Why Right to Choose is England-only
NHS Right to Choose derives from the NHS Patient Choice Guidance (England) published by NHS England in June 2023, which itself implements the National Health Service (Procurement, Patient Choice and Competition) Regulations 2013 (SI 2013/257). These are instruments of English NHS law. Health is a devolved matter under the Scotland Act 1998, the Government of Wales Act 2006, and the Northern Ireland Act 1998. NHS Scotland, NHS Wales (Senedd Cymru) and Health and Social Care Northern Ireland each operate under their own primary and secondary legislation.
The practical consequence is stark: an NHS GP in Scotland, Wales or Northern Ireland cannot make an NHS e-Referral Service referral to an England-based Right to Choose provider at NHS expense. The commissioning infrastructure — integrated care boards, NHS Standard Contracts under English law — simply does not exist outside England.
This is not an administrative quirk that a well-worded letter will fix. It is a constitutional feature of UK health policy. Any guide or social media post claiming you can invoke Right to Choose from Scotland is incorrect.
Scotland: your options
NHS Scotland adult ADHD services are commissioned by the 14 regional health boards. There is no national waiting-time standard for ADHD assessment (unlike, for example, the 18-week target that applies to most NHS England referrals). Waits reported by ADHD Scotland and its members range from 18 months to over 5 years depending on the health board.
Self-referral to some voluntary sector services. ADHD Scotland (adhdscotland.org.uk) runs peer support groups and a helpline, and can direct you to the most appropriate local pathway. Some health boards in Scotland have piloted third-sector partnerships for initial screening, which may not reduce wait times but can provide interim support.
GP referral to psychiatry. Your GP can refer you to general adult psychiatry rather than a dedicated ADHD service, where the waiting list may be shorter. This is worth asking about explicitly. A consultant psychiatrist in any specialty can diagnose ADHD if they assess it carefully.
University students. Scottish universities typically have well-funded disability support services. Students at the University of Edinburgh, Glasgow, Aberdeen, St Andrews and others can access assessments through the university rather than the NHS. This does not require being an NHS patient and is free to students.
Private assessment. Several private psychiatry clinics operate in Scotland, including Priory Group clinics in Edinburgh and Glasgow, and national telehealth providers such as Psychiatry UK, ADHD 360 and Meandmyadhd. See the private assessment section below.
Wales: your options
NHS Wales does not have a Right to Choose equivalent. The Welsh Government's Access to NHS Care guidance allows patients to request referral to a named NHS consultant, but this is limited to consultants within the seven Welsh health boards or via cross-border agreements — not an open market of Right to Choose providers.
Cross-border agreements. Some Welsh health boards have cross-border commissioning agreements with English NHS trusts, particularly in the border counties (Powys, Monmouthshire, Flintshire). If you live near the English border, ask your Welsh GP whether your health board has commissioned any English NHS ADHD service — and whether you could be referred under that agreement.
ADHD Wales. ADHD UK's Welsh arm and local support groups can signpost current pathways. The charity ADHD UK operates UK-wide and provides a helpline.
Neurodevelopmental pathway referral. Some Welsh health boards have combined adult neurodevelopmental services (covering ADHD and autism together), which can be accessed via GP referral. Waits are typically 18 months to 3 years but vary by board.
Northern Ireland: your options
Health and Social Care (HSC) Northern Ireland is the most distinct from the English model. Adult ADHD services are underdeveloped relative to England and Scotland. There is no adult ADHD assessment service in most HSC trust areas; adults are often directed to general adult psychiatry or must self-fund entirely.
The charity ADD-NI is the primary source of peer support and signposting in Northern Ireland. Their helpline can advise on current NHS pathways in your HSC trust area.
Private assessment in Belfast and the surrounding area is available through independent psychiatrists and, for adults willing to travel, clinics in Dublin (Republic of Ireland) — though Irish assessments follow NICE guidelines and are generally NHS-compatible for the purposes of requesting shared care.
Border-GP registration: the honest picture
Under the NHS Constitution for England, any person ordinarily residing in England can register with an NHS GP in England without giving a reason. If you genuinely live near the English border — in a town stradding Berwick-upon-Tweed, in Monmouth, or in the Foyle corridor — you may legitimately register with an English GP and access Right to Choose.
