Something has been nagging at you for a while — maybe for years. A pattern you can't quite explain, the effort it takes to do things others seem to manage without thinking, the exhaustion that nobody else seems to feel, the sense that you've been running a different operating system to everyone around you and spending most of your energy hiding it.
You've started looking things up. Maybe a thread, a TikTok video, a reel that finally put words to something. And now you're wondering: do I need an assessment? How does that even work? How long will it take?
The NHS waiting lists for neurodevelopmental assessments are long — in some areas, several years. But there's a pathway that many people don't know about, one that gives you a legal right to choose who carries out your assessment and can significantly reduce that wait. This pathway is known as the Right to Choose (RTC), and this article will walk you through it clearly, step by step.
In this article, we'll explore:
What the NHS Right to Choose pathway is and who it's for
How to access it, step by step, including what to do if your GP pushes back
What to expect from the assessment itself
What the emotional reality of seeking a diagnosis looks like — and why it's worth taking seriously
How therapy can support you at each stage — including what I can offer as part of that
What Is the NHS Right to Choose Pathway?
The NHS Right to Choose (RTC) pathway is part of the NHS Choice Framework. It gives adults in England the legal right to choose which approved provider delivers their first outpatient appointment — including assessments for ADHD and autism. Assessments are funded by your local Integrated Care Board (ICB) — the NHS body responsible for commissioning healthcare in your area — meaning there is no cost to you.
In practice, this means that rather than being placed on your local NHS trust's waiting list (which can stretch to several years), you can choose from a list of approved providers across England. Many of these offer online assessments, meaning geography isn't a barrier.
Who Can Use Right to Choose?
You can access the RTC pathway if you are:
Registered with a GP in England
Not already receiving NHS care or treatment for the same condition
Showing significant signs of ADHD and/or autism that are affecting your daily life
You cannot use RTC if you are currently receiving urgent or crisis care, are an active member of the armed forces, or are detained in hospital under the Mental Health Act.
To understand more about your legal right to choose within the NHS, you can take a look at the your choices in the NHS page.
How to Access the Right to Choose Pathway: Step by Step
Step 1: Prepare Before your GP Appointment
Before you go to your GP, it's worth spending some time thinking about how your difficulties show up in your daily life — at work, in relationships, in managing tasks or your environment. Think across both childhood and adulthood, since assessors will want to understand patterns over time, not just how things feel right now.
You don't need to have a formal list or know the "right" words. But the more specific and concrete you can be, the more useful it will be — for your GP appointment, and for the assessment itself.
Two screening tools are worth completing before you go. The ASRS-v1.1 (Adult ADHD Self-Report Scale) is the questionnaire most commonly used in primary care for ADHD, and some RTC providers require it before they'll accept a referral. The AQ-10 is the short autism screening tool GPs typically use as a first step. Both are free and printable — you can find the ASRS-v1.1 here and the AQ-10 here.
Bringing your completed scores to the appointment gives you something concrete to refer to, and can help you articulate your experiences more clearly.
Step 2: Choose your provider first
Before booking your GP appointment, spend some time choosing which provider you'd like to use. Going in with a name ready makes the process much simpler.
ADHD UK maintains an up-to-date list of approved RTC providers — covering both ADHD and autism. This is the best place to start.
When comparing providers, look at three things:
Assessment wait time: ADHD waits currently range from zero to around 37 weeks depending on provider. Autism waits are considerably longer — from zero at the faster end to over three years at the longest — so provider choice matters even more if autism is what you're seeking.
Medication wait time (ADHD): Assessment and medication are separate queues. Some providers have short assessment waits but much longer titration waits. If medication is likely to be relevant, factor both into your decision.
Shared care: Most providers will continue prescribing if your GP declines shared care — but not all. Worth checking before you commit.
A growing number of ICBs are using something called an Indicative Activity Plan to limit RTC access in their area.
At the time of writing, the affected ICBs are:
Buckinghamshire, Oxfordshire and Berkshire West
Bedfordshire, Luton & Milton Keynes
Birmingham & Solihull
Bristol, North Somerset and South Gloucestershire
Cheshire & Merseyside
Coventry
Dorset
Frimley
Hampshire & Isle of Wight
Kent & Medway
Leicestershire and Rutland
Norfolk & Waveney
North Central London
North Cumbria and North East England
Suffolk & North East Essex
Greater Manchester
Somerset
Sussex
If you're in a restricted area, here's what people are doing:
Try a different provider. If your assessment hasn't started yet, you can ask your GP to refer you to a different provider. Due to high demand this may not always result in a shorter wait, but some providers have less restrictive ICB arrangements than others — it's worth checking the ADHD UK list for your area.
Contact your ICB directly. You can contact your local Integrated Care Board to ask about your options and make clear the impact the restriction is having on you.
