If choice of provider and team was not offered at elective first-outpatient referral in England, start with the referrer, then your ICB, then NHS England at england.choice@nhs.net, then the Parliamentary and Health Service Ombudsman. A GP may decline a referral they do not consider clinically appropriate. A practice policy of “we don’t do Right to Choose” is not how the Standing Rules describe the duty. This page is not legal advice.
This is independent information. It is not the NHS, not a clinic, not diagnostic advice and not a referral service. Written by Pete, editor, not a clinician. England only.
Who this applies to
Use this page if you are in England and one of these is true:
- You asked for choice at first outpatient referral (see How to ask your GP) and received no choice at all.
- You were told “this practice / this ICB does not do Right to Choose”, or that independent or out-of-area NHS-contracted providers are automatically banned.
- You were told you need prior ICB approval before a clinically appropriate elective referral can be sent, even though NHS England says prior approval is not required when the legal right applies.
- Choice was swallowed by an interface service (CAS, SPA, referral management) and never offered before the first outpatient appointment. Interface services must not obstruct the legal rights.
You should already have checked eligibility. If you are out of scope (self-referral, crisis, maternity, cancer Faster Diagnosis, prison, armed forces, Mental Health Act detention, already in treatment for the same condition), this complaints path will not create a right you do not have.
Who this does not apply to
- Scotland, Wales or Northern Ireland.
- A GP who has considered your request and explained, as a clinical opinion, why this referral or this named provider/team is not clinically appropriate. That is regulation 39(6) working as written. You can ask for other clinically appropriate choices. You should not treat a documented clinical opinion as an automatic “unlawful refusal”.
- Trying to force a named independent clinic regardless of clinical judgement. The GP script is written to avoid that.
- Anyone expecting this site to complain, refer, or litigate on their behalf. We do not.
Do not read this page as a promise of a court outcome, damages, or a guaranteed referral. The Constitution mentions complaints routes; the Choice Framework and NHS England set the choice-complaint path below. This site stops at the Ombudsman.
What is a refusal, and what is clinical judgement?
These are easy to mix up.
Clinical judgement (can be a lawful reason not to refer to that provider): the referrer does not believe a referral is needed, or does not believe that provider or team offers services clinically appropriate for you. Standing Rules regulation 39(6) defines “clinically appropriate” as the referrer’s opinion. NHS England says referrers are not required to refer to a provider they do not believe is clinically appropriate.
Not offering choice (the complaints path below): no shortlist; no discussion of provider or team; a blanket “we don’t do Right to Choose”; “only the local trust”; “independent providers are not allowed”; “your ICB has banned it so we cannot”; “not on our preferred list, so no”. NHS England is clear that ICBs must make arrangements so patients can exercise legal choice. Preferred-provider lists and activity plans are not described in that guidance as repealing the right. This site will not tell you that a named ICB has “banned” Right to Choose as a statement of law.
A practice-level “we don’t do RTC” policy is not how Part 8 of the Standing Rules, the Choice Framework, or NHS England’s 2023 guidance describe the duty.
Step by step — complaints path
Follow this order. Keep copies. Dates matter.
1. The referrer (GP, dentist, optometrist, or practice manager)
- Write. Ask what was decided and why.
- If the reason is clinical, ask them to record the opinion and to offer other clinically appropriate choices where practicable (Choice Framework: on average five, where practicable).
- If the reason is “we don’t do Right to Choose”, “out of area”, “independent not allowed”, or “ICB prior approval required”, quote the official tests: qualifying contract with any ICB or NHS England; no prior approval when the legal right applies; clinically appropriate = referrer’s opinion, not a practice ban.
- Give a clear deadline for a written reply (for example ten working days).
- The NHS Constitution says complaints should be acknowledged within three working days and investigated.
If this resolves it, stop. Send the referral via e-Referral where used, with your preference from the providers index.
2. The integrated care board (ICB)
- If the referrer still does not offer choice, complain to the local ICB that commissions your NHS care.
- Ask the ICB to rectify a failure to offer choice at referral. NHS England says commissioners must rectify if choice was not offered.
- Send: your letter to the practice, their reply, your eligibility notes, and the provider’s public contract claim (not this site’s verification).
- You can find ICB complaints details on the ICB’s own website. This site does not publish a live 42-ICB tracker.
3. NHS England — england.choice@nhs.net
- NHS England oversees ICB compliance with patient choice and investigates choice complaints from patients, providers and others. Informal resolution first.
- Email england.choice@nhs.net (the contact given in the Choice Framework and in NHS England’s patient-choice guidance).
- Explain that you have already raised it with the referrer and the ICB. Attach the paper trail.
- Ask them to advise, and to help the commissioner put choice back on the pathway.
4. Parliamentary and Health Service Ombudsman (PHSO)
- If it is still unresolved, the Choice Framework and the Constitution point to the Parliamentary and Health Service Ombudsman.
