How to ask your GP for Right to Choose

Ask your GP in writing for a clinically appropriate elective referral for a first outpatient appointment, and name a preferred qualifying NHS-contracted provider if they judge a referral appropriate. The referrer decides clinical appropriateness — in law, that is their opinion. Do not tell a GP they must refer you to a named independent clinic regardless of clinical judgement. Prior ICB approval is not required when the legal right applies.

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 have checked eligibility and you are in England.
  • You want a GP, dentist or optometrist to consider an elective first-outpatient referral (often for ADHD or autism assessment).
  • You understand that clinical appropriateness is the referrer’s decision (Standing Rules regulation 39(6)).
  • You can name a preferred provider only as a preference, after checking that they claim a qualifying NHS Standard Contract on their own page. Start with the providers index.

NHS England’s guidance for primary-care referrers is that they determine clinical appropriateness, working within NICE and other relevant guidelines; they are not required to refer to a provider or team they do not believe is clinically appropriate; they should consider ongoing care after assessment, including shared-care protocols for medicines; and commissioner prior approval is not required when the patient exercises the legal right. The Choice Framework asks referrers to shortlist on average five choices where practicable, clinically appropriate, and preferred by the patient.

Who this does not apply to

  • People outside England.
  • Anyone trying to self-refer.
  • Using this script to order a GP to send you to a named independent provider “because Right to Choose says you must”. That is not what the law says.
  • Crisis, emergency, maternity, cancer Faster Diagnosis, prison, armed forces, Mental Health Act detention, or already-in-treatment-for-the-same-condition situations — see eligibility.
  • Asking the GP to skip a judgement about whether assessment is needed at all.

If the practice will not offer choice at all, that is a different problem: If your GP refuses.

Step by step

  1. Confirm eligibility on eligibility and skim What is Right to Choose?.
  2. Note why you are asking for assessment, in your own words (impact at home, work, education, two or more settings for ADHD as NG87 describes, or the social-communication pattern CG128/CG142 describe). Do not claim a diagnosis. This site is not diagnostic.
  3. Pick a preferred provider as a preference, from organisations that claim an NHS contract on their own RTC page. Use the providers index. Copy their public URL. Do not assume this site has verified the contract.
  4. Think about aftercare. If ADHD medication might follow, ask how titration and shared care would work. NHS England tells referrers to consider this. GPs are not forced by choice law to accept shared care.
  5. Send or take the script below. Ask for it to be filed in your record. Request e-Referral where the practice uses it, and that your preference appears on the shortlist.
  6. Give the GP room to disagree on clinical grounds. Ask them to say so in writing if they do, and to offer other clinically appropriate choices where practicable (the Framework’s “on average five”).
  7. Do not attach an ICB prior-approval form as if it were legally required. NHS England says it is not, when the legal right applies.
  8. If you get a blanket “we don’t do Right to Choose”, keep the written reply and go to If your GP refuses.

Charity illustration only (not law): ADHD UK publishes GP-support letter tone along the lines of “your GP writes the referral letter, you can write the envelope.” The envelope is your preference. The letter remains a clinical referral.

Printable GP script (plain English)

Copy, complete the brackets, and take this to the practice or send it via their online consultation tool. It is a request, not a demand.

To: The GP / referring clinician, [practice name]
From: [full name], date of birth [DOB], NHS number [if you have it]
Date: [date]
Subject: Request for a clinically appropriate elective referral — choice of provider and team

Dear Doctor,

I am asking you to consider an elective referral for a first outpatient appointment for [ADHD assessment / autism assessment / both / other, in your words].

I am not asking you to diagnose me in this letter, and I am not asking you to refer me against your clinical judgement.

Why I am asking
[In a few sentences: how long the difficulties have been present; where they show up — for example home, work, education, relationships; what impact they have; any previous relevant history. Keep to facts you can stand by.]

The legal right I am asking you to apply if you do refer
In England, if a GP, dentist or optometrist makes 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, the team may be led by a consultant or a named mental health professional. Official publications call this the legal right to choice of provider and team. “Right to Choose” is patient-facing shorthand.

I understand, and I am not disputing, that:

  1. You decide whether a referral is clinically appropriate, and whether a particular provider and team are clinically appropriate for me. Standing Rules regulation 39(6) defines “clinically appropriate” as, in the opinion of the person making the referral, the provider or team offering services clinically appropriate for that person for the referred condition.
  2. NHS England’s patient-choice guidance (19 December 2023) says referrers determine clinical appropriateness, working within NICE and other relevant guidelines, and are not required to refer to a provider or team they do not believe is clinically appropriate.
  3. If you do make an elective referral, commissioner prior approval is not required when this legal right applies, even if our integrated care board has no written contract with the chosen provider.
  4. A qualifying contract is an NHS Standard Contract signed and in effect before the referral date, for the required service, from a specified location or with stated access criteria (which can include remote delivery), and not a one-person spot purchase.

