ICB restrictions and Right to Choose

Integrated care boards in England have, in 2026, used operational tools — activity caps, Indicative Activity Plans, prior-approval or panel processes, e-Referral friction and booking pauses — that can make Right to Choose harder to use for ADHD and autism assessment. Those tools exist. They do not repeal Part 8 of the NHS Standing Rules. This site will not say that a named ICB has “banned” Right to Choose as a statement of law.

This is independent information. It is not the NHS, not a clinic, not diagnostic advice, not legal 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 you have been told that:

  • your ICB “does not do Right to Choose”, or has a cap, pause or prior-approval step for ADHD or autism choice referrals
  • the GP needs ICB permission before sending a clinically appropriate elective referral
  • only a local preferred-provider list is allowed
  • an interface service (CAS, SPA, referral management) will not offer choice

You should already have checked eligibility. If you are out of scope, operational friction is not the issue — the right does not apply.

Who this does not apply to

  • Scotland, Wales or Northern Ireland. See England, Scotland, Wales and Northern Ireland.
  • A GP who has recorded a clinical opinion that this referral or this named provider/team is not clinically appropriate. That is Standing Rules regulation 39(6), not an ICB “ban”. See If your GP refuses.
  • Anyone treating a clinic’s ICB pause list, a charity postcode tool, or a secondary blog as a court finding that the right has been abolished.
  • This page naming an ICB as having “banned RTC in law”. We will not.

What exists operationally in 2026

Providers who publish Right to Choose pages, and secondary patient sites, document operational restrictions in 2026. Typical forms:

  • Indicative Activity Plans (IAPs) and other activity or budget caps that affect how many appointments a provider will book for a commissioner’s patients
  • Prior approval, panels or interface sign-off before a referral is accepted or booked
  • Preferred-provider lists or e-Referral shortlists that omit independent NHS-contracted providers
  • Booking pauses a provider itself announces for named ICBs, sometimes while still accepting referrals onto a list

Those notes live on the provider’s own URL and, as dated snapshots, on our provider pages. They can change without a change in the Standing Rules. Check the provider and your ICB on the day.

A charity (ADHD UK) maintains local restriction notes and a postcode lookup, and says it does not believe those restrictions are legally or morally correct. That is advocacy, not a court finding. Finally Seen’s mid-2026 ICB guide reports that some ICBs have issued guidance, caps or prior-approval processes; as of 17 June 2026 their promised live 42-ICB tracker was not yet published. There is no live Finally Seen ICB snapshot index for this site to cite. Point to the ICB’s own site, the chosen provider’s ICB list, and (secondary) ADHD UK’s tools.

What the law and NHS England still say

The legal right is in Part 8 of the Standing Rules (SI 2012/2996 as revised, including SI 2023/1105, in force 1 January 2024). ICBs cannot disapply Part 8 by policy, IAP, or GP guidance. The regulations do not name ADHD, autism or “Right to Choose”; they are condition-neutral.

NHS England’s patient-choice guidance (19 December 2023) is explicit on the points that matter when an ICB process appears:

  1. Commissioner prior approval is not required when the patient exercises the legal right, even if the responsible commissioner has no written contract with the chosen provider.
  2. If the patient’s commissioner has no written contract, an implied contract on the terms of the qualifying NHS Standard Contract applies (non-contract activity). NCA should not be the long-term model for material flows; it is still how the guidance describes payment where there is no written contract. The guidance does not say the commissioner may refuse to pay because there is no local contract.
  3. The provider needs a qualifying contract with any ICB or NHS England for the service — not necessarily with your ICB.
  4. ICBs must make arrangements so patients can exercise legal choice. If choice was not offered at referral, the commissioner must rectify.
  5. Interface services must not obstruct legal rights. Choice should be offered at the most appropriate point in the pathway before the first outpatient appointment.
  6. Providers holding a qualifying contract must accept clinically appropriate referrals for that service where the legal rights apply, including NCA referrals from other commissioners.
  7. Preferred-provider lists and Indicative Activity Plans may affect capacity and booking. NHS England’s guidance does not describe them as abolishing the legal right.

Regulation 42: commissioners must publicise and promote the availability of choice.

A practice-level “we don’t do Right to Choose” line is not how Part 8, the Choice Framework, or the 2023 guidance describe the duty. A GP may still decline a referral that is not clinically appropriate.

Escalate path if choice is not offered

Keep copies. Dates matter. This is the Choice Framework path, aligned with NHS England.

