If you or your child needs an ADHD or autism assessment in England, there are two NHS-funded routes open to you. The first is your local NHS pathway, where your GP refers you to the neurodevelopmental service your local area has commissioned. The second is NHS Right to Choose, a legal right that lets you ask for your referral to go to a provider you have picked instead. Both are free, and both run under the NHS. What changes between them are how they work and what that means for your wait, your eligibility, and the support you get afterwards.
Most families and adults are not sure which route suits them. This guide sets the two side by side so you can decide. It does not walk through how to request a referral step by step; that is covered separately in our step-by-step guide to requesting a Right to Choose referral from your GP. Here, the focus is on the decision itself.
If you want to understand how these NHS-funded routes compare with going private, our guide on the differences between NHS-funded and private autism assessments covers that. This piece stays on the topic of choosing between the two NHS routes.
Local NHS Pathway vs Right to Choose at a Glance
Both routes are free to you and funded by the NHS. The difference comes down to who chooses the provider. On the local NHS pathway, your Integrated Care Board (ICB) decides which service you are referred to. Under Right to Choose, you choose the provider, and your GP refers you there.
| Local NHS pathway | NHS Right to Choose | |
|---|---|---|
| Who chooses the provider | Your ICB. You are referred to the service it has commissioned. | You do. You name a provider that holds a qualifying NHS contract. |
| Who can refer | GP, or a school SENCO, in some areas for children. | GP only. A SENCO cannot make a Right to Choose referral. |
| Typical waiting time | Often two years or more, varying by ICB. | Sometimes shorter, but ICB activity limits can narrow the gap. |
| Where it applies | England, through your local ICB. | England only. Not Wales, Scotland, or Northern Ireland. |
| What the assessment covers | NHS neurodevelopmental assessment and diagnostic report. | NHS neurodevelopmental assessment and diagnostic report. |
| Post-diagnostic support | Usually managed within the same local service. | Varies by provider. Some offer it, some assess only. |
| ADHD medication and titration | Handled within or alongside the local service. | Only if the provider offers it, usually with GP shared care. |
What Is the Local NHS Pathway?
The local NHS pathway is the standard route. Your GP, or for children, a GP or school SENCO, refers you to the neurodevelopmental service your Integrated Care Board (ICB) has commissioned for your area. You join that service’s waiting list, and in time, the local team carries out the assessment, gives the diagnosis, and coordinates the support that follows.
The main advantage is that it is joined up. Post-diagnostic support, ADHD medication titration for children where it applies, and school liaison are usually handled within the same system or one closely linked to it. You are not stitching different services together yourself.
The main drawback is the wait. Demand has climbed sharply, and capacity has not kept pace. The rate of autism referrals for children and young people rose from 397 to 1,133 per 100,000 of the population between January 2022 and December 2025, close to tripling in four years. For ADHD, NHS data suggests up to 549,000 people in England may have been waiting for an assessment as of March 2025. Waiting on the local pathway runs for two or more years in many ICBs.
For children, it is worth knowing that a school SENCO can sometimes refer to the local service directly. In some areas, that moves things along faster than waiting for a GP appointment, though it varies by area.
What Is NHS Right to Choose?
Right to Choose is a legal right under the NHS Choice Framework. If your GP agrees that a referral is clinically appropriate, you can ask for that referral to go to a provider you have chosen, including independent providers that hold an NHS contract, rather than to your local commissioned service. The assessment is still NHS-funded, so you pay nothing.
A few things to understand:
- It is England only. It does not apply if you are registered with a GP in Wales, Scotland, or Northern Ireland. Those patients go through their local devolved NHS pathways.
- It is not self-referral. Your GP has to submit the referral. You identify the provider, and your GP does the paperwork.
- It covers the initial assessment. Right to Choose is a right to choose a provider for the referral, not an ongoing treatment right. What happens after the assessment varies by provider.
There is also a catch on waiting times. ICBs can set limits on how many assessments Right to Choose providers carry out in their area each year. Where demand is high, that can mean a provider is only able to accept a capped number of referrals, which eats into the time-saving the pathway is known for.
