NHS Right to Choose in County Durham: 2026 Guide

Waiting for a GP referral in County Durham can often feel like a long process, particularly when you are concerned about extended waiting times. The NHS Right to Choose programme provides an alternative route, offering patients the ability to select an eligible provider elsewhere in England at no extra cost to themselves.

The rules are more specific than many people realise. You must require an NHS referral for a clinically appropriate, planned service, and your chosen provider must hold the relevant NHS contract. This 2026 guide explains how the process works for those seeking an ADHD assessment or an Autism assessment, how to manage the GP referral process, and the steps to take if your request is unfortunately refused.

Key Takeaways

• The NHS Right to Choose applies to patients across England, including those living in County Durham, for most planned outpatient consultant-led referrals.
• Your GP must agree that a referral is clinically appropriate, and you should initiate the process by requesting a GP referral to a specific NHS-funded provider of your choice.
• Eligible independent sector providers can deliver NHS care, meaning your treatment does not have to take place at an NHS hospital trust.
• ADHD and autism assessment services frequently use this route, though access can be influenced by age criteria, existing service contracts, clinic capacity, and your current treatment status.
• Always request your referral in writing and keep a record of the provider name, the date of your request, and your NHS e-Referral Service details for your own reference.

What NHS Right to Choose means for County Durham patients

NHS Right to Choose is a legal right to choose in England. It lets you select where you receive certain NHS-funded healthcare after an NHS GP, dentist, or optometrist refers you for a first appointment.

Under the NHS Choice Framework, this selection can include an NHS trust, a hospital in another part of England, or an independent provider commissioned to deliver NHS services. The chosen facility must hold an NHS Standard Contract for the relevant treatment or assessment. A clinic offering only private appointments is not automatically eligible.

The route covers the provider, not the diagnosis or treatment you receive. Your GP decides whether a referral is clinically suitable. You can then ask to be referred to an eligible provider that offers the service you need.

For County Durham residents, the most important geographical point is that the right applies because your GP is in England. You do not have to choose a service within County Durham or even within the North East. However, the provider must accept referrals under its NHS contract and have a pathway that matches your circumstances.

The North East and North Cumbria NHS guide to patient choice is particularly useful for local families and adults considering neurodevelopmental services. It sets out the difference between ordinary local referