Right to Choose is patient-facing shorthand, not a phrase used in the official documents. In England, if your GP, dentist or optometrist makes a clinically appropriate elective referral for a first outpatient appointment, you have 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.
This page is independent information for people in England. It is not the NHS, not a clinic, not a diagnostic service and not a referral service. Written by Pete, editor, not a clinician.
Who this applies to
It can apply if all of the following are true:
- You are using NHS services in England. The Choice Framework, the NHS Constitution for England, the Standing Rules and NHS England patient-choice guidance apply to England.
- A GP, dentist or optometrist is making an elective referral — a referral for treatment that is not immediately required. That includes a referral first assessed by an interface service on their behalf.
- The referral is for a first outpatient appointment, for physical or mental health.
- The referrer judges the referral, the provider and the team clinically appropriate. In law, that means in the opinion of the person making the referral.
- The organisation you want already holds a qualifying NHS Standard Contract for the service you need, signed and in effect before the referral date, with any integrated care board or NHS England — not necessarily with your own ICB.
- 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.
Age is not a legal cut-off in the choice documents. The Choice Framework applies to people of all ages. A provider may still set its own age, modality or geography rules in its contract. Those are that provider’s rules, not a national adult-only law. Check eligibility before you ask.
If the tests are met, the same provider should usually continue any subsequent treatment that follows from that referral, unless the diagnosis changes significantly or there are other clinical reasons to change provider.
Who this does not apply to
The legal right does not apply if:
- You live in, or are using, the separate systems in Scotland, Wales or Northern Ireland.
- You want to self-refer. Legal choice does not extend to self-referrals.
- There is no clinically appropriate elective referral. A GP is not required to refer just because you ask.
- The organisation has no qualifying NHS Standard Contract for that service (a purely private clinic is not Right to Choose).
- You are already receiving care for the same condition after an elective referral (a new episode can be different).
- Care is urgent, emergency or crisis; maternity; or cancer Faster Diagnosis Standard services.
- You are detained under the Mental Health Act 1983; in prison or on temporary release from prescribed accommodation; or serving in the armed forces.
- The referral is consultant-to-consultant, rather than from a GP, dentist or optometrist.
Local interface services (sometimes called CAS, SPA or referral management) must not obstruct the right. They can sit on the pathway. Choice should be offered at the most appropriate point before the first outpatient appointment.
This is also not the separate legal right about maximum waiting times (often described as 18 weeks). First-outpatient choice and waiting-time choice are different rights.
Step by step
- Check that you are in scope. Start with eligibility. England only; GP, dentist or optometrist referral; not self-referral; not an excluded situation.
- Decide what you are asking to be referred for. Right to Choose is condition-neutral in law. People often use it for ADHD or autism assessment because those are first outpatient, mental-health-professional-led services. See Right to Choose ADHD and Right to Choose autism. NICE guidelines describe how those assessments should be done; they do not create this right.
- Shortlist providers that claim a qualifying NHS contract. Use the providers index as a starting point. Check each organisation’s own page, and that it says it holds an NHS Standard Contract for the service you need. This site does not verify contracts and does not refer you.
- Ask the referrer. Take a plain-English request to your GP (or dentist or optometrist). We publish a printable-style GP script. 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 clinics.
- The referrer decides clinical appropriateness. They work 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 arrangements for medicines if relevant.
- No prior ICB approval is required when the legal right applies, even if your commissioner has no written contract with the chosen provider. If there is no written contract, the terms of the qualifying contract apply to that referral (often called non-contract activity).
- Booking. Many referrals go through the NHS e-Referral Service. Tell the referrer your preferred provider so it can appear on the shortlist.
- If choice is not offered. Speak to the referrer first. Then the local integrated care board, then NHS England at england.choice@nhs.net, then the Parliamentary and Health Service Ombudsman. See If your GP refuses.
Charity wording, not law: ADHD UK describes the split as “your GP writes the referral letter, you can write the envelope.” The referral decision stays with the clinician; destination choice is yours if the legal tests are met.
What the official documents actually say
Official publications 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 your GP, dentist or optometrist makes a clinically appropriate elective referral for a first outpatient appointment, you have 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 team may be led by a consultant or a named mental health professional. The same provider should usually continue any treatment that follows from that referral. This right does not apply in Scotland, Wales or Northern Ireland, does not allow self-referral, and does not apply in the situations listed in the NHS Choice Framework and the NHS Standing Rules. NICE guidelines describe how ADHD and autism should be assessed; they do not create this right.
A qualifying contract, in the current Standing Rules, is an NHS Standard Contract that:
- is signed and in effect before the referral date;
- is a commissioning contract for the required service;
- requires the service from a specified location or sets criteria for how the service is accessible (for example remotely); and
- is not a contract solely for a named individual.
Independent-sector organisations that provide NHS services can appear alongside NHS trusts. That does not mean “any private clinic”.