Once you have decided Right to Choose is right for you, our guide to requesting a Right to Choose referral from your GP covers exactly how it works and what to expect.
Who Can Refer: GP, SENCO, and Self-Referral
Both routes need a GP to submit the formal referral. Self-referral is not available on either pathway, despite being a common assumption. You cannot approach a Right to Choose provider directly and book yourself in, unless they also offer a private service, which you then pay for outside of Right to Choose.
For children, a school SENCO can begin the process on the local NHS pathway by referring to the local service in some ICBs, which can be a helpful head start. For Right to Choose, though, the referral has to come from the child’s GP. A SENCO cannot start a Right to Choose referral, although they can provide school evidence that supports it.
For adults, the GP is the only referral route on both pathways.
The practical difference is this. On the local pathway, your GP refers you to whichever service the ICB commissions. For Right to Choose, you decide on your preferred provider first and bring that information to the GP appointment.
Waiting Times: What to Expect on Each Route
Both routes can carry long waits, and Right to Choose is not automatically faster. It depends on the provider you choose and the ICB you fall under.
On the local NHS pathway, waits vary a lot by area but are long across the board. As of March 2026, 270,701 patients in England had an open referral for a suspected autism assessment, and 89.7% of them had been waiting at least 13 weeks, the point at which NICE guidance suggests an assessment should already be starting. In some ICBs, the wait stretches to several years.
Right to Choose can be quicker. Some providers offer waits measured in months rather than years. But the picture has shifted. To manage their budgets, ICBs have brought in activity limits, capping how many assessments a Right to Choose provider can carry out for their area. At least nine ICBs restricted or paused Right to Choose bookings during the 2025-26 financial year, in some cases, less than eight months into the year, reportedly adding five or more months on top of waits that could already pass twelve months. So the headline advantage of Right to Choose still holds in some areas, and has largely closed in others.
Two practical points. First, check the provider’s current waiting time estimate before you book the GP appointment, because these figures often change. Second, if you start on one route and later switch to the other, you will usually rejoin the new waiting list from the beginning rather than carry your time over. That switching cost is worth weighing before you commit.
Who Qualifies: Eligibility and Clinical Exclusions
Both routes are open to anyone registered with an NHS GP in England who has a clinical need for assessment. There is no age limit on the basic eligibility for either route. Children and young people qualify just as adults do, with the referral made by their GP.
Where Right to Choose differs is that individual providers set their own clinical suitability criteria on top of the standard NHS eligibility. These are not national, so each provider publishes its own list.
Common exclusions across Right to Choose providers include the following, though this is not exhaustive:
- Intellectual disability with an IQ below 70, or significant developmental delay (often because remote assessment formats are not designed for this)
- An active or recent psychotic episode, typically within the last three to six months
- Detention under the Mental Health Act 1983, or being subject to a Community Treatment Order
- An ongoing safeguarding investigation or an active child protection plan
- Being non-verbal and unable to engage with the assessment format, particularly with online-only providers
- Already being on another NHS waiting list for the same assessment
Having another mental health diagnosis does not automatically rule you out, but a provider may recommend deferring the assessment during an active mental health crisis.
For children, the child must be registered with a GP in England, and the referral comes from their GP. Right to Choose applies to children and young people as well as adults, but the age ranges providers accept vary, so always check before requesting the referral.
The practical takeaway is to read the provider’s suitability criteria before the GP appointment, not after. A mismatch found later only adds delay.
What Each Route Covers: Assessment, Post-Diagnostic Support, and Medication
Both routes fund the initial neurodevelopmental assessment. The assessment under Right to Choose follows the same NICE guidelines, and the resulting diagnosis is an NHS diagnosis. Where the routes differ is in what happens after the assessment.
On the local NHS pathway, the local service usually manages what comes next within the same team or one closely linked to it: post-diagnostic support, onward referral for therapy or educational support, and, for ADHD, medication titration and prescribing. This integration is one of the strongest positives for the local route.