- PHSO is for unresolved NHS complaints, not a same-week override of a GP’s clinical opinion.
- NHS.uk’s choices page also describes: referrer first, then ICB, then PHSO. The current Choice Framework (section 11) inserts NHS England in that chain. Use the Framework path: referrer → ICB → NHS England → PHSO.
Charity / independent-admin wording (unofficial, not law): ADHD UK and Finally Seen describe similar escalation (written request, practice manager, ICB, NHS England, PHSO). Use them as navigation only. They are not official directories and not a court finding.
Sources
Primary sources. Retrieved 1 September 2026.
- NHS Choice Framework, DHSC — if you are not offered choice: speak to the GP, dentist or optometrist first; then the local ICB; NHS England can advise at england.choice@nhs.net; then the Parliamentary and Health Service Ombudsman. Published 29 April 2016; landing last updated 23 October 2024. HTML
- Patient choice guidance, NHS England, 19 December 2023 — if choice is not offered; NHS England investigates choice complaints; informal resolution first; ICBs must make arrangements so patients can exercise choice and must rectify if choice was not offered at referral; interface services must not obstruct. Long-read · Choice hub
- Standing Rules Part 8, SI 2012/2996 as revised, including SI 2023/1105 (in force 1 January 2024). Regulation 39(6) (referrer’s opinion); regulation 42 (commissioners must publicise and promote choice). Revised Part 8 · SI 2023/1105
- The NHS Constitution for England — complaints: acknowledgement within three working days; investigation; PHSO if unresolved. Informed-choice right. Published 8 March 2012; landing last updated 17 August 2023. HTML
- Your choices in the NHS, NHS.uk. Page last reviewed 10 May 2023 (review overdue as of 1 September 2026; still live). If not offered choice: referrer, then ICB, then PHSO. Prefer the Choice Framework’s inclusion of NHS England. NHS.uk
Secondary (unofficial escalation colour only):
- ADHD UK Right to Choose hub. Hub
- Finally Seen, Right to Choose (NHS-funded): what it is and how to use it, page last updated 21 May 2026. Independent administrative site, not NHS, not a law firm. Guide
Frequently asked questions
What if my GP refuses Right to Choose?
Write to the referrer first. If they are refusing to offer choice rather than recording a clinical opinion about you or a named team, complain to the ICB, then NHS England at england.choice@nhs.net, then PHSO.
Can my GP refuse because the provider is independent or out of area?
The official position is that the test is a qualifying NHS Standard Contract with any ICB or NHS England, plus clinical appropriateness. Out-of-area or independent status, on its own, is not the legal test. That is not a guarantee every practice complies — which is why the complaints path exists.
Is a “we don’t do Right to Choose” practice policy lawful?
This site will not describe a practice-level ban as lawful. Part 8 of the Standing Rules and NHS England’s guidance require arrangements so patients can exercise choice. A GP may still decline a referral that is not clinically appropriate.
Can my ICB ban Right to Choose?
NHS England says ICBs must make arrangements so patients can exercise the legal right, and must rectify if choice was not offered. Operational restrictions are reported by providers and secondary sites in 2026; that is not the same as the right having been repealed. This site does not publish “your ICB has banned RTC” as law.
Do I need prior ICB approval?
Not when the legal right applies.
Who do I email at NHS England?
england.choice@nhs.net — the address given in the Choice Framework and NHS England’s patient-choice guidance.
When do I go to the Ombudsman?
After the referrer and the ICB, and after NHS England has had a chance to advise, if the complaint is still unresolved. PHSO is the Choice Framework’s next step.
Will you take my GP to court?
No. This site does not represent you, take court action, or refer you.
What if the GP’s reason is “not clinically appropriate”?
Ask them to explain and to offer other clinically appropriate providers. Regulation 39(6) is their opinion. A documented clinical view is not automatically a complaints win. You can still complain if choice itself was never offered.
Should I start again with a different GP practice?
You have a separate Constitution right to choose a GP practice (unless there are reasonable grounds to refuse). Changing practice is a personal decision, not a shortcut this site recommends as the complaints path.
Does this apply to ADHD and autism?
Yes, where the legal tests are met. See Right to Choose ADHD and Right to Choose autism. The complaints path is the same because the right is condition-neutral.
Can this site complain for me?
No. Use eligibility, the GP script, and the providers index, then send your own letters.
Next steps
- Re-check eligibility.
- If you have not already made a written request, send the GP script.
- Name a preference only from organisations that claim a contract on the providers index.
- Then: referrer → ICB → england.choice@nhs.net → PHSO.
Last reviewed: 1 September 2026
Author: Pete, editor, not a clinician
Right to Choose Pathway is an independent England-only information site. It is not the NHS, not affiliated with the NHS, not a clinic, not a diagnostic service and not a referral service. It does not promise a referral, a diagnosis, shared care, a short wait, or a court outcome.