Right to Choose ADHD Explained for Commissioners UK
The Right to Choose framework in England allows patients to select an alternative provider for their NHS funded care, including ADHD assessments. For commissioners in local authorities and NHS clinical commissioning groups, understanding the Right to Choose ADHD pathway is essential for managing waiting lists, controlling costs, and ensuring that patients receive timely, high quality care. This guide explains the pathway in detail, highlights the key differences from autism Right to Choose, and offers practical advice for evaluating providers.
What is the Right to Choose ADHD Pathway?
The Right to Choose legislation, introduced under the NHS Constitution in England, gives patients the legal right to choose a provider for their first outpatient appointment, provided the provider holds a contract with an NHS commissioner. For ADHD, this means that a GP or another referrer can refer a patient to a private or NHS provider that meets the required standards, and the cost is covered by the patient’s local commissioner.
The pathway works as follows:
- A patient presents with suspected ADHD to their GP.
- The GP, following NICE guideline NG87, decides a referral is appropriate.
- The patient exercises their Right to Choose and selects a provider that is on the NHS e-Referral Service or has a direct contract.
- The provider conducts the assessment and, if appropriate, initiates treatment.
- After diagnosis, the provider may offer ongoing medication management or hand back to primary care for shared care.
Key criteria for a provider to be eligible under Right to Choose include:
- They must hold a contract with an NHS commissioner (often a CCG or NHS England).
- They must employ clinicians who are on the appropriate specialist register (e.g., General Medical Council specialist register for psychiatry, or Nursing and Midwifery Council register for specialist nurses).
- They must follow NICE guidelines for ADHD (NG87) including the use of standardised diagnostic tools and structured clinical interviews.
- They must have robust governance arrangements, including safeguarding policies, data protection, and clinical audit.
For commissioners, the Right to Choose offers a way to reduce local waiting lists by channelling patients to pre-approved external providers. However, it also introduces complexity around provider vetting, cost variation, and post diagnostic support.
How the Right to Choose ADHD Pathway Differs from Autism
Although ADHD and autism often co-occur and some providers offer combined assessments, the commissioning and clinical requirements are distinct. Understanding these differences is critical for commissioners who may be tempted to treat both pathways identically.
Separate NICE guidelines. ADHD is governed by NICE guideline NG87 (Attention deficit hyperactivity disorder: diagnosis and management), while autism is governed by NICE guideline CG128 (Autism spectrum disorder in adults: diagnosis and management). NG87 places greater emphasis on medication management, including titration and ongoing monitoring. CG128 focuses on diagnostic assessment and post diagnostic support without routine medication pathways.
Titration and medication management. ADHD assessment is only the first step. Once an ADHD diagnosis is confirmed, the provider (or a separate prescriber) must initiate and titrate medication, then stabilise the patient before returning to primary care for ongoing prescriptions. This adds clinical complexity and requires the provider to have a clear prescribing pathway, including access to a consultant psychiatrist or specialist nurse prescriber. Autism assessments do not require titration; post diagnostic support is typically psychosocial (e.g., psychoeducation, peer support, cognitive behavioural therapy).
Combined ADHD/autism assessments. Many providers now offer a “combined neurodevelopmental assessment” that screens for both conditions. While this can be efficient, commissioners must ensure that the provider has the expertise to differentiate between ADHD and autism, particularly when symptoms overlap. A provider that is strong in autism may lack experience with ADHD titration, and vice versa. Commissioners should require that combined assessments are conducted by clinicians competent in both pathways.
Regulatory expectations. ADHD services are often subject to CQC inspection under the “specialist mental health services” framework. Autism assessment services may fall under different CQC categories. Providers must meet the relevant standards for each condition, including having appropriate Clinical Commissioning Group (CCG) or NHS England contracts.
For commissioners, the key takeaway is that ADHD Right to Choose is not the same as autism Right to Choose. The need for prescribing infrastructure, ongoing medication review, and adherence to NG87 makes ADHD commissioning more demanding. Specialist recruitment of ADHD assessors and prescribers is therefore a critical success factor.
Implications for Commissioners: Cost, Quality, and Waiting Times
The Right to Choose pathway can significantly reduce ADHD assessment waiting times, but only if commissioners manage provider selection carefully.
