Right to Choose for GPs in England

This page is for GPs and other primary-care referrers in England. It summarises NHS England’s patient-choice guidance for referrers, Standing Rules regulation 39(6), and the Choice Framework’s first-outpatient choice right. It is not an instruction to refer to a named independent clinic. Clinical appropriateness stays with you. This site is independent, not the NHS, not a clinic and not a medical-defence body.

Written by Pete, editor, not a clinician. This is editor-researched information with named primary sources. It is not professional regulatory guidance and not a substitute for the documents linked below.

Who this applies to

  • GPs (and, in law, dentists and optometrists) in England considering an elective first-outpatient referral, including many ADHD and autism assessments.
  • Practice managers and interface-service clinicians handling those referrals on a GP’s behalf.
  • Patients’ representatives who want the referrer-facing tests rather than the patient GP script.

Legal rights to choice in mental health, learning disability and autism were introduced in 2014. NHS England states that remote ASD and ADHD assessments may be subject to the legal right when the other conditions are met. The Choice Framework applies to people of all ages. Children’s Right to Choose exists in those primary sources; a provider’s age band is that provider’s rule, not an adult-only statute.

Who this does not apply to

  • Referrers in Scotland, Wales or Northern Ireland.
  • A demand that you must refer to a named independent clinic regardless of clinical judgement. That is not what the Standing Rules or NHS England say.
  • Urgent, emergency or crisis care; maternity; cancer Faster Diagnosis Standard services; self-referrals; consultant-to-consultant referrals; people already receiving care for the same condition after an elective referral; detention under the Mental Health Act 1983; prison / prescribed accommodation; serving armed forces. See eligibility.
  • Treating NICE NG87, CG128 or CG142 as the legal basis for choice. They are clinical guidelines. They do not create, and do not repeal, Part 8.

What the legal right actually is

Official documents rarely use the brand “Right to Choose”. They say a legal right to choice of provider and team, or choice of where to go for a first outpatient appointment.

In England, if you make a clinically appropriate elective referral for a first outpatient appointment, the patient has a legal right to choose any clinically appropriate provider that already holds a qualifying NHS Standard Contract for that service with any integrated care board or NHS England — and a clinically appropriate team at that provider. For mental health, including many ADHD and autism assessment services, the first appointment may be with a consultant or a health care professional, and the team may be led by a named consultant or named health care professional. The same provider should usually continue any subsequent treatment required as a result of that referral, unless the diagnosis changes significantly or there are other clinical reasons to change provider.

A qualifying contract is an NHS Standard Contract that is signed and in effect before the referral date; is for the required service; requires the service from a specified location or sets access criteria (remote can count); and is not a contract solely for a named individual. If the responsible commissioner has no written contract with the chosen provider, the terms of the qualifying contract apply to that referral (regulation 39(7)).

Independent-sector providers who provide NHS services can appear on the NHS e-Referral Service alongside NHS providers. That is not “any private clinic”.

Clinical appropriateness — regulation 39(6)

“Clinically appropriate” means, in the opinion of the person making the referral, that the provider or team offers services clinically appropriate for that person for the referred condition.

NHS England’s guidance for primary-care referrers:

  • You determine clinical appropriateness, working within NICE and other relevant guidelines.
  • You are not required to refer to a provider or team you do not believe is clinically appropriate.
  • You should consider ongoing care after assessment, including how the service interacts with local pathways and shared-care protocols for prescribed medicines.

You may refuse a named provider on clinical grounds. You should not refuse solely because the provider is independent, out of area, or absent from a local preferred list — that is the NHS England / Standing Rules position. A practice policy of “we don’t do Right to Choose” is not how Part 8 describes the duty.

Patients on this site are told the same split: the referral decision is yours; destination choice is theirs if the legal tests are met.

Average five choices where practicable

The Choice Framework asks referrers to shortlist on average five choices where practicable, clinically appropriate, and preferred by the patient. That is not a hard legal minimum of five named independent clinics. Where fewer providers are clinically appropriate, say so.

NHS.uk describes booking via the NHS e-Referral Service, at the surgery or online from the shortlist in the appointment-request letter. The shortlist is selected by the GP — patients should tell you their preferences. Independent providers of NHS services can appear on e-Referral.

No prior commissioner approval

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.

ICB caps, Indicative Activity Plans, panels and prior-approval processes exist operationally in 2026. They do not repeal Part 8. This site will not tell patients that a named ICB has “banned” Right to Choose as law. See ICB restrictions. If choice was not offered at referral, NHS England says the commissioner must rectify.

Interface services (CAS, SPA, referral management) must not obstruct legal rights. Choice should be offered at the most appropriate point before the first outpatient appointment. They can still sit on the pathway.

Providers holding a qualifying contract must accept clinically appropriate referrals for that service where the legal rights apply, including non-contract-activity referrals from other commissioners.

Shared care and NICE

NG87 (ADHD, children, young people and adults): diagnosis only by a suitably qualified specialist; not solely on rating scales; primary care must not make the initial diagnosis or start medication in children and young people; medication initiated only by a trained specialist; after titration and dose stabilisation, prescribing and monitoring should be under shared-care protocol arrangements with primary care. NG87 does not mention Right to Choose, e-Referral, ICBs or independent-sector clinics. It does not force you to accept shared care as a matter of choice law. Whether you agree shared care is a local professional and contractual issue.

CG128 (autism under 19s) and CG142 (autism in adults) describe the content of a diagnostic assessment. They do not create the choice right. CG142’s recommendation of a single point of referral including self-referral for autistic adults is a NICE local-pathway recommendation. It is not the legal RTC right. Legal choice does not extend to self-referrals.

NICE guidelines are not mandatory; professionals must take them fully into account. They do not override individual clinical decisions.

Some independent providers claim they will continue NHS prescribing if you decline shared care; some do not prescribe. Those claims are on their own pages and on our providers index. We have not verified contracts.

e-Referral

Where you use the NHS e-Referral Service for this type of referral, include the patient’s preference on the shortlist where the provider is listed and you judge it clinically appropriate. Tell patients if a named organisation is not on e-Referral, and record why a listed preference is not clinically appropriate if that is your opinion.

If you are pressured to name a clinic

Patients may arrive with a printed script from How to ask your GP. That script is written as a request, not an order. It quotes regulation 39(6) and NHS England’s line that you are not required to refer to a provider you do not believe is clinically appropriate.

If you do refer, prior ICB approval is not required when the right applies. If you do not refer, record the clinical reason and, where practicable, offer other clinically appropriate choices (on average five, where practicable).

If choice itself is not offered, the patient’s complaints path is: referrer → ICB → NHS England (england.choice@nhs.net) → PHSO. NHS England investigates choice complaints. This site does not complain on anyone’s behalf.

Step by step (referrer checklist)

  1. Decide whether an elective first-outpatient referral is clinically appropriate at all (NICE NG87 / CG128 / CG142 as relevant).
  2. If yes, offer choice of provider and team among clinically appropriate qualifying providers. Shortlist on average five where practicable.
  3. Check the organisation claims a qualifying NHS Standard Contract for the service, in effect on the referral date. This website is not a contract register.
  4. Do not require ICB prior approval when the legal right applies.
  5. Use e-Referral where you use it for this pathway; put the patient’s preference on the shortlist if clinically appropriate.
  6. Discuss ongoing care, including titration and shared care if ADHD medication might follow. You are not forced by choice law to accept shared care.
  7. Do not let an interface service swallow choice before the first outpatient appointment.
  8. If your ICB has issued restricting GP guidance, remember Part 8 is still in force. See ICB restrictions.

Sources

Primary sources. Retrieved 1 September 2026.

  1. Patient choice guidance, NHS England, B1441, 19 December 2023 — for primary-care referrers: clinical appropriateness; NICE; no prior commissioner approval; e-Referral; shared-care conversation; subsequent treatment; remote ASD and ADHD assessments may be in scope; interface services must not obstruct; providers must accept clinically appropriate referrals where rights apply; commissioners must rectify if choice was not offered. Long-read · Publication record
  2. NHS Choice Framework, DHSC. Section 3 — first-outpatient choice of provider and team; on average five choices where practicable; applies to England, all ages; independent providers of NHS services on e-Referral; complaints path. HTML
  3. Standing Rules Part 8, SI 2012/2996 as revised, regulation 39(6) (clinically appropriate = referrer’s opinion); regs 38–42; SI 2023/1105 (in force 1 January 2024). Revised Part 8 · SI 2023/1105
  4. The NHS Constitution for England — informed-choice right; NICE-recommended treatments if the doctor says they are clinically appropriate; complaints rights. Does not create new legal rights. HTML
  5. NICE NG87 — ADHD diagnosis and management (clinical; silent on Right to Choose). NG87 · Recommendations
  6. NICE CG128 — autism under 19s: recognition, referral and diagnosis. CG128
  7. NICE CG142 — autism in adults: diagnosis and management. Self-referral recommendation is not the legal RTC right. CG142
  8. Your choices in the NHS, NHS.uk — e-Referral shortlist selected by the GP. NHS.uk

Secondary (illustration only):

  1. ADHD UK GP-letter tone — charity, not statute. Hub

Frequently asked questions

Must I refer to the independent clinic the patient names?

No. Regulation 39(6) makes clinical appropriateness your opinion. NHS England says you are not required to refer to a provider or team you do not believe is clinically appropriate.

Must I offer five providers?

On average five, where practicable, clinically appropriate, and preferred by the patient. Not a hard legal minimum of five named clinics.

Do I need ICB prior approval?

Not when the legal right applies.

Does Right to Choose apply to children?

Yes, where the tests are met. The Choice Framework is all ages. A named provider may still only accept certain ages.

Does NICE require the local NHS trust rather than an independent NHS-contracted provider?

No. NICE describes what a good assessment contains. Choice law describes who the patient may choose if the provider holds a qualifying contract and you judge it clinically appropriate.

Am I forced to accept shared care after an RTC diagnosis?

No. NG87 recommends shared-care arrangements after titration. Choice law does not force you to accept a shared-care protocol. Discuss aftercare before you refer.

What if our ICB has issued restricting guidance?

Operational restrictions exist in 2026. They do not repeal Part 8. Prior approval is not required when the right applies. If choice is not offered, the commissioner must rectify. Escalate: practice → ICB → england.choice@nhs.net → PHSO.

Can an interface service refuse to offer choice?

They must not obstruct the legal rights. Choice should be offered before the first outpatient appointment.

Is this official NHS guidance?

No. This is an independent England-only information site. The official texts are linked in Sources. Pete is an editor, not a clinician.

Next steps

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 tell GPs they must refer to a named independent clinic.