What you should not do is register with an English GP at a false address while living in Scotland, Wales or Northern Ireland. This constitutes obtaining NHS services by deception, breaches NHS Terms of Service for patients, and if discovered can result in removal from the GP list and — in serious cases — police referral. The practical problems compound: you would need to attend an English GP for titration and annual review, creating significant travel costs and logistical difficulties.
If you are genuinely considering relocating to England for health reasons, that is a lawful personal decision — but be clear-eyed about whether the cost and disruption of relocation is genuinely outweighed by the benefit of Right to Choose access versus a private assessment.
Private assessment: UK-wide option
The most consistent route for people in Scotland, Wales and Northern Ireland who cannot wait years for an NHS appointment is a private ADHD assessment. Several providers operate UK-wide via video consultation:
- Psychiatry UK — holds NHS Standard Contracts in England as a Right to Choose provider, but also accepts private self-pay patients from Scotland, Wales and NI.
- ADHD 360 — another major Right to Choose provider that accepts private patients UK-wide.
- Priory Group — has physical clinics in Scotland and offers consultant-led assessments.
- Psychiatry-UK, Meandmyadhd, and similar telehealth platforms — typically use nurse prescribers and are suitable for straightforward presentations.
A private assessment costs approximately £500–£2,000 depending on provider and complexity. The resulting diagnosis, made by a GMC-registered clinician, is NHS-valid and your NHS GP (whether in Scotland, Wales, NI or England) should accept it for the purposes of requesting a shared-care prescribing agreement.
Be aware that shared-care uptake by NHS Scotland, NHS Wales and HSC NI GPs for privately diagnosed ADHD is more variable than in England, and there is no NICE enforcement mechanism in devolved NHS systems equivalent to the NHS Standard Contract in England.
Charity and low-cost routes
The following charities offer free support, signposting and sometimes funded assessments:
- ADHD Scotland (adhdscotland.org.uk) — peer support, helpline, advocacy.
- ADHD UK (adhduk.co.uk) — UK-wide, including Wales. Runs a free helpline and directory of services.
- ADD-NI (addni.co.uk) — Northern Ireland-specific.
- MIND and local mind affiliates sometimes fund or subsidise assessments in partnership with local NHS services — worth asking your local MIND branch.
- University disability services — if you are a student or prospective student, these services can be significantly better-resourced than NHS waiting lists.
None of these routes guarantees a fast assessment, but exhausting free options before committing to a private fee is always sensible.
Frequently asked questions
›Does Right to Choose apply in Scotland?
No. The NHS Patient Choice Guidance (England) 2023 is England-only legislation. NHS Scotland operates under entirely separate legislation and does not have an equivalent provider-choice mechanism for outpatient referrals. Scottish patients cannot invoke Right to Choose when registered with an NHS Scotland GP.
›Can I register with an English GP to access Right to Choose?
Technically, NHS GP registration is open to anyone ordinarily residing in England. If you genuinely move to or live near the English border, you can register with an English GP and be referred under Right to Choose. However, registering with an English GP while living in Scotland, Wales or Northern Ireland purely to access English NHS services — without genuinely residing in England — is against NHS terms and could constitute fraud. It is also impractical: titration, shared care and ongoing prescribing all require a local GP.
›What is the ADHD waiting time in Scotland?
NHS Scotland does not publish a single national figure because each health board manages its own ADHD service. Reports from charities including ADHD Scotland suggest adult waits of 2–5 years in many health boards, broadly similar to England before Right to Choose providers became widespread.
›Is there any equivalent to Right to Choose in Wales?
No direct equivalent exists. NHS Wales patients may request a second opinion or a referral to a specific named consultant within the Welsh health board system, but there is no patient-choice mechanism for selecting from a national list of independent providers at ICB expense. Some health boards in Wales have commissioned specific ADHD services, but waits remain long in most areas.
›Can I get a private ADHD assessment in Scotland?
Yes. Several private providers — including Priory Group clinics in Scotland and telehealth services such as Psychiatry UK and ADHD 360 — accept self-pay patients from Scotland, Wales and Northern Ireland. A private assessment costs £500–£2,000. The resulting diagnosis is clinically valid and your NHS GP should accept it for the purpose of requesting a shared-care agreement.
›Are there any free or lower-cost alternatives to private assessment in Scotland?
ADHD Scotland maintains a directory of local support groups, and some charitable organisations occasionally fund or subsidise assessments. The process is slower and less certain than NHS Right to Choose in England, but it is worth contacting ADHD Scotland and ADHD UK directly. Some universities also offer free or subsidised assessment for students through their disability support services.