Escalate via PALS or Healthwatch. If you feel the restriction is causing you harm, you can contact your local PALS (Patient Advice and Liaison Service) or Healthwatch to raise a formal concern.
Contact your MP. This is a politically contested issue and MPs are receiving correspondence about it. A letter or email setting out your situation can add to the pressure for change.
Make a formal complaint. If you believe your legal right to choose is being unlawfully restricted, you can make a complaint through the NHS complaints process.
Step 3: Ask your GP for a Right to Choose referral
Once you've chosen your provider, book a GP appointment and ask specifically to be referred under the Right to Choose pathway, naming the provider.
Some GPs are unfamiliar with RTC and may initially suggest the standard local waiting list instead. If this happens, you can politely let them know that you're exercising your legal right under the NHS Choice Framework. Most providers have a template letter or referral form you can bring to the appointment to make this easier — it's worth checking the provider's website before you go. Alternatively, ADHD UK have a template letter you can use.
Step 4: Complete the intake process
Once the referral is submitted and accepted, your chosen provider will send you questionnaires to complete. These cover your history, your current experiences, and how your difficulties affect your daily life.
Most providers will also ask for a collateral contact — someone who knew you as a child, or who knows you well now — who can share their observations. This part of the process can feel exposing. It's common to feel anxious about whether your experiences will be "enough," or to worry about being believed. These feelings are worth naming, and worth bringing to therapy if you have it.
Step 5: The assessment
Assessments are typically carried out online, by trained clinicians using validated diagnostic tools. They'll include a clinical interview covering your life history — childhood, adolescence, work, relationships — and your current day-to-day experiences.
If you're being assessed for both autism and ADHD, both can be explored in the same pathway. The assessor will also consider whether other conditions might explain your difficulties, and will take co-occurring diagnoses and experiences into account.
Step 6: The feedback session
After the assessment, you'll receive a feedback session where the clinician discusses the outcome, explains their reasoning, and outlines what support or next steps are available. If ADHD medication is recommended, this is usually a separate process with its own waiting period.
How Do I Know If I Should Seek an Assessment?
This question comes up a lot, and there's no single answer — but there are some common patterns people describe before pursuing a diagnosis.
You might be wondering about an assessment if you:
Have spent years struggling with things that seem to come more easily to others — organisation, focus, social situations, sensory environments
Have previously received diagnoses (anxiety, depression, trauma responses) that feel only partially right
Have always felt "different" but couldn't name why
Recognised yourself in something you read or heard about autism or ADHD, and felt a shift of understanding
Are exhausted by how much effort daily life takes compared to what it appears to take for others
Were recently told by a professional, partner, or close person that they suspect you might be neurodivergent
Want access to reasonable adjustments at work or in education — a formal diagnosis can support requests under the Equality Act 2010, and some workplaces and institutions require one as evidence
None of these on their own means you're definitely autistic or have ADHD — but they're worth exploring. An assessment isn't a test you can pass or fail. It's a process of gathering information to understand yourself more fully.
What an ADHD and/or Autism Assessment Actually Looks Like
Assessments under the RTC pathway follow NICE guidelines and are delivered by trained clinicians — typically psychologists, psychiatrists, or specialist nurses. They're thorough, and they're designed to gather a full picture rather than a quick checklist.
Most assessments include:
A detailed clinical interview (often two or more sessions)
Standardised questionnaires and rating scales completed by you and your collateral contact
Review of relevant history — including childhood experiences, education, and any previous diagnoses or support
Discussion of alternative explanations for your difficulties where relevant
After the assessment, you'll receive a written report outlining the clinician's findings and recommendations. This report is important — it's the basis on which your GP will consider next steps, including shared care for medication if ADHD is diagnosed.
The Emotional Side of Seeking a Diagnosis
The RTC pathway handles the clinical process. What it doesn't account for is everything surrounding it. Deciding to pursue an assessment often stirs things up — hope, doubt, the fear of not being believed, or a dawning recognition of how much has gone unnamed for a long time.
The assessment itself can be depleting: having to articulate experiences you've spent years minimising, to a clinician you've just met, takes something. And the outcome, whatever it is, tends to land with more weight than people expect — relief, grief, disorientation, or all of it at once. A negative outcome has its own particular difficulty, especially when your experiences feel real and significant regardless of what the report says.
None of this is incidental to the process. It's part of it.
How Therapy Can Help With The Assessment Process
As a neurodivergent therapist working with autistic and ADHD adults, I work with clients across every stage of this — not only once a diagnosis is in place.
Before and during the wait
The waiting period is often when support is most needed and least available. Therapy can be a space to hold the uncertainty, explore what a diagnosis would mean to you, and work somatically with the anxiety that not-knowing tends to activate. We might also use parts-based work to understand what different parts of you feel about seeking assessment — the hopeful part, the sceptical one, the part that's afraid of being told you're fine again.