The NHS Constitution for England restates that you have the right to make choices about the services commissioned by NHS bodies and to information to support those choices. It does not create new legal rights. The detail sits in legislation and the Choice Framework.
Sources
Primary sources (law and official publications). Retrieved 1 September 2026.
- NHS Choice Framework — what choices are available to you in your NHS care, Department of Health and Social Care. Applies to England, all ages. Published 29 April 2016; landing page last updated 23 October 2024. Section 3 is the first-outpatient choice right. HTML · Landing
- Patient choice guidance, NHS England, publication B1441, last updated 19 December 2023. Qualifying contract with any ICB or NHS England; subsequent treatment; no prior commissioner approval; GP, dentist or optometrist referrers; mental-health-professional-led teams; remote ASD and ADHD assessments may be in scope. Long-read · Publication record · Choice hub
- NHS Standing Rules, Part 8 (choice of health service provider), SI 2012/2996 as revised. Regulations 38–41: elective referral; choice of clinically appropriate provider and team; “clinically appropriate” is the referrer’s opinion (reg 39(6)); qualifying contract; exceptions. Revised Part 8
- The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) (No. 2) Regulations 2023, SI 2023/1105. Made 17 October 2023, laid 19 October 2023, in force 1 January 2024. Extends choice to subsequent treatment after the first outpatient appointment and defines qualifying contracts. As made
- The NHS Constitution for England, Department of Health and Social Care. Published 8 March 2012; landing last updated 17 August 2023. Informed-choice right; does not create new legal rights. HTML
- Your choices in the NHS, NHS.uk. Page last reviewed 10 May 2023 (review overdue as of 1 September 2026; still live). Plain-English patient page. Prefer the Choice Framework and the 2023 NHS England guidance for 2026 detail. NHS.uk
Secondary (not law):
- ADHD UK, NHS Choices and Right to Choose hub. Charity explanation, including “GP writes the referral letter, you can write the envelope.” Hub · Learn
Frequently asked questions
What is Right to Choose?
It is shorthand for the legal right, in England, to choose a clinically appropriate provider and team for a first outpatient appointment when a GP, dentist or optometrist makes a clinically appropriate elective referral to an organisation that already holds a qualifying NHS Standard Contract for that service.
Is Right to Choose a legal right?
Yes, where the tests are met. Some NHS choices are legal rights; others are local policy. First-outpatient choice of provider and team is a legal right, with listed exceptions, in the Choice Framework and in Part 8 of the Standing Rules.
Does the NHS Constitution create Right to Choose?
No. The Constitution restates rights that already exist in legislation, plus non-legal pledges. The enforceable detail is in the Standing Rules and the Choice Framework.
Does Right to Choose apply in Scotland, Wales or Northern Ireland?
No. The Choice Framework, Constitution, Standing Rules and NHS England guidance apply to England.
Can I self-refer using Right to Choose?
No. NHS England’s patient-choice guidance is explicit: the legal rights do not apply to self-referrals. You still need an elective referral from a GP, dentist or optometrist.
Does my GP have to refer me to the provider I name?
No. The referrer decides whether a referral is clinically appropriate, and whether that provider and team are clinically appropriate for you. They are not required to refer to a provider they do not believe is clinically appropriate. They should not refuse solely because the provider is independent, out of area, or not on a local preferred list — that is the official position, not a guarantee every practice complies.
Does the provider need a contract with my ICB?
No. The provider needs a qualifying NHS Standard Contract with any commissioning body (any ICB or NHS England) for the service, in effect before the referral. If your commissioner has no written contract with that provider, the qualifying-contract terms still apply to that referral.
Is Right to Choose the same as the 18-week waiting-time right?
No. Maximum waiting-time choice is a separate legal right. First-outpatient provider choice does not guarantee a shorter wait.
Does Right to Choose cover ADHD and autism?
The regulations do not name ADHD or autism. They are condition-neutral. NHS England says remote ASD and ADHD assessments may be subject to the legal right when the other conditions are met. NICE guidelines on ADHD and autism do not create the right.
Do I have to pay for a Right to Choose assessment?
NHS-funded care is free at the point of use except for limited Parliamentary exceptions, such as standard prescription charges if medicine is later prescribed. This site does not charge an NHS fee. A purely private assessment is not Right to Choose.
What is a qualifying NHS Standard Contract?
An NHS Standard Contract, signed and in effect before the referral, 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.
Can an independent provider be a Right to Choose provider?
Yes, if they hold a qualifying NHS Standard Contract for the service and the referrer judges them clinically appropriate. Independent providers of NHS services can appear on e-Referral alongside NHS providers. That is not the same as any private clinic.
Next steps
- Read eligibility — including who is out of scope.
- Use the GP script if you are ready to ask for a clinically appropriate elective referral.
- Browse the providers index for organisations that claim to accept these referrals. Check their own pages. This site does not refer you and does not rank clinics.
- If choice is not offered, follow If your GP refuses.
For ADHD- or autism-specific overlay, continue to Right to Choose ADHD or Right to Choose autism.
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.