Right to Choose (RTC) has become the dominant alternative pathway for adult ADHD assessment in England. Where NHS waiting lists routinely stretch to three, five, or more years in a given Integrated Care Board (ICB) footprint, RTC lets patients exercise their legal right to choose any NHS-commissioned provider in England, often with waits measured in weeks rather than years. The system works, but it is under pressure. This guide walks through the 2026 landscape: who the active providers are, what the workforce behind them looks like, and what the recent regulatory shifts mean for commissioners, providers, and assessors.
If you are a patient or family member looking for a plain-English explanation of how Right to Choose works for you personally, read our separate guide: Right to Choose ADHD: A Plain-English Guide for Patients and Families.
What Right to Choose actually is
RTC is grounded in the NHS Constitution. An adult patient whose GP refers them for elective non-urgent mental health assessment has a statutory right to choose any provider in England that holds an NHS contract for that service. In practice this means a patient in Bristol can be assessed by a provider registered in Manchester, and the home ICB must fund the assessment and any resulting treatment under a tariff arrangement. RTC does not apply to children's services in the same way, and it does not apply to everything in mental health. For adult ADHD assessment, however, it has become the single largest route into diagnosis outside the NHS core pathway.
The named RTC providers operating at scale
As of early 2026, the RTC ADHD provider market in England includes a handful of providers operating at meaningful scale. Psychiatry UK is the longest-established and carries the largest market share. ProblemShared operates a multi-condition platform covering ADHD and autism across the lifespan. ADHD 360, Clinical Partners, and Care ADHD all hold NHS contracts and offer RTC pathways. Several newer entrants have joined over the last eighteen months. The landscape is fluid, and named provider lists on ICB websites lag the actual market by months.
Each provider runs a different operating model. Some run salaried clinical teams. Some run hybrid models with salaried leads and a layer of self-employed assessors. A few run pure network models where almost every assessor is self-employed and paid per assessment. The operating model matters because it determines how the provider responds to demand surges. Salaried models scale slowly but predictably. Network models can scale quickly but depend on assessor availability in the wider market, which is where workforce specialists enter the picture.
The workforce reality behind the pathway
Every RTC assessment requires a qualified clinician. The minimum standard for ADHD assessment in England is a psychiatrist, specialist mental health nurse, specialist clinical psychologist, or other specialist clinician with appropriate training. The supply of these clinicians is the binding constraint on the whole RTC model.
UK ADHD referral rates tripled between July 2020 and January 2023, rising from eleven to thirty three referrals per one hundred thousand people every month. ADHD medication prescriptions doubled over the same period, from 1.4 million to 3.1 million annually. The April 2026 government Independent Review into Mental Health, ADHD and Autism confirmed what services already knew: assessment demand is outpacing clinical capacity at every level, and the workforce shortage is now the primary constraint on service delivery.
This is why assessor recruitment sits at the centre of the RTC market. Providers that can scale their assessor pool quickly can win more contracts and serve more patients. Providers that cannot scale lose ground even when their clinical reputation is strong. Specialist workforce suppliers with deep pools of ADOS-2 trained and ADHD-experienced clinicians are in a position to tilt this balance.
What the 2026 regulatory shifts mean
The April 2026 Independent Review set out a series of recommendations that are now shaping commissioner thinking. Two points stand out. First, the review confirmed that RTC has been valuable but has also created a fragmented data landscape where no single body holds a full view of demand, capacity, or outcomes. Second, the review flagged workforce expansion as the single most effective lever commissioners have.
For ICBs this translates into two practical shifts. Several ICBs are revisiting their provider approval lists and tightening clinical governance requirements. At the same time, most ICBs are accepting that capping RTC without expanding local NHS capacity simply transfers the waiting list back onto the NHS service, where it is typically longer. The dominant commissioner strategy for 2026 is therefore to expand both NHS internal capacity and RTC provider capacity in parallel, with sharper governance on both sides.
If you are weighing the full set of options for clearing a local waiting list, our companion piece walks through five realistic approaches: How Private ADHD Providers Clear NHS Waiting Lists: A Commissioner's Guide.
What this means for commissioners
Commissioners choosing RTC providers in 2026 are looking at three criteria:
- Clinical governance maturity, which means the provider can demonstrate peer review, caseload oversight, and safeguarding protocols comparable to NHS expectations.
- Workforce stability, which means the provider can name its senior clinical team and show a reasonable ratio of salaried to self-employed assessors.
- Throughput transparency, which means the provider reports assessment volumes, diagnostic rates, and waiting times on a regular cadence.
None of these are mandatory under current RTC rules. All of them are becoming de facto requirements as ICBs tighten provider lists.
What this means for assessors
For clinicians qualified to deliver ADHD assessment, 2026 is a strong market. Day rates for self-employed assessors have risen steadily and show no sign of reverting. The providers competing for assessor time are increasingly offering structured continuing professional development, supervision, and indemnity as part of their package, rather than pure per-session rates. Assessors who can also deliver autism assessment using ADOS-2 are particularly sought after, since several providers are expanding from ADHD-only into combined ADHD and autism pathways.
If you are evaluating your own career options in this space, we break down what the 2026 market looks like from a candidate's perspective in ADHD and Autism Assessor Jobs in the UK: What the 2026 Market Looks Like.
Where Vantis sits in this market
Vantis supplies the assessor workforce behind RTC providers, NHS trusts, and private clinics operating in this space. Our pool includes ADOS-2 trained autism assessors, ADHD specialist psychiatrists and clinical psychologists, specialist and titration nurses, and full diagnostic teams. We scope workforce requirements against a provider's operating model and governance requirements, not against generic healthcare recruitment templates. For backlog clearance programmes we operate end to end, from scoping through clinical governance to weekly throughput reporting.
If you commission RTC services, run an RTC provider, or work as an assessor in this space and want to understand where the workforce market is heading, get in touch and our specialist team will respond within one working day.