Impact on waiting lists. Many NHS trusts report ADHD referral waiting times of 18 months or more. By commissioning external providers via Right to Choose, commissioners can divert a portion of this demand to organisations with shorter wait times. For example, a provider with a 4 week wait for initial assessment can dramatically reduce the backlog. However, if the provider cannot meet demand or offers poor quality assessments that require rediagnosis, waiting lists may not improve in the long term.
Cost variation. The cost of an ADHD assessment via Right to Choose varies widely, from approximately £800 to £1,500 per assessment depending on provider, region, and whether titration is included. Commissioners must negotiate fixed tariffs that reflect the full package of care: assessment, titration, and stabilisation. Some providers offer lower prices by excluding medication management, leaving patients stranded after diagnosis. A comprehensive contract should define exactly what is covered.
Ensuring NICE compliance. A provider that fails to follow NG87 may produce incomplete diagnoses, leading to incorrect treatment or the need for repeat assessments. Commissioners should audit provider processes against NICE recommendations, including the use of standardised rating scales (e.g., Conners, Wender Utah) and structured clinical interviews (e.g., DIVA 5). Post diagnostic support should be proportionate and evidence based.
Post diagnostic support. NICE NG87 recommends that after diagnosis, patients receive information about ADHD, lifestyle advice, and if medication is prescribed, regular monitoring of side effects and efficacy. Some Right to Choose providers offer only the assessment and then discharge the patient back to primary care with a treatment plan. Commissioners must decide whether this is acceptable, or whether ongoing support should be part of the contract. The risk of patients being lost to follow up is real.
To mitigate these risks, commissioners should develop a provider evaluation framework that covers clinical governance, capacity, cost, and patient outcomes.
How to Evaluate ADHD Right to Choose Providers
When assessing potential Right to Choose providers for ADHD assessments, commissioners should use a structured set of criteria:
Clinician credentials. All clinicians conducting ADHD assessments must be on the relevant specialist register. For consultant psychiatrists, this means inclusion on the GMC Specialist Register (Mental health). For specialist nurses, they must be on the NMC register with evidence of ADHD specific training. Providers should provide biographic details of every clinician involved.
Diagnostic tools and training. ADHD assessors should have training in structured interview tools such as the DIVA 5 or the CAADID. Autism (ADOS 2) training is not relevant for ADHD alone, but if combined assessments are offered, then ADOS 2 trained clinicians are needed for the autism component.
Titration and prescribing pathway. The provider must have a clear protocol for medication initiation and titration, including access to a prescriber who can adjust doses. They should be able to produce a titration plan within two weeks of diagnosis. Commissioners should ask how emergencies (e.g., adverse reactions) are handled.
Capacity and waiting times. Providers should provide current waiting times for assessment and for titration initiation. Commissioners should verify that the provider can scale capacity in response to demand, without compromising quality.
Governance and safeguarding. The provider must have a safeguarding policy, clinical audit cycle, data protection impact assessment, and complaints procedure. They should be CQC registered (if required) and able to share outcome data with the commissioner.
Patient feedback. Collecting patient satisfaction data and monitoring re referral rates helps assess real world quality.
By using these criteria, commissioners can avoid the pitfalls of selecting a provider that looks good on paper but fails in practice.
Common Commissioning Pitfalls and How to Avoid Them
Even experienced commissioners can fall into traps when implementing Right to Choose for ADHD. Here are the most common pitfalls and how to avoid them.
Pitfall 1: Over reliance on a single provider. Placing all Right to Choose demand with one organisation creates a single point of failure. If that provider reduces capacity or loses key staff, waiting times can balloon. Solution: commission at least two providers and monitor their performance quarterly.
Pitfall 2: Lack of clarity on medication review. After titration, who is responsible for ongoing medication reviews? If the provider hands back to the GP, the GP must have the confidence and training to continue prescribing shared care. Some GPs refuse, leaving patients without medication. Solution: include a shared care agreement in the contract, specifying review frequency and responsibility.
