You may use Right to Choose if you are in England, a GP, dentist or optometrist makes a clinically appropriate elective referral for a first outpatient appointment, and the provider already holds a qualifying NHS Standard Contract for that service with any ICB or NHS England. It does not apply in Scotland, Wales or Northern Ireland, does not allow self-referral, and does not apply in the listed exceptions.
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.
Who this applies to
Work through this list. All of the positive tests need to be true.
- England. The Choice Framework, the NHS Constitution for England, the Standing Rules and NHS England guidance apply to England.
- Elective referral by a GP, general dental practitioner or optometrist, including when first assessed by an interface service on their behalf, for treatment not immediately required (Standing Rules regulation 38).
- First outpatient appointment, for physical or mental health. For mental health — including many ADHD and autism assessments — 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.
- Clinically appropriate, in the opinion of the person making the referral (regulation 39(6)). The referrer is not required to refer to a provider or team they do not believe is clinically appropriate.
- Qualifying NHS Standard Contract already in effect before the referral date, held with any commissioning body (any ICB or NHS England), for the required service, from a specified location or with stated access criteria (which can include remote delivery), and not a contract solely for a named individual.
- Not an excluded situation (below).
The NHS Constitution says you have the right to make choices about services commissioned by NHS bodies and to information to support those choices, and that options develop over time and depend on individual needs.
Age is not a legal eligibility cut-off. The Choice Framework applies to all ages. A provider may still only see certain ages; that is that provider’s rule. See the providers index.
If the tests are met, choice applies at first outpatient appointment and any subsequent treatment required as a result of that referral, unless the diagnosis changes significantly or there are other clinical reasons to change provider. Commissioner prior approval is not required.
Who this does not apply to
Geography and referral route
- Scotland, Wales or Northern Ireland.
- Self-referrals. Legal choice does not apply.
- Consultant-to-consultant referrals.
- A clinic with no qualifying NHS Standard Contract for that service (purely private care is not Right to Choose).
Already in treatment / urgency / maternity / cancer
From the Choice Framework, NHS England guidance and Standing Rules regulations 40–41:
- You are already receiving care for the same condition after an elective referral. The right can apply to a new episode.
- Urgent, emergency or crisis care, or where urgent care is necessary.
- Maternity.
- Cancer Faster Diagnosis Standard services (the Choice Framework also lists urgent cancer / breast-symptom pathways).
- Local-authority-commissioned services, unless jointly arranged with the NHS.
Status exceptions (Standing Rules regulation 41)
- Detained under the Mental Health Act 1983.
- Detained in, or on temporary release from, prison or other accommodation listed in regulation 10(2).
- Serving as a member of the armed forces.
Clinical judgement is not “automatic eligibility”
Meeting the legal tests still requires a referrer who considers the referral, provider and team clinically appropriate. Right to Choose is not a right to a named private brand, and not a right to overrule clinical judgement.
A blanket practice line of “we don’t do Right to Choose” is not how the Standing Rules describe the commissioner’s and choice duties. A GP may still say this referral or this provider is not clinically appropriate. Those are different things. See If your GP refuses.
Provider rules are not national law
Examples of provider-published limits (claims on their own RTC pages, retrieved 1 September 2026 — not law, not a verification of their contracts):
- Some organisations say they see adults 18+ only for ADHD and/or autism.
- Some publish child age bands (for example from age 5, 6, 7 or 8).
- Some offer assessment only and do not prescribe; others offer titration; others say they will keep prescribing if the GP declines shared care.
Treat those as that provider’s rules. They do not rewrite Standing Rules eligibility. Check the providers index and the clinic’s own URL before you ask.
Step by step
- Confirm England and that you would be referred by a GP, dentist or optometrist — not by yourself.
- Confirm it is a first outpatient, elective, non-urgent assessment or treatment, and that you are not already in an episode of care for the same condition.
- Read the exceptions above. If you are in crisis, detained, in prison, serving in the armed forces, or on a maternity or Faster Diagnosis cancer pathway, this right is not the tool.
- Check the provider’s public contract claim and age/modality rules on the providers index. This site does not verify NHS Standard Contracts.
- Ask using clinical language, not an order. The GP script is written so the referrer keeps clinical judgement, including Standing Rules 39(6).
- Do not request prior ICB permission as if it were a legal requirement. NHS England says prior approval is not required when the legal right applies.
- If you are told you are ineligible for a reason that is not on this list (out of area; independent sector; “not on our preferred list”), that is the situation If your GP refuses is for. This site does not tell you your ICB has “banned” the right as a statement of law.
- For condition-specific clinical standards, which do not themselves decide eligibility, see Right to Choose ADHD (NG87) and Right to Choose autism (CG128 / CG142).
Sources
Primary sources. Retrieved 1 September 2026.
- NHS Choice Framework, DHSC. England; all ages; section 3 first-outpatient choice and the listed exceptions; complaints path. Published 29 April 2016; landing last updated 23 October 2024. HTML
- Patient choice guidance, NHS England, 19 December 2023. Who and what is out of scope (already in treatment for the same condition; urgent/crisis; maternity; cancer FDS; armed forces; prison; Mental Health Act; self-referral; consultant-to-consultant); qualifying contract; no prior approval; remote ASD/ADHD may be in scope. Long-read
- Standing Rules Part 8, SI 2012/2996 as revised. Regulation 38 (elective referral); 39 (choice, qualifying contract, clinically appropriate = referrer’s opinion); 40 (cancer FDS, maternity, urgent care); 41 (Mental Health Act, prison, armed forces). Revised Part 8
- SI 2023/1105, in force 1 January 2024. Subsequent treatment; qualifying-contract definition; interface services. As made
- The NHS Constitution for England. Informed-choice right; options depend on individual needs. Published 8 March 2012; landing last updated 17 August 2023. HTML
Frequently asked questions
Who is eligible for Right to Choose?
People in England who need a clinically appropriate elective first-outpatient referral from a GP, dentist or optometrist to a provider that already holds a qualifying NHS Standard Contract for that service, and who are not in a listed exception.
Does Right to Choose apply in Scotland, Wales or Northern Ireland?
No.
Can I self-refer if I am eligible?
No. Eligibility still requires a GP, dentist or optometrist elective referral. Self-referral is out of scope of the legal right.
Do I need to live in the same area as the provider?
The legal test is a qualifying contract with any ICB or NHS England for the service, plus clinical appropriateness. The provider must be accessible as the contract describes (including remote where that is how the service is commissioned). Your own ICB does not have to hold a written contract with that provider.
Do I need my ICB’s permission?
Not when the legal right applies. NHS England says commissioner prior approval is not required.
Does eligibility depend on age?
Not in the choice documents, which apply to all ages. Provider age bands are that provider’s rules. See Right to Choose autism and Right to Choose ADHD.
I am already on a local ADHD or autism waiting list. Can I still use Right to Choose?
If you are already receiving care for the same condition after an elective referral, the right generally does not apply to switching provider mid-episode. A new episode can be different. Whether your current list position counts as “already receiving care” is a facts-and-clinical question for the referrer and commissioner, not something this site decides.
I am in crisis. Can I use Right to Choose?
No. Urgent, emergency and crisis care are out of scope. Use emergency or crisis services, not this pathway.
I am in the armed forces, in prison, or detained under the Mental Health Act. Am I eligible?
Standing Rules regulation 41 says the choice duty does not apply in those situations.
Does a GP have to refer me if I am eligible on paper?
They still decide clinical appropriateness. Eligibility is not a voucher the GP must stamp. See the GP script.
Can my practice say nobody is eligible because “we don’t do Right to Choose”?
A practice-level refusal to operate choice at all is not how the Standing Rules and NHS England guidance describe the duty. A case-by-case clinical decision is different. See If your GP refuses.
Are independent clinics automatically eligible providers?
No. They need a qualifying NHS Standard Contract for the service, in effect before the referral, and the referrer must judge them clinically appropriate.
Next steps
You are on eligibility.
- If you think you are in scope, use the GP script.
- Check organisations that claim to take these referrals on the providers index.
- Recap the legal right on What is Right to Choose?.
- If the referrer will not offer choice, read If your GP refuses.
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.