Right to Choose in Wales 2026: NHS Wales choice rules explained

Why Right to Choose does not apply in Wales

NHS Right to Choose is a creature of English statute. Its legal basis is section 6A of the National Health Service Act 2006 (inserted by the Health Act 2009) and, operationally, regulation 39 of the NHS Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012. Both instruments place duties on NHS England and on what are now integrated care boards — bodies that exist only in England.

Health is a devolved matter. The Government of Wales Act 2006 confers legislative competence over health services on the Senedd Cymru. NHS Wales — the collective term for the seven health boards and three NHS trusts commissioned by Welsh Government — operates under Welsh statutory instruments, including the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013 equivalent in Wales. No Welsh statutory instrument creates a Right to Choose mechanism comparable to England's. The Senedd has not legislated one.

This means there is no well-worded letter, no NHS ombudsman ruling, and no legal argument that will compel a Welsh health board to fund a referral to an English Right to Choose provider for a Welsh-registered patient. Any online guide suggesting otherwise is wrong.

2013 Wales-England cross-border statement

The Welsh Government and NHS England published the Wales-England Cross-Border Healthcare Statement in 2013 (updated periodically). It establishes the following principle: commissioning responsibility follows the patient's registered GP, not their country of residence or nationality.

The practical consequences are:

• Welsh resident, Welsh GP: commissioned by a Welsh health board under Welsh rules. Right to Choose does not apply. The health board is responsible for funding all elective referrals, including ADHD assessment.
• Welsh resident, English GP: commissioned by an English integrated care board under English rules, including Right to Choose. This patient can, in principle, request a Right to Choose referral to an English ADHD provider. However, ongoing care — titration, shared care, prescribing — will still need to be managed locally in Wales, which creates practical difficulties.
• English resident, Welsh GP: commissioned by a Welsh health board. Right to Choose does not apply.

The statement also covers emergency and maternity care, which follow different rules; those are outside the scope of this guide.

Registering with an English GP while genuinely residing in Wales is not permitted under NHS GP registration rules, which require patients to live within the practice's catchment area or to be accepted as an out-of-area patient without home visits. An English GP cannot realistically take on a patient living in Swansea or Bangor as a standard registered patient. Patients who use a false English address to register with an English GP risk removal from the list and are potentially in breach of the Fraud Act 2006.

WHSSC and Individual Patient Funding Requests

The Welsh Health Specialised Services Committee (WHSSC) is a joint committee of all seven Welsh health boards. It jointly commissions specialised services — tertiary and highly specialised treatments that no single health board could efficiently commission alone. WHSSC does not commission routine ADHD assessment; that remains a health-board responsibility.

Where a patient's clinical needs cannot be met by any Welsh provider, a clinician (not the patient) can submit an Individual Patient Funding Request (IPFR) to WHSSC or, for non-specialised services, to the relevant health board's own exceptional funding panel. An IPFR must demonstrate that the patient's case is clinically exceptional relative to others with the same condition — not merely that the local waiting list is long.

For ADHD assessment, an IPFR is unlikely to succeed unless there are highly unusual clinical circumstances — for example, an established patient with a complex comorbidity profile for whom no Welsh service has appropriate clinical expertise, and where an out-of-Wales provider demonstrably does. A long wait alone, however distressing, does not constitute clinical exceptionality under WHSSC's published IPFR policy.

If you believe your case is genuinely exceptional, ask your GP or consultant to review the WHSSC IPFR guidance and, if they agree, to submit a request on your behalf with supporting clinical evidence.

Health board ADHD waiting times

NHS Wales publishes referral-to-treatment data by health board, but ADHD-specific breakdowns are not always separately reported. The following reflects published data and reports from patient advocacy organisations as of mid-2026. All waits are indicative; contact your health board's patient liaison team for current figures.

