NHS Right to Choose: what it covers and how to use it

NHS patients in England have legal rights over where their treatment is delivered. The rights are written into the NHS Constitution for England and are enforceable. This article sets out what the rights actually are, which conditions attract extended Right to Choose provisions, how to use the route, and where its limits sit.

Sources are at the end.

The headline right

Under the NHS Constitution for England and supporting regulations, an NHS patient being referred for non-urgent consultant-led treatment has the right to choose which NHS-funded provider delivers the treatment. The right applies to first outpatient appointments and to most elective secondary-care pathways. Urgent cancer pathways, emergency care, maternity, prison healthcare, and some mental-health services are excluded from the standard Right to Choose rules.

In practice this means:

• You can choose any NHS trust or foundation trust in England that offers the service you need.

• You can see expected waiting times for each option on the NHS e-Referral Service, accessible through the NHS App or your referral letter.

• You can choose based on waiting time, location, specific specialist expertise, or anything else that matters to you.

• You can ask for a specific named consultant where the provider supports it.

Your GP is legally required to inform you of this right when offering a referral. Most GPs do; if yours does not, ask.

The extended Right to Choose: independent providers contracted to the NHS

For a defined set of conditions, the patient's Right to Choose extends beyond NHS trusts to include any provider that holds an NHS contract to deliver the service, including independent-sector providers. These providers are still NHS providers in the sense that the care is funded by the NHS and is free to the patient. The difference is that they are not NHS trusts; they are private companies or social enterprises delivering under NHS contracts.

The most widely used example of this extended route is adult attention-deficit/hyperactivity disorder (ADHD) assessment. Other conditions where extended Right to Choose has been used include adult autism assessment, gender-identity services, some musculoskeletal pathways, and some psychological-therapy pathways. The specific list of eligible conditions varies over time and by Integrated Care Board (ICB). Your GP's practice pharmacist or the ICB's own patient-information page can confirm the current position for your specific condition.

How Right to Choose is used for adult ADHD

Adult ADHD has been the most visible use case for extended Right to Choose. NHS waits for adult ADHD assessment through traditional NHS-trust specialist services have been long in many parts of England for several years. In response, a number of independent-sector providers hold NHS contracts specifically to deliver ADHD assessment and initial treatment. Patients have used Right to Choose to direct their NHS referrals to these providers, with shorter waits than the traditional NHS-trust route.

The process runs like this:

• The patient speaks to their NHS GP and asks for a Right to Choose referral to a specific independent provider for ADHD assessment.

• The GP writes the referral. The patient specifies which provider they want to go to.

• The referral goes to the chosen provider. Assessment and, where indicated, initial treatment follow.

• If medication is started, the provider handles initial titration and stabilisation. Long-term prescribing is often transferred back to the NHS GP through a shared-care agreement.

The ADHD UK Right to Choose pages are the most widely used patient-facing resource for this specific pathway, including a current list of providers and template letters for patients to use with their GPs. It is a patient-advocacy site, not an NHS site, and should be read as such, but the content is reliable and the template letters are well constructed.

How to invoke Right to Choose

The practical steps for any Right to Choose referral are:

• Ask your GP directly. Say you want to use Right to Choose, name the provider you are interested in, and have a clinical reason for the referral ready. For ADHD specifically, it can help to say "I would like a referral under Right to Choose to [named provider] for ADHD assessment."

• Confirm the provider is contracted to the NHS. All NHS-trust hospitals qualify by definition. Independent providers need to hold an NHS contract for the service you are requesting. The provider's own website will usually say whether it accepts Right to Choose referrals; if it does, it is almost always contracted.

• Ask the GP to note Right to Choose on the referral. This flags the referral correctly in the NHS system and avoids it being misdirected to the default local provider.

• Follow up on the referral. Take down the provider's contact details. If you have not heard from them within a reasonable time, chase the provider directly.

A small minority of GPs are reluctant to make Right to Choose referrals, either through unfamiliarity with the process or scepticism about independent providers. If this happens, the template letters on ADHD UK and the NHS Constitution for England are useful supports. You can also change GP practice if the issue persists.