  1. The referrer (GP, dentist, optometrist, or practice manager). Write. Ask whether the reason is clinical (regulation 39(6)) or “ICB prior approval / we don’t do RTC / not on the preferred list”. If it is the second kind of reason, quote: qualifying contract with any ICB or NHS England; no prior approval when the legal right applies. The NHS Constitution says complaints should be acknowledged within three working days.
  2. The local ICB. Complain to the integrated care board that commissions your NHS care. Ask it to rectify a failure to offer choice at referral.
  3. NHS England — england.choice@nhs.net. NHS England oversees ICB compliance with patient choice and investigates choice complaints. Informal resolution first. Attach the paper trail.
  4. Parliamentary and Health Service Ombudsman (PHSO) if it remains unresolved.

Detail, including what is and is not a refusal: If your GP refuses. Patient script: How to ask your GP. For referrers: Right to Choose for GPs.

This site will not complain, refer, or litigate for you. It does not promise judicial review.

Step by step

  1. Confirm eligibility.
  2. Read the chosen organisation’s own ICB/restriction note and the dated snapshot on our providers page for that clinic. Treat it as operational colour, not a repeal.
  3. Ask the GP using the GP script. Do not attach an ICB prior-approval form as if it were legally required when the right applies.
  4. If choice is not offered, follow the escalate path above.
  5. Check waits as snapshots only: waiting times. Do not assume a cap means “no lawful referral is possible”.

Sources

Primary sources. Retrieved 1 September 2026.

  1. Patient choice guidance, NHS England, B1441, 19 December 2023. No prior commissioner approval; qualifying contract with any ICB or NHS England; non-contract activity; ICBs must make arrangements and must rectify if choice was not offered; interface services must not obstruct; providers must accept clinically appropriate referrals where rights apply. Long-read · Publication record · Choice hub
  2. NHS Standing Rules, Part 8, SI 2012/2996 as revised — regulations 38–42 (choice duty; clinically appropriate = referrer’s opinion, reg 39(6); qualifying contract, including where the responsible commissioner has no written contract, reg 39(7); commissioners must publicise and promote choice, reg 42). Further refinement SI 2024/302. Revised Part 8
  3. SI 2023/1105, The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) (No. 2) Regulations 2023. Made 17 October 2023, in force 1 January 2024. Subsequent treatment; qualifying contracts; interface services. Not SI 2023/635 — that number is not the 2023 choice amendment. As made
  4. NHS Choice Framework, DHSC. If choice is not offered: referrer, then ICB, then NHS England at england.choice@nhs.net, then PHSO. HTML
  5. The NHS Constitution for England — informed choice; complaints acknowledgement within three working days; PHSO. HTML

Secondary (operational landscape only; not law; not a live 42-ICB register):

  1. ADHD UK, Right to Choose hub — local restriction notes and postcode tool; advocacy position on restrictions. Hub
  2. Finally Seen, ICB Right to Choose status 2026, page last updated 17 June 2026. Independent administrative site, not NHS, not a law firm. Live 42-ICB tracker not yet published on that date. They cite “SI 2023/635” in places — do not copy that number; the 2023 amendment is SI 2023/1105. Guide

Provider operational notes (claims/snapshots, not a finding that any ICB has banned the right): see each clinic on providers and that clinic’s own URL.

Frequently asked questions

Can my ICB ban Right to Choose?

Not as a statement of law on this site. NHS England says ICBs must make arrangements so patients can exercise the legal right, and must rectify if choice was not offered. Operational caps and pauses are documented in 2026; that is not repeal of Part 8.

Do I need prior ICB approval?

Not when the legal right applies. NHS England’s patient-choice guidance says commissioner prior approval is not required, even if your ICB has no written contract with the chosen provider.

What is an Indicative Activity Plan?

An operational commissioning tool that can affect how much activity a provider books. NHS England’s choice guidance does not describe IAPs as abolishing legal choice. They may still change how long you wait. Waits are snapshots — waiting times.

My GP says the ICB has banned independent providers.

Ask for that in writing. The legal test is a qualifying NHS Standard Contract with any commissioning body, plus clinical appropriateness. Independent or out-of-area status, on its own, is not the legal test. Then use the escalate path.

Which ICBs have restrictions?

This site does not publish a live 42-ICB “banned” list. Check your ICB’s own website, the chosen provider’s published ICB note, and (secondary) ADHD UK’s postcode tool. Provider pause lists are their operational snapshots.

Must an interface service offer choice?

Interface services must not obstruct the legal rights. Choice should be offered before the first outpatient appointment. They can still sit on the pathway.

Is SI 2023/635 the choice regulation?

No. The 2023 Standing Rules choice amendment is SI 2023/1105. Do not cite SI 2023/635.

Next steps

  1. Eligibility
  2. How to ask your GP
  3. If your GP refuses — referrer → ICB → england.choice@nhs.net → PHSO
  4. For GPs

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.