• Aneurin Bevan University Health Board (Newport, Blaenau Gwent, Caerphilly, Monmouthshire, Torfaen): adult ADHD waits reported at 18–36 months. The board covers the English border area; some patients in Monmouthshire may have English GP options.
• Betsi Cadwaladr University Health Board (North Wales — Anglesey, Gwynedd, Conwy, Denbighshire, Flintshire, Wrexham): Wales's largest health board by geography. Adult ADHD waits have been reported at 3–5 years in some localities. Flintshire and Wrexham border England (Cheshire, Shropshire); cross-border GP options exist for those genuinely near the border.
• Cardiff and Vale University Health Board (Cardiff, Vale of Glamorgan): adult neurodevelopmental service waits reported at 2–4 years. The board has piloted a combined ADHD/autism pathway but demand substantially exceeds capacity.
• Cwm Taf Morgannwg University Health Board (Rhondda Cynon Taf, Merthyr Tydfil, Bridgend): waits of 2–3 years reported. The board has historically had limited dedicated adult ADHD provision.
• Hywel Dda University Health Board (Carmarthenshire, Ceredigion, Pembrokeshire): rural geography creates access difficulties beyond waiting time. Waits of 18 months to 3 years reported.
• Powys Teaching Health Board (Powys): Wales's most rural health board, which commissions many services from English providers under cross-border agreements. Patients in Powys should specifically ask their GP whether a cross-border commissioned ADHD service exists, as Powys has historically used English secondary care more than other Welsh boards.
• Swansea Bay University Health Board (Swansea, Neath Port Talbot): adult ADHD waits of 18–30 months reported. The board has published a neurodevelopmental strategy but implementation timescales remain uncertain.

Powys Teaching Health Board is the most likely route to a legitimately commissioned cross-border referral, given its established practice of commissioning English secondary care services. If you are a Powys patient, ask your GP explicitly whether ADHD services are among the cross-border commissions.

Welsh RTT 26-week and 36-week targets

The Welsh Government's Referral to Treatment (RTT) performance framework requires health boards to ensure that 95% of patients receive their first treatment within 26 weeks of a referral being accepted. A further standard holds that no patient should wait longer than 36 weeks.

These targets are governance tools: they generate performance data reported to the Welsh Government and, when breached, trigger escalation between the health board and the Welsh Government's NHS Executive. They are not enforceable rights in the sense that a patient can go to court to compel treatment within a set period. The remedy for a patient waiting beyond 36 weeks is a formal concern under the Putting Things Right procedure (see below), followed if necessary by a referral to the Public Services Ombudsman for Wales.

If your RTT clock started on the date your GP referral was accepted by the health board and you are now beyond 26 weeks without a treatment date, write to the health board's Concerns team. Note the clock-start date, the current date, and ask for a projected treatment date and what steps the board is taking to manage the RTT breach. This creates a documented record and often accelerates contact.

GP referral process and funding responsibility

In NHS Wales, your GP is the standard gateway to specialist ADHD assessment. A GP referral to secondary care is funded by the patient's health board. Unlike in England, GPs in Wales do not operate under a system that allows them to refer to any provider the patient chooses from a national list. Referrals go to the health board's commissioned ADHD or neurodevelopmental service.

Your GP can, however, refer you to a named consultant within the health board or to a consultant in a different Welsh health board if there are clinical reasons to do so — for example, a particular subspecialty interest. This is not the same as Right to Choose; it requires the receiving consultant and health board to accept the referral, and funding must be agreed between the two boards.

If your GP declines to refer you at all, you can request a second opinion from another GP within the practice or register with a new GP and request a referral. If a referral is refused on clinical grounds you disagree with, you can raise a concern under Putting Things Right.

Private assessment and shared-care reality in Wales

A private ADHD assessment by a GMC-registered psychiatrist produces a clinically valid diagnosis regardless of where you live. However, the pathway after diagnosis is more complicated in Wales than in England.

Shared-care agreements. In England, NHS England's model shared-care framework and the NHS Standard Contract create pressure on GPs to accept shared-care arrangements after a private ADHD diagnosis. No equivalent mechanism exists in Wales. The All Wales Medicines Strategy Group (AWMSG) advises on medicines policy for NHS Wales but has not issued a national ADHD shared-care protocol. Decisions on shared care are made by individual GPs or, in some boards, by medicines management committees.

In practice, some Welsh GPs will accept a shared-care agreement after a private diagnosis; many will not, citing the absence of a local AWMSG-approved protocol, concerns about clinical responsibility, or practice policy. The variability is significant and there is no reliable way to predict the outcome in advance.

Before booking a private assessment, have an explicit conversation with your GP about shared care. Ask them to confirm in writing whether they will, in principle, prescribe ADHD medication under shared care if a GMC-registered consultant psychiatrist provides a diagnosis and management plan. If your GP declines, ask your health board's medicines management team whether a board-wide policy exists that your GP should be following.

