Right to Choose for mental health care (including all aged Autism and ADHD)

In England, all NHS patients have a legal right to choose the service or hospital that provides their physical and mental health care.

This means people can make choices that best suit their individual needs and enables people to be more involved, and have more control over, their care.

For mental health services, this means people have the right to choose their mental health provider and their mental health team. This is known as ‘Right to choose’ and is part of the national NHS Choice Framework. 

For example, if a GP refers someone for an ADHD or an autism assessment, in most cases, that person (or their parent or carer) can choose the provider that best suits their needs. When considering the right service, people may consider the service location, waiting times and other factors such as what the service offers. 

NHS England guidance: choice of provider and team in mental health care

Private assessments (outside of Right to Choose)

We know some people choose to pay for private assessments (which fall outside of the Right to Choose pathway).

It’s important to be aware that NHS services, including GPs, are not required to prescribe medication recommended by private providers. Where NHS services are requested to initiate medications or to take over medication reviews and prescribing following assessment and diagnosis by independent/ private providers, these requests must be accompanied by the relevant diagnostic reports that follow NICE guidelines and are NICE compliant.

This requirement relates to diagnostic reports from private providers, Right to Choose providers, and other NHS Trusts seeking to transfer care of the children and young people in their care to Neurodevelopmental services in Surrey or Sussex.  This decision will always be based on clinical judgement and NHS prescribing guidelines, so we would advise checking what services providers offer before you choose (some only offer assessments and some offer ongoing care).

Your questions answered

What do these rights mean for you and your family?

The legal rights to choice of mental health provider and team apply when :

  • A GP refers a patient for treatment when it is not urgent or an emergency (crisis)  and
  • A GP refers a patient for a first appointment with a chosen provider for a new episode of care  and
  • The patient is not already under the care of a provider or has previously received treatment from this provider for the same condition  and
  • the referral is clinically appropriate  and
  • the service and team are led by a consultant or a mental healthcare professional e.g. a psychologist  and
  • the chosen provider has a commissioning contract with NHS Surrey Heartlands or NHS England for the required service.

Prior commissioner approval is not required when the above apply.

When do the rights to choice not apply?

If any of the following describe your situation, the legal rights to choice do not apply.

Where a patient is:

  • already receiving mental health care following an elective referral for the same condition
  • referred to a service that is commissioned by a local authority, for example a drug and alcohol service (unless commissioned under a Section 75 Agreement)
  • accessing urgent or emergency (crisis) care
  • accessing services delivered through a primary care (GMS) contract
  • in high secure psychiatric services
  • detained under the Mental Health Act 1983
  • detained in a secure setting. This includes people in or on temporary release from prisons, courts, secure children’s homes, certain secure training centres, immigration removal centres or young offender institutions
  • serving as a member of the armed forces (family members in England have the same rights as other residents of England)

Talk to your GP about whether you can choose your provider.

What are the options to choose from?

The options available will depend on the referral that has been made by the GP and the type of service needed but generally people can choose from any service providers that provide a service to the NHS.

This may include charities, not-for-profit organisations and independent providers that deliver services as part of an NHS contract. 

How do I know which providers I can choose from?

If you need a referral into a mental health service, your GP will be able to talk you through the next steps and the options available to you, including your right to choose and providers that would be suitable and able to meet your, or your child’s needs.

You can also search for services online, although your GP would need to confirm an NHS contract is in place before they can make a referral – and they can check this with us (NHS Surrey and Sussex ICB).

Why can I only choose services that already provide an NHS contract?

We want to ensure that people are being referred to services that meet individual needs and meet NHS quality standards.

For that reason, under Right to Choose, GPs will only be able to refer to organisations that already meet these standards as part of an existing NHS contract – but there will still be many options available where an NHS contract is already in place, both locally and nationally. 

What about community care?

Community mental health care is covered by the legal rights to choice.

However, it is important to understand that community mental health teams are not obliged to travel to patients outside the area they are commissioned to serve. This means that patients must consider how they would travel to and from their chosen provider.

Does Right to Choose apply for adult mental health services, including Autism and ADHD services?

If you or a family member need a referral into an adult mental health service, including Autism and ADHD services, then Right to Choose may apply, but it would depend on the type of service you need.

For example, some services such as crisis support, would not be part of Right to Choose because people would need immediate support and timely access is really important.

There may also be some highly specialist services where a choice of service isn’t available because the service is so specialist.

Your GP will be able to advise you on whether there are different services or organisations that could provide the type of support you need. We would recommend talking to your GP about the options available. 

Can I use right to choose for my child’s autism or ADHD assessment?

ADHD assessments are available for children and young people who meet the referral criteria for this service.

We recognise the current waiting times are longer than we would want them to be, and whilst children are supported while they await an assessment, Right to Choose could be another option. If parents wanted their child to be seen by a different provider, they should discuss this with their GP. The GP can make the referral, as long as the provider already holds an NHS contract for providing autism or ADHD services. 

Providers often vary in the type of service they provide. Some offer assessment only, whilst some offer ongoing support. If you are considering Right to Choose, it is important to look at what the different services provide so your GP can make a referral to the service that best meets your child’s needs, including any ongoing support they may need. 

Is ADHD medication available for children and adults through Right to Choose?

Providers often vary in the type of service they provide.

For example, some organisations only offer assessments, whilst others offer ongoing support, including medication.

If you are considering Right to Choose, it’s important to look at what the different services provide so your GP can make a referral to the service that best meets your, or your child’s, needs, including any ongoing support they may need. 

How is a referral made for Right to choose?

Your GP would make a referral on your, or your child’s, behalf.

When you have your appointment, let them know if you are interested in considering a referral through Right to Choose. They can then advise you on the different options and the services that would be appropriate

I have had my first outpatient appointment, what happens now?

Once you have chosen your provider and attended your first outpatient appointment, you must be treated by that same provider for the entire episode of care for which you were referred.

That is unless the appropriate service cannot be provided, or professional opinion is that a patient is unsuitable to receive the relevant service.