to discuss with you how best to meet your child’s needs.

For autism assessments, NHS and Right to Choose referrals can be made at any age. Speaking to a health visitor or other key professional is also a good place to start. Some areas have child development centres that will do a full assessment and support plan for a child who meets their criteria.

Across Cheshire and Merseyside, we are training professionals in schools/education settings to complete a Knowing Me neurodiversity profiling tool with you and your child. This is a tool that helps everyone to better understand your child’s neurodevelopmental needs and offer the most appropriate support right away. It can be used by children of all ages, whether or not they’ve been assessed for autism or ADHD. Ask your health visitor or other key professional about the Knowing Me tool.