On Right to Choose, what you get beyond the assessment varies a lot by provider. Some offer assessment only. Others include post-diagnostic support, ADHD medication titration, and ongoing reviews. You need to confirm this before you choose a provider.
On ADHD medication specifically, if ADHD is diagnosed through Right to Choose and the provider offers titration, the provider can prescribe and manage that phase. For ongoing prescribing, most providers then move to a shared care arrangement where your GP takes over once you are stable. That depends on your GP agreeing to it, which is not guaranteed, so it is worth raising with your GP before you choose a provider. For a fuller picture of what an ADHD assessment for children and young people involves, see our dedicated page.
For autism, post-diagnostic support on both routes is largely community-based and varies by local provision. Neither route guarantees ongoing therapy. Under Right to Choose, you receive the assessment and diagnostic report unless the provider explicitly offers more.
Provide Wellbeing is an NHS Right to Choose provider for ADHD and autism assessments for children and young people. Adult ADHD through Right to Choose is not currently available, though self-pay options exist. You can read more about Provide Wellbeing’s Right to Choose pathway for children and young people.
Which Route Is Right for You?
There is no single right answer. The best route depends on what matters most to you, your circumstances, and where you live.
If you want the most joined-up follow-on care and you are not in a hurry, the local NHS pathway keeps the assessment, post-diagnostic support, and medication management within one system. The tradeoff is a longer wait.
If waiting time is your priority and you are ready to do some research, Right to Choose may cut the wait, but it asks more of you. You choose the provider, check the suitability criteria, and confirm what the provider covers beyond the assessment.
If you are a parent or carer of a child, both routes apply. A SENCO referral may be faster for the local pathway in some areas, but for Right to Choose, the referral still has to come from the GP.
If you or the person being assessed has complex needs, or is already receiving other specialist NHS care, the local NHS pathway may suit you better. Right to Choose providers have exclusion criteria that can apply, and the integrated local route tends to handle complexity more smoothly.
If you are an adult seeking an ADHD assessment, note that Right to Choose for adult ADHD is not currently available through Provide Wellbeing. Our self-pay assessment options are an alternative to consider.
If you are in Essex or East Anglia, Provide Wellbeing’s clinics in Chelmsford, Colchester, and Halstead offer Right to Choose assessments for children and young people, with in-person appointments. Right to Choose is open to patients across England regardless of location, so you are not limited to providers near you.
Not sure where to start? Our start here page can help you work out which pathway is right for you or your child.
Frequently Asked Questions
Is Right to Choose Faster Than the Local NHS Pathway?
Not always; Right to Choose providers have much shorter waiting times. However, ICBs can limit the number of assessments that Right to Choose providers carry out, which can narrow the gap. Check the provider’s current waiting time estimate before the GP appointment.
Can a Child Access Right to Choose?
Yes, Right to Choose applies to children and young people as well as adults in England. The referral must come from the child’s GP. A SENCO cannot start a Right to Choose referral, though they can support the local NHS pathway and provide school evidence.
Does Right to Choose Cover ADHD Medication?
It can, if the provider offers ADHD medication titration and management, but not all do. Once a patient is stable on medication, prescribing usually transfers to the GP under a shared care arrangement. Confirm this with the provider and your GP before choosing a provider.
Can I Switch From Right to Choose Back to the Local NHS?
Yes, but you will generally rejoin the waiting list from the beginning, not carry over the time already waited. A new assessment may also be needed depending on the circumstances. Weigh this before committing to a provider.
Does Right to Choose Apply in Wales, Scotland, or Northern Ireland?
No, Right to Choose operates in England only. It applies to patients registered with a GP in England. Patients in Wales, Scotland, and Northern Ireland are referred through their local devolved NHS pathways.
What Are the Clinical Exclusions for Right to Choose?
Each provider sets its own criteria, but common exclusions include an IQ below 70, an active or recent psychotic episode, detention under the Mental Health Act, an ongoing safeguarding investigation, and already being on another NHS waiting list for the same condition. Always check the provider’s criteria before the GP appointment.