If your GP refuses shared care after a private diagnosis and there is no clinical reason for the refusal, you may raise this with the health board under Putting Things Right, and ultimately with the Public Services Ombudsman. The PSOW has upheld complaints where GPs have applied blanket policies against shared care without individual clinical assessment.

Your practical options

Given the absence of Right to Choose in Wales, the following are the realistic options, ranked broadly by accessibility:

• NHS referral through your Welsh GP. The standard route. Ask your GP to refer you to the health board's ADHD or neurodevelopmental service and record the referral acceptance date as your RTT clock-start. Engage the health board proactively if you approach or exceed 26 weeks without an appointment.
• Cross-border referral (Powys patients in particular). Ask your GP whether your health board has a cross-border commissioning agreement with any English NHS ADHD service. Powys Teaching Health Board has the most established cross-border commissioning practice.
• Register with an English GP if you genuinely live near the border. Patients in Monmouthshire, Flintshire, Wrexham or parts of Powys who genuinely reside close to the English border may be within the catchment area of an English GP practice. If you can legitimately register, you gain access to English ICB commissioning and Right to Choose. Confirm that the English GP's catchment area actually includes your address.
• Private assessment. Available UK-wide from telehealth providers (Psychiatry UK, ADHD 360, Clinical Partners) and from private psychiatrists in Wales and across the border in England. Costs range from £500 to £2,000. Confirm shared-care position with your GP before booking.
• IPFR via your clinician. If your case is clinically exceptional, ask your GP or referring clinician whether an IPFR to WHSSC is appropriate. This is a clinician-led process and will not succeed on waiting-time grounds alone.
• Advocacy via your MS. Members of the Senedd can raise individual constituency cases with health boards and Welsh Government ministers. This is particularly effective for systemic RTT failures or refused funding requests. Find your MS at senedd.wales.

Complaints: Putting Things Right and the Public Services Ombudsman for Wales

The Welsh NHS complaints procedure is established by the National Health Service (Concerns, Complaints and Redress Arrangements) (Wales) Regulations 2011, commonly known as Putting Things Right. It applies to health boards, NHS trusts, GPs, dentists, and other NHS Wales bodies.

To raise a concern:

• Write to the Concerns team at your health board (contact details are on each health board's website). Describe what happened, the dates, and what outcome you are seeking.
• The body must acknowledge within two working days and provide a full response within 30 working days (or explain why more time is needed and give a revised date).
• If the response is inadequate or you remain dissatisfied, you can refer the matter to the Public Services Ombudsman for Wales (PSOW) within 12 months of the act or omission complained of, or within 12 months of becoming aware of it.

The PSOW can investigate complaints about health boards and GPs, recommend remedial action, and — in serious cases — issue public reports. The PSOW cannot compel a health board to provide treatment immediately but can require procedural corrections, apologies and, occasionally, financial redress.

Step-by-step: what to do now

The following steps represent the most logical sequence for a Welsh patient who believes they need an ADHD assessment and is frustrated by the absence of Right to Choose.

• Step 1 — Confirm your commissioning position. Establish whether your GP is a Welsh or English practice. Your Right to Choose eligibility depends entirely on this. Check your GP surgery's postcode at gov.wales/find-your-local-health-board.
• Step 2 — Request the referral and record the RTT clock-start. Ask your GP for a referral to the health board's ADHD service. Ask them to confirm in writing the date the referral was sent and, once accepted, the date the health board accepted it. That acceptance date is your RTT clock-start.
• Step 3 — Submit a Putting Things Right concern if the 26-week standard is breached. If you have not received an appointment within 26 weeks of your clock-start date, write to the health board's Concerns team citing the RTT target, your clock-start date, and requesting a projected treatment date.
• Step 4 — Explore private assessment with GP shared-care agreement in advance. Before committing to private assessment fees, get your GP's written position on shared care. If they will accept it, proceed. If not, consider whether you are prepared to fund ongoing private prescribing as well.
• Step 5 — Escalate to your MS and the PSOW if health board responses are inadequate. Use your Member of the Senedd for political advocacy and the Public Services Ombudsman for Wales for formal investigation if Putting Things Right responses do not resolve your concern.

Frequently asked questions