What Right to Choose does not cover

Right to Choose is not unlimited. Several categories are out of scope.

• Urgent and emergency care. You cannot use Right to Choose for a cancer two-week-wait referral or any urgent clinical situation; the NHS directs you to the fastest-available provider.

• Maternity care. Maternity follows its own patient-choice framework, not the standard Right to Choose.

• Mental health detention and specific mental health services. Some mental-health pathways are excluded.

• Prison healthcare.

• Care commissioned by NHS England directly (specialised commissioning). Most rare-disease and complex-specialist care is specialised-commissioned and does not follow the Right to Choose rules.

• Care delivered wholly in primary care. Right to Choose applies to consultant-led secondary-care referrals.

Right to Choose also does not extend to privately funded care. If you want to see a private specialist outside the NHS, that is the private consultation route, not Right to Choose.

Scotland, Wales, and Northern Ireland

Right to Choose as written into the NHS Constitution for England is an English arrangement. Scotland, Wales, and Northern Ireland have their own patient-choice rules under their own health systems.

• Scotland does not have a direct equivalent to English Right to Choose; patient choice operates differently under the Scottish NHS.

• Wales has some patient-choice provisions within NHS Wales but does not replicate English Right to Choose in the same legal form.

• Northern Ireland operates under the Health and Social Care NI system with its own choice rules.

Patients moving between the UK nations may find that access routes that worked in one system do not apply in another. Check the NHS rules for the nation where you now live.

Honest limits of Right to Choose in practice

Even where the legal right exists, three practical limits apply.

• Not all GPs are familiar with it. Some practices process Right to Choose referrals routinely; others need a gentle prompt. The more specific your request, the easier the referral usually is.

• Provider capacity varies. A popular Right-to-Choose provider can develop its own waiting list over time. Check current waiting times before choosing.

• Shared-care transfer back to the NHS GP can be complicated for some conditions (ADHD medication particularly), because not all NHS GPs feel comfortable continuing prescribing initiated by an independent provider. The shared care article covers this.

None of these limits removes the legal right. They describe the shape of how the right is used in practice.

The summary

NHS patients in England have a legal right to choose where their NHS treatment is delivered. The right covers all NHS trusts and, for specific conditions including adult ADHD, extends to independent providers contracted to the NHS. Your GP is required to inform you of the right when referring you. Using the right effectively usually means asking for a specific named provider, being clear about the clinical reason, and confirming the referral is marked as Right to Choose.

The right does not cover urgent care, maternity, prison healthcare, or specialised commissioning. It does not extend to private self-funded care. It does not apply outside England in the same legal form.

Within those limits, Right to Choose is a genuinely useful patient entitlement, and for patients facing long NHS waits in their local area it can materially shorten the path to specialist assessment.

Sources and further reading

• NHS, Your right to choose where you have your NHS treatment. The NHS-facing summary of the right.

• gov.uk, NHS Constitution for England. The legal basis of the right.

• NHS, NHS e-Referral Service. Online referral and provider selection.

• ADHD UK, Right to Choose. Patient-advocacy resource for the ADHD-specific Right to Choose pathway, including template letters.

• NHS England, Integrated Care Boards. Local NHS commissioners that administer Right to Choose referrals.

• Scottish Government, NHS Scotland patient choice. Patient-choice position for NHS Scotland.

• Welsh Government, NHS Wales patient rights. Patient-choice position for NHS Wales.

About the author

Dr Seth Rankin qualified in medicine at Auckland School of Medicine in New Zealand in 1990 and worked as a junior doctor across New Zealand, Australia, and the UK before qualifying as a Member of the Royal College of General Practitioners (MRCGP) through the London Deanery in 2004. He was Managing Partner of Wandsworth Medical Centre from 2006 to 2016 and served as a Board Member of Wandsworth Clinical Commissioning Group for nine years. He is the founder of London Travel Clinic, London Doctors Clinic, London Medical Laboratory, and LoveMyLife.

Read more about Dr Seth Rankin.

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