ADHD and ASD Right To Choose (Child and Adolescent)

Families are increasingly seeking ADHD or Autism (ASD) assessments through private clinics, overseas providers, or NHS Right to Choose (RTC). However, not all assessments meet NHS or NICE standards, and this affects whether local NHS services can provide follow-up care, including medication. We appreciate that this is a long read but do try to understand the sections below as it important for you to understand how the sections below effect your child’s assessment and management long-term.

This page explains:

1. · Our surgery’s position on referrals
2. · What Right to Choose means
3. · When the NHS will accept (ratify) an external diagnosis
4. · How ADHD shared care prescribing works
5. · Important considerations before choosing a private or RTC provider

Section 1 – Arbury Road Surgery’s Position on Child (<18 years old) ADHD/ASD Referrals

We recommend school-based referrals wherever possible. 

Schools know your child best and can provide crucial information about learning, behaviour, and support needs. Their involvement is essential for accurate assessment.

· Most children should begin the ADHD/ASD pathway via their school.

· We are happy to discuss individual situations where this is not straightforward.

Right to Choose may be discussed on a case-by-case basis.

We can discuss whether RTC is appropriate, but there are significant limitations, especially involving ADHD medication in children (see Section 5).

Section 2 – What is NHS Right to Choose (RTC)?

Right to Choose gives families the legal right to choose an NHS-funded provider for certain assessments. It does not entitle one to an assessment.

To use RTC:

· Your child must be registered with an English GP

· They must not already be under NHS care for the same condition

· The provider must offer NHS-commissioned services (not private-only)

· You must request the referral to your chosen provider

Your responsibilities when choosing RTC

Parents/carers must:

· Check the provider accepts NHS RTC patients

· Confirm whether they offer assessment AND treatment

· Understand you may need to travel for appointments

· Be aware that after the RTC diagnosis, the NHS may still require ratification, which has long waiting times

· Know that GPs cannot recommend specific RTC providers

Section 3 – When Will Local NHS CAMHS Accept a Private/RTC/Overseas Diagnosis?

Cambridgeshire & Peterborough CAMHS will only review external diagnoses if NHS treatment/support is being requested.

They will check whether the assessment:

✔ meets NICE standards

✔ includes school information

✔ includes a full developmental history

✔ includes face-to-face assessment (ADOS/BOSA for autism; QB/observation for ADHD) ✔

uses validated questionnaires (e.g., Conners, SCQ)

✔ includes MDT formulation

If it does not meet these standards:

· The diagnosis will not be accepted, and

· A full or partial NHS reassessment may be required

Ratification waiting times are the same as a new NHS assessment.

Section 4 – ADHD Medication & Shared Care: Important Information

Prescribing ADHD medication in children requires:

· Physical monitoring (BP, HR, growth)

· Mental health review

· Dose titration

· Specialist oversight

Until CAMHS ratifies the diagnosis, the RTC provider remains responsible for:

· Prescribing

· Monitoring

· Dose changes

· Side-effect review

Arbury Road Surgery cannot take over prescribing until:

1. Local CAMHS has ratified the diagnosis

2. CAMHS has agreed a Shared Care Agreement

3. A named NHS specialist oversees ongoing care

Why Shared Care is more complex in children than adults:

1. Higher clinical risks: Children require closer monitoring than adults.

2. Variable quality among RTC providers: Some assessments do not meet NHS standards.

3. Transition at age 18 is uncertain:

o Some RTC providers do not have adult ADHD teams.

o If adult services are absent, care must transfer to the local NHS adult ADHD team, who may re-review the childhood assessment before accepting Shared Care.

Because of these risks, Shared Care cannot be guaranteed after RTC assessments in children.

We do not enter into Shared Care agreement with private providers as per BMA guidance.

Section 5 – If You Are Considering Right to Choose for Your Child

Please make sure you understand:

✔ A diagnosis may not be accepted by local NHS services

✔ ADHD medication prescribing is not automatic

✔ Ratification involves long waiting times

✔ You may need to travel for follow-up appointments

✔ The GP cannot choose a provider for you

We are happy to discuss these points with you before you decide.