The rules a GP has to follow
Referral is a clinical decision. A GP doesn't have to refer everyone for everything. But three rules govern how they make that decision:
- GMC Good Medical Practice — decisions must be based on a careful assessment and explained to the patient.
- NICE guidelines — for many conditions (suspected cancer, ADHD, autism, endometriosis, Long Covid) NICE sets clear referral criteria GPs are expected to consider.
- NHS Constitution — you have the right to be involved in decisions, to ask for a second opinion, and (in England) to choose your provider.
"Our practice doesn't refer for that" is not a clinical reason. Neither is "the waiting list is too long". A clinical reason is something specific to your case.
Step 1: get the reason in writing
Before doing anything else, ask the practice in writing to record the clinical reason for the refusal in your notes, and to send you a copy. This single step does more work than anything else: it forces specificity, creates an audit trail, and either resolves the issue or gives you the grounds you need to escalate.
Step 2: pick your lever
You have four practical routes from here. They aren't mutually exclusive — many people use two in parallel.
Second opinion
Book with a different GP at the practice or another nearby practice. Bring your notes and the written refusal reason. A second clinician looking at the same evidence often reaches a different decision.
Right to Choose
Once a referral is agreed, England's Right to Choose lets you pick the NHS-funded provider — often with shorter waits. See our pillar guide on Right to Choose, the ADHD pathway and the autism pathway.
Private referral
Your GP can write a private referral letter to a specialist of your choice — you'd pay for the appointment. A private diagnosis can usually be brought back to the NHS for treatment, though the GP will normally need to re-refer formally.
Formal complaint
If the refusal isn't reasonable, or it's a pattern of dismissal, a formal complaint to the practice or your ICB triggers a statutory response in writing — see our NHS complaints guide.
In our experience, the fastest single lever is the one that comes before complaint: a formal, NICE-cited letter that names the relevant guideline (e.g. NG87 for ADHD, NG188 for Long Covid, NG73 for endometriosis, CG142 for autism) and asks the GP to either refer or record the reason for not referring. That letter goes on your medical record and changes the dynamic in the room. Finally Seen writes one for £49.
Frequently asked questions
›Can a GP refuse to refer me?
Yes — referral is a clinical decision. But the GMC's Good Medical Practice requires the decision to be reasonable, explained, and documented. A blanket 'we don't refer for that' is not a clinical reason and is challengeable.
›Can I ask for a second opinion?
Yes. The NHS Constitution gives every patient the right to ask for a second opinion. Your GP isn't legally obliged to arrange one, but in practice most do, and it's a strong lever when a first GP is reluctant to refer.
›What is Right to Choose?
Right to Choose is your legal right in England (NHS Constitution + 2012 regulations) to pick your NHS-funded provider for most first outpatient appointments — including adult ADHD and autism assessment. Once your GP agrees a specialist is needed, you can choose the provider.
›Can I get a private referral instead?
Yes. Your GP can write a private referral letter; you'd then pay for the appointment. Some private specialists also accept self-referral. If you later want to return to NHS care, you'll usually need re-referral by the GP.
›How do I get the refusal on my record?
Ask in writing for the clinical reason for the refusal to be added to your notes — and for a copy. This both creates accountability and gives you grounds for a complaint or escalation if needed.