Pitfall 3: Not including safeguarding and governance requirements. Some providers may not have robust safeguarding or data protection measures. This poses a risk to vulnerable patients and exposes the commissioner to regulatory scrutiny. Solution: require providers to share their CQC report, or if not CQC inspected, provide an independent audit of their governance.
Pitfall 4: Ignoring post diagnostic support. Assessment without follow up can lead to patients feeling abandoned. This is especially true for those with co occurring anxiety or depression. Solution: specify minimum post diagnostic support: psychoeducation, signposting to support groups, and a 6 week follow up call after diagnosis.
Pitfall 5: Assuming all providers are NICE compliant. Not all providers follow the latest guidance. Some may use outdated tools or insufficient assessment protocols. Solution: ask providers to map their processes to NICE NG87 recommendations and submit evidence.
Avoiding these pitfalls requires a proactive commissioning approach, with clear contracts, ongoing monitoring, and a willingness to switch providers if standards slip.
How Vantis Workforce Solutions Can Help
Commissioners face a difficult task: sourcing qualified ADHD assessors and prescribers who can deliver high quality Right to Choose services. This is where Vantis Workforce Solutions brings specialist neurodevelopmental recruitment expertise.
Vantis does not take a generalist approach. Every member of our team understands the clinical and regulatory demands of ADHD assessment and medication management. We recruit consultant psychiatrists, specialist nurses, clinical psychologists, and other professionals who are trained in NICE NG87 compliant pathways. Our rigorous vetting process ensures that every clinician we place holds the correct registrations, has demonstrable experience with titration and shared care, and can work across temporary, contract, or permanent arrangements.
We have helped NHS trusts, private providers, and local authorities staff their ADHD services quickly, reducing waiting times without compromising quality. Whether you need a full time consultant psychiatrist to lead your Right to Choose service or a temporary specialist nurse to clear your assessment backlog, we can match you with professionals who meet your exact requirements.
By partnering with Vantis, you gain a recruitment partner that shares your commitment to quality over volume. We do not send CV spam. We put forward only considered matches.
To learn more about how we can support your ADHD commissioning needs, contact Vantis Workforce Solutions today. Our neurodevelopmental recruitment team is ready to help you build a workforce that delivers timely, NICE compliant ADHD assessments and care.
Frequently asked questions
What is the Right to Choose ADHD pathway and who can use it?
The Right to Choose ADHD pathway is a legal right for NHS patients in England to select an approved provider for their first ADHD outpatient appointment. It applies to all patients registered with a GP who suspect they have ADHD and who meet the referral criteria. The provider must hold an NHS contract, follow NICE guideline NG87, and employ appropriately registered clinicians. The cost is covered by the patient’s local commissioner.
How does commissioning for ADHD Right to Choose differ from autism?
ADHD commissioning is more complex because it requires a full titration and medication management pathway, whereas autism assessments focus on diagnosis and psychosocial support. Commissioners must ensure providers have prescribing infrastructure, a clear titration protocol, and a shared care agreement for ongoing medication. The two sets of NICE guidelines (NG87 for ADHD, CG128 for autism) have different requirements for assessment tools and follow up.
What should commissioners look for in an ADHD provider?
Commissioners should verify that providers employ clinicians on the GMC Specialist Register or NMC register with ADHD specific training. The provider must demonstrate a structured assessment process using validated tools like DIVA 5, a robust titration pathway, and governance policies including safeguarding and data protection. Capacity, waiting times, and patient outcome data are also critical evaluation criteria.
How can Right to Choose reduce waiting times for ADHD assessments?
By diverting patients from overstretched NHS services to pre approved external providers with shorter wait times, commissioners can quickly reduce assessment backlogs. Effective Right to Choose commissioning requires accurate demand forecasting, capacity verification, and ongoing monitoring to ensure providers do not become overwhelmed themselves. Quality must be maintained to avoid repeat assessments.
What post diagnostic support is required under Right to Choose?
NICE NG87 recommends that after an ADHD diagnosis, patients receive information about the condition, lifestyle advice, and medication monitoring if prescribed. Many Right to Choose providers offer assessment only, so commissioners should specify in the contract that post diagnostic support includes a follow up call, psychoeducation resources, and a clear plan for titration and shared care with the GP. Ongoing medication reviews should be part of the package.