What Right to Choose is
Right to Choose is a patient's legal right in England, codified in the NHS Commissioning Board and CCGs (Responsibilities and Standing Rules) Regulations 2012 and reflected in the NHS Constitution for England. It says that when your GP refers you for a first outpatient appointment for most conditions, you can choose any provider in England that holds an NHS Standard Contract for that service — including independent (private) providers who are NHS-commissioned.
You pay nothing. The provider is reimbursed at the NHS national tariff by the Integrated Care Board (ICB). The clinical pathway you receive is an NHS pathway, your notes go back to your GP, and any onward referrals continue inside the NHS.
The point of the right is simple: waiting lists vary wildly by region and provider. Right to Choose lets you skip a 3-year local wait by choosing a contracted provider with a 6-month one.
What Right to Choose covers
- Most adult elective outpatient referrals — gastroenterology, neurology, gynaecology, rheumatology, dermatology, ENT, cardiology and so on.
- Adult ADHD assessments — one of the most-used Right to Choose pathways, with several providers (e.g. Psychiatry-UK, ProblemShared, ADHD 360) holding NHS contracts in most ICB areas.
- Adult autism assessments — available in many areas via NHS-commissioned independent providers; check the specific provider holds your ICB's contract.
- Some adult mental health pathways where the provider holds an NHS contract.
How to use it (step by step)
1. You still need a GP referral. Right to Choose is not self-referral. The GP makes the referral; you choose where it goes.
2. Find an NHS-contracted provider. The provider's website must explicitly state that it holds an NHS Standard Contract with ICBs for the service you want. If it only mentions "private" or "self-pay", it isn't a Right to Choose route.
3. Ask your GP in writing. A short, specific written request is much harder to brush aside than a verbal one in a 10-minute appointment. See the exact wording below.
4. Get the e-Referral booking reference. Right to Choose referrals go through the NHS e-Referral Service. Ask the practice for the reference so you can call the provider and book.
5. Book your appointment. The provider contacts you, or you call them, and pick an appointment slot.
Exact wording for your GP
If your GP refuses
Some GPs are unfamiliar with Right to Choose; some practices have informal policies against using it (usually citing workload or local ICB "preferred providers"). Neither is a legal basis to refuse.
- Ask for the refusal in writing. Specifically: what clinical reason, and what regulation or guidance it relies on. Add this letter to your medical record.
- Escalate to the practice manager. A practice-wide policy of refusing Right to Choose is something the practice manager and partners need to know is being challenged.
- Contact your Integrated Care Board (ICB). ICBs commission these services and are responsible for ensuring patient choice is respected. Find yours at england.nhs.uk/integratedcare.
- Raise a formal complaint. Refusing a clinically appropriate referral to a contracted provider can be a breach of the NHS Constitution.
If your underlying problem is that the GP isn't taking your symptoms seriously enough to write any referral, that's a different fight — see Your GP won't listen — what to do next and consider our £49 formal letter, which cites the relevant NICE guidance, the GMC duty to refer, and your NHS Constitution rights in one document.
What Right to Choose doesn't cover
- Children's services (CAMHS, paediatric ADHD/autism).
- Cancer 2-week-wait referrals (these go to the local urgent pathway).
- Maternity services and most urgent care.
- Specialist secondary referrals once you're already under one consultant's care (these are at clinical discretion).
- Providers that don't hold an NHS contract — pure private care is not Right to Choose.
Frequently asked questions
›What is Right to Choose on the NHS?
Right to Choose is a legal right in England, set out in the NHS Constitution and the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012, that lets most adult patients pick where they have their first outpatient appointment for a condition. As long as the provider holds an NHS contract for that service, the NHS pays — even if the provider is private or in a different region.
›Is NHS Right to Choose free?
Yes. You pay nothing. The provider must hold an NHS Standard Contract with an Integrated Care Board for that service, and is paid the NHS national tariff. You only pay if you go fully private outside the NHS.
›Does Right to Choose apply to ADHD and autism assessments?
Yes — for adult ADHD and many adult autism assessments in England, Right to Choose lets you pick an NHS-contracted independent provider, often with a much shorter waiting list than your local NHS service. It does not apply to children's services or to some specialist secondary referrals.
›Can my GP refuse a Right to Choose referral?
Generally no — if the referral is clinically appropriate and the provider holds the right NHS contract, the GP should make it. They can refuse if the referral isn't clinically indicated, or if the provider isn't commissioned for your situation. They cannot refuse simply because it isn't the local default pathway.
›What if my GP says they 'don't do Right to Choose'?
Practices sometimes say this, but the right belongs to the patient, not the practice. Ask for the refusal in writing, citing which regulation or guideline it relies on. If they still won't refer, raise it with the practice manager and your Integrated Care Board (ICB).
›Does Right to Choose apply in Scotland, Wales or Northern Ireland?
No. Right to Choose is an English legal right. Scotland, Wales and Northern Ireland have their own (much more limited) patient choice arrangements.