Practically, I can also write a supporting letter for your assessment — outlining what I've observed clinically, how your difficulties present in our work together, and the impact on your daily functioning. This can be a useful accompaniment to your referral, particularly if your GP has been uncertain.
Around the assessment itself
Many late-diagnosed neurodivergent adults have spent years masking or second-guessing themselves, which can make presenting your difficulties clearly feel counterintuitive. Therapy sessions around the time of your assessment can help you find words for your experiences, notice where you might minimise, and feel more grounded going in.
After the outcome
A late diagnosis deserves more than a feedback form. Therapy after diagnosis can be a space to make sense of it — to process the grief or relief, untangle past wounds from your authentic self, and work out what you actually need now that you have a clearer picture. For those who receive a negative outcome, therapy can help you think carefully about what was and wasn't captured, and whether another pathway is worth exploring. A negative outcome is not the end of the road.
A Note On Co-occurring Conditions
Autism and ADHD frequently occur together — a combination the neurodivergent community often refers to as AuDHD. Both also often co-occur with anxiety, depression, trauma responses, and other mental health difficulties.
If you've received previous diagnoses that feel only partially right, or if the full picture has never quite been explained by a single diagnosis, it's worth discussing this with both your GP and your therapist. An RTC assessment can explore both autism and ADHD, and a thorough assessor will take the whole picture into account rather than assessing in isolation.
You can read more about the AuDHD experience here.
From Me To You
The RTC pathway is, frankly, a minefield — and it's becoming more complex as demand increases and ICBs introduce restrictions that didn't exist a year ago. None of that is your fault, and none of it should put you off.
The single most useful thing you can do right now is start the process. The sooner your referral goes in, the sooner the clock starts — and waiting lists move, restrictions shift, and new providers come online. Whatever is happening at a system level, being on a list is always better than not being on one.
Meet Fi: ADHD & AuDHD Therapy for Late Diagnosis and Burnout
Common Ground offers neurodivergent-affirming online therapy across the UK and Europe for adults who are questioning whether they may be ADHD, autistic or AuDHD, waiting for assessment, or making sense of a recent diagnosis.
All of our therapists work neurodivergent-affirmatively, with different areas of specialist experience. Fi works particularly with ADHD and AuDHD adults navigating late diagnosis, masking, burnout and identity, alongside LGBTQ+ and queer experiences.
You can meet Fi and learn more about working with her, or explore the Common Ground therapy team to find the therapist who feels right for you.
FAQs About the Right to Choose Pathway
How does Right to Choose work with ADHD?
If you're registered with a GP in England and showing significant signs of ADHD, you have a legal right to choose which approved provider carries out your assessment rather than being placed on your local NHS waiting list. You ask your GP to refer you by name to an RTC provider of your choice, they submit the referral, and the provider contacts you to begin the intake process. The assessment and any follow-on care — including medication where appropriate — are fully NHS-funded. ADHD UK maintains an up-to-date list of approved providers, including current wait times and medication availability.
One thing worth noting: RTC only applies to the first referral for a new episode of care. It cannot be used for a second opinion, reassessment, or follow-up if you've already been seen for the same condition.
Can a GP refuse Right to Choose for ADHD?
Technically, no — the right is a legal one under the NHS Choice Framework, and GPs are not permitted to refuse a referral simply because they'd prefer you to use the local service. In practice, some GPs are unfamiliar with the pathway and may initially push back or suggest the standard route instead. If this happens, you can let them know you're exercising your legal right and direct them to the provider's referral information — most RTC providers have a GP referral form and guidance on their website specifically for this reason.
There is one exception worth knowing: GPs can decline a referral if the chosen provider doesn't hold a contract with your local ICB, or if the referral is deemed clinically inappropriate. This is why it's worth checking your ICB's preferred provider list before your appointment if you can.
It's also worth knowing that if the RTC provider doesn't carry out a thorough enough assessment, your GP may refuse shared care for medication — and your local NHS service may not accept the report as valid evidence of a diagnosis. Quality of assessment matters for what comes after, which is another reason to check providers carefully before committing.
Can you use Right to Choose for autism?
Yes. The Right to Choose pathway covers autism assessments as well as ADHD, and is available to adults in England. The same process applies — you ask your GP for a referral to an approved RTC provider of your choice. Wait times for autism assessments tend to be longer than for ADHD assessments, so it's worth checking the ADHD UK provider list for current figures before deciding where to be referred.
Can you use Right to Choose for both ADHD and autism?
Yes, and if you think both might be relevant, it's worth saying so from the outset. Many RTC providers offer combined assessments, and a thorough assessor will consider both rather than assessing in isolation. Autism and ADHD co-occur frequently — research suggests around four in ten autistic adults also meet criteria for ADHD — and an assessment that looks at the full picture is usually more useful than two separate ones. If you're unsure, you can ask your chosen provider whether they assess for both before your GP submits the referral.