My preferred provider, if you judge a referral appropriate
If you decide that an elective referral is clinically appropriate, my preference is:

  • Organisation: [name]
  • Service: [e.g. adult ADHD assessment / autism assessment aged …]
  • Their public Right to Choose or NHS-patient page (their claim, not a contract I can verify): [URL from the providers index or the organisation’s own site]

Please check, before you send a referral, that they hold a qualifying NHS Standard Contract for this service that is in effect on the referral date. I know you are not obliged to use this organisation if you do not believe it is clinically appropriate.

If this organisation is not clinically appropriate in your opinion
Please tell me why, in writing, and offer other clinically appropriate choices. The NHS Choice Framework asks referrers to shortlist on average five choices where practicable, clinically appropriate, and preferred by the patient. I understand that is not a hard legal minimum of five named clinics.

Aftercare
Please consider ongoing care after assessment, including how any service would interact with local pathways and, if medicine might be recommended, with shared-care protocols. I understand choice law does not force you to accept shared care.

How to send it
Please use the NHS e-Referral Service if you use it for this type of referral, and include this preference on the shortlist where possible. I am happy to complete any questionnaires you need.

Documents I am pointing to (for your convenience, not as legal advice)
– NHS Choice Framework, section 3: https://www.gov.uk/government/publications/the-nhs-choice-framework/the-nhs-choice-framework-what-choices-are-available-to-me-in-the-nhs
– NHS England, Patient choice guidance, 19 December 2023: https://www.england.nhs.uk/long-read/patient-choice-guidance/
– Standing Rules Part 8 (revised), including regulation 39(6): https://www.legislation.gov.uk/uksi/2012/2996/part/8

Thank you for considering this. I would be grateful if this letter is filed in my record, and for a written decision either way.

Yours sincerely,
[name]
[contact details]

Sources

Primary sources. Retrieved 1 September 2026.

  1. Patient choice guidance, NHS England, 19 December 2023 — section for primary-care referrers: clinical appropriateness; NICE; no prior commissioner approval; e-Referral; shared-care conversation; providers must accept clinically appropriate referrals where legal rights apply. Long-read
  2. NHS Choice Framework, section 3 — what to ask for (choice of provider and team at first outpatient appointment); on average five choices where practicable; independent providers of NHS services on e-Referral. HTML
  3. Standing Rules Part 8, SI 2012/2996 as revised, regulation 39(6) — clinically appropriate means in the opinion of the person making the referral. Also regs 38–39 generally. Revised Part 8
  4. SI 2023/1105, in force 1 January 2024 — subsequent treatment; qualifying contracts; interface services. As made

Secondary (illustration only):

  1. ADHD UK GP-letter tone and hub — charity, not statute. Hub · Learn

Frequently asked questions

How do I ask my GP for Right to Choose?

Write a request for a clinically appropriate elective first-outpatient referral, explain the impact in your own words, name a preferred qualifying provider as a preference, and leave clinical judgement with the GP. Use the script on this page.

Can I tell my GP they must refer me to a named clinic?

No. Regulation 39(6) makes clinical appropriateness the referrer’s opinion. NHS England says referrers are not required to refer to a provider they do not believe is clinically appropriate.

What should I take to the appointment?

The script, your notes on impact, and the provider’s public URL. Optionally the three official links in the script.

Does the GP have to offer five providers?

The Choice Framework asks for 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.

Do I need the ICB to approve the referral first?

Not when the legal right applies. NHS England says prior commissioner approval is not required.

Should the referral go through e-Referral?

Where the practice uses the NHS e-Referral Service, yes — tell them your preference so it can appear on the shortlist. NHS.uk also describes booking from the shortlist in the appointment-request letter.

What if the GP says the independent provider is not clinically appropriate?

Ask for the reason in writing and for other clinically appropriate choices. You can then use If your GP refuses if choice itself was not offered, or if the reason is “out of area” / “we don’t do Right to Choose” rather than a clinical view about you.

Do I have to mention NICE?

Helpful, not mandatory. For ADHD, NG87 is the clinical guideline; for autism, CG128 (under 19s) and CG142 (adults). They do not create the legal right. See Right to Choose ADHD and Right to Choose autism.

Will this force shared care later?

No. Ask the GP to consider aftercare. Choice law does not force a GP to accept a shared-care protocol.

Can a dentist or optometrist make the referral instead of a GP?

The legal referrers are a GP, dentist (GDP) or optometrist. In practice, ADHD and autism assessments are almost always GP referrals.

Is this site writing to my GP for me?

No. This is a script for you to complete. We are not a referral service.

Where do I find providers to name?

The providers index. Treat every row as that organisation’s claim.

Next steps

This GP script is a request, not an order.

  1. Confirm eligibility.
  2. Choose a preference from the providers index.
  3. Send the script.
  4. If the practice refuses to offer choice, use 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.