ICB Right to Choose status 2026: ADHD and autism assessments across England's 42 Integrated Care Boards

What an ICB is — and why it matters for your assessment

On 1 July 2022 the Health and Care Act 2022 restructured NHS commissioning in England by dissolving 211 Clinical Commissioning Groups (CCGs) and replacing them with 42 Integrated Care Boards (ICBs). Each ICB sits within an Integrated Care System (ICS) alongside NHS trusts, local authorities, and primary care networks, and is the statutory body responsible for planning and paying for most NHS services in its area — including mental health services and neurodevelopmental assessments for ADHD and autism.

This matters for Right to Choose because the commissioning decision — which providers hold an NHS Standard Contract for ADHD or autism assessment in your area — is made at ICB level. A provider that is contracted in one ICB may not be contracted in a neighbouring one. Two people living five miles apart, but on different sides of an ICB boundary, can have dramatically different access to Right to Choose providers.

The 42 ICBs vary significantly in size, population, and commissioning approach. Some cover large urban areas (NHS Greater Manchester, NHS South East London), others cover predominantly rural geographies (NHS Cornwall & Isles of Scilly). Each ICB publishes its own commissioning policies, and — increasingly since 2024 — its own position on Right to Choose for neurodevelopmental services.

The NHS Standard Contract 2024/25 and 2025/26 — paragraph SC6.18

The NHS Standard Contract is the mandatory contract used by NHS commissioners (ICBs) when contracting with providers for NHS-funded services. It is updated annually by NHS England. Paragraph SC6.18 of the 2024/25 and 2025/26 contracts addresses patient choice directly: it requires commissioners and providers to comply with the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013, and with the Patient Choice Regulations SI 2023/635, which set out the legal framework for patient entitlement to choose a provider.

SC6.18 also requires that where a patient exercises a choice of provider, the commissioner must not take action that prevents or deters the patient from exercising that choice. This is the contractual basis on which patient choice restrictions by ICBs are legally vulnerable: they are in tension with an obligation that ICBs have entered into as part of every NHS Standard Contract they hold.

The 2025/26 contract additionally reflected NHS England's 'mainstreaming' agenda for ADHD services — a programme encouraging ICBs to build local NHS capacity and reduce spend on independent sector providers. This created an inherent tension: NHSE told ICBs to bring services in-house, while the same Standard Contract told ICBs they could not lawfully prevent patients from choosing AQP-registered independent providers.

Why ICBs have restricted Right to Choose for ADHD and autism since 2024–25

Several interacting pressures explain the wave of ICB restrictions that emerged from late 2023 onwards:

• Demand explosion following widespread RtC awareness: As Right to Choose for ADHD and autism became better-known among patients — partly through social media, partly through advocacy organisations — referral volumes to independent providers grew sharply. ICBs that had budgeted modestly for these pathways found spend materially exceeding projections.
• Provider cost pressures post-Right to Choose mainstreaming (RTM): The NHS national tariff for ADHD assessments is a fixed rate, but the operational costs of managing large volumes of referrals — particularly for providers serving multiple ICBs — created financial pressure on both providers and commissioners. Some ICBs sought to renegotiate or cap volumes in their local contracts with providers.
• NHS England's 2025 mainstreaming programme: NHSE issued guidance in 2024–25 encouraging ICBs to develop local NHS ADHD services so that patients no longer needed to exercise RtC to access a timely assessment. In practice, local NHS capacity did not materialise quickly enough for this to reduce pressure on ICBs, but it gave some ICBs cover to issue guidance discouraging RtC referrals while local services were "being developed".
• Uneven distribution across ICBs: Some ICBs with higher socioeconomic deprivation or larger neurodiverse communities saw disproportionately high RtC volumes, creating localised budget pressures that did not affect ICBs with lower uptake.

Legal position: can an ICB lawfully refuse Right to Choose?

The short answer is no — not where a provider is AQP-registered and holds a valid NHS Standard Contract for the relevant service. The Patient Choice Regulations 2023 (SI 2023/635) give patients a statutory entitlement to choose a provider, and SC6.18 of the NHS Standard Contract requires ICBs to honour that entitlement. An ICB policy that instructs GPs not to make RtC referrals, or that operates a blanket prior-approval requirement as a deterrent rather than a genuine clinical gateway, would be susceptible to legal challenge.

The reason ICBs have not faced large-scale successful legal challenge is that restrictions are typically framed as guidance to GPs rather than outright refusals. Guidance that "encourages" local pathways, or that establishes a prior-approval process (theoretically available to patients who meet criteria), is harder to challenge than a flat refusal. Judicial review of ICB policy is also a high bar — requiring irrationality, illegality or procedural impropriety — and resource-intensive for individual patients.

However, the individual patient's position is stronger than the systemic picture suggests. When a patient writes to an ICB citing SI 2023/635 and SC6.18 by name, and specifically requesting a patient choice complaint review by NHS England, many ICBs will resolve the referral rather than face regulatory scrutiny. The legal framework is sound; the enforcement mechanism is underfunded. Persistence, in writing, works more often than not.

ICBs that have communicated restrictions — as of mid-2026

The following ICBs have, as of mid-2026, issued communications or taken commissioning actions that restrict, cap, or discourage Right to Choose for ADHD and/or autism assessments. This picture changes frequently — ICBs revise their positions, court pressure from patient groups, and sometimes reverse restrictions. Always verify the current position directly with the ICB or via our live tracker (coming soon).

• NHS Cambridgeshire & Peterborough ICB — has communicated restrictions including guidance to GPs limiting referrals to a reduced panel of approved providers, and a prior-approval requirement for new RtC ADHD referrals.
• NHS Norfolk & Waveney ICB — has communicated restrictions including guidance discouraging RtC referrals to out-of-area providers and signposting GPs to the local NHS waitlist instead.
• NHS Suffolk & North East Essex ICB — has communicated restrictions including a capped provider panel and guidance to GPs that RtC referrals should be made only to named providers on the approved list.
• NHS Hampshire & Isle of Wight ICB — has communicated restrictions including a prior-approval gateway and guidance to GPs framing local NHS services as the preferred first pathway for ADHD assessment.
• NHS Bath, North East Somerset, Swindon & Wiltshire ICB (BSW) — has communicated restrictions including a reduced approved provider panel and GP guidance discouraging new RtC referrals pending development of local capacity.
• NHS Devon ICB — has communicated restrictions including guidance to GPs limiting ADHD RtC referrals to providers on a narrow contracted list, and in some periods pausing new referrals pending capacity review.

The above list is illustrative, not exhaustive, and the situation is highly dynamic. ICBs not listed above may also have informal restrictions that do not appear in published policy. Conversely, some ICBs on this list may have revised their position since mid-2026. This guide is a landscape overview; the live tracker below will provide a regularly updated ICB-by-ICB table.

What "restriction" actually looks like in practice

Because ICBs cannot lawfully abolish Right to Choose by policy, restrictions take indirect forms that are designed to reduce uptake without constituting an outright refusal. The most common mechanisms are:

• Capped or reduced provider panels: The ICB limits its approved RtC provider list to one or two contracted providers, removing previously available options. Patients seeking a provider not on the list are told it is not available in their area, even if that provider holds contracts with other ICBs.
• Prior-approval requirements: GPs are told to submit a prior-approval form to the ICB before making an RtC referral. In theory this is a clinical gateway; in practice the approval criteria are sometimes vague, and the burden of the process discourages GPs from making the referral at all.
• GP guidance discouraging RtC referrals: ICBs send letters to GP practices — often framed as "commissioning updates" — explaining that RtC is creating budget pressure and asking GPs to use the local NHS pathway instead. This guidance has no legal force to override the patient's right, but GPs often follow it without informing patients of their choice entitlement.
• Slow or broken e-Referral pathways: Some ICBs do not maintain up-to-date provider listings on the NHS e-Referral Service, making it practically difficult for GPs to make an RtC referral even when they are willing to do so.

Your options if your ICB has restricted Right to Choose

Even where an ICB has issued restrictive guidance, the legal right remains in place. These are your escalation options, broadly in order of effort:

• 1. Assert your right in writing, citing SI 2023/635: Write to your GP practice citing your entitlement under the Patient Choice Regulations 2023 (SI 2023/635) and paragraph SC6.18 of the NHS Standard Contract. Confirm the provider holds an NHS Standard Contract with your ICB and ask the GP to confirm whether they are refusing the referral, and on what legal basis. Written requests are harder to brush aside and create a paper trail for escalation.
• 2. Formal complaint to the ICB: If your GP refuses or the ICB's prior-approval process denies your referral, raise a formal complaint with the ICB's complaints team. Label it a "patient choice complaint" in your correspondence — this framing triggers the ICB's obligation to respond on patient choice grounds specifically, not just as a general service complaint.
• 3. Patient choice complaint to NHS England: NHS England has a patient choice oversight function. Email england.contactus@nhs.net with "patient choice complaint — Right to Choose — [ICB name]" in the subject line, and attach your GP refusal and ICB complaint response. NHSE can issue guidance or directions to ICBs that are not complying with choice obligations, and the prospect of regulatory scrutiny often prompts resolution.
• 4. Parliamentary and Ombudsman routes: Contact your MP and ask them to raise the issue with the Secretary of State for Health and Social Care. The Parliamentary and Health Service Ombudsman (PHSO) can investigate unresolved NHS complaints, including patient choice failures, where the ICB's complaints process has not resolved the matter.
• 5. Judicial review pre-action letter (rare): Where an ICB's blanket restriction policy is clearly unlawful — refusing all RtC referrals regardless of individual circumstances, or operating a prior-approval process that is a sham — a pre-action protocol letter for judicial review, sent by a solicitor, can produce rapid resolution. This is resource-intensive and appropriate only where other routes have been exhausted, but organisations including the Patients Association and ADHD charities have supported test-case approaches in the past.
• 6. MP escalation and media: ICBs are acutely sensitive to local political and media pressure. A well-documented case, shared with a sympathetic MP or local journalist, can move an ICB more quickly than formal process. This works particularly well where the ICB's policy is not clearly published — ICBs that rely on informal guidance to GPs are vulnerable to transparency scrutiny.

Live ICB-by-ICB tracker

A live, regularly updated table showing the current Right to Choose position for each of England's 42 ICBs — including approved provider panels, known restrictions, and links to ICB commissioning documents — is being built and will be published on Finally Seen shortly. This guide will link to it when it goes live.

In the meantime, the most reliable sources for your specific ICB's current position are: (1) your ICB's published commissioning policies on its website; (2) the provider you want to use — they track contract status by ICB as a matter of operational necessity; and (3) ADHD and autism community groups on social media, which often aggregate real-time reports of GP and ICB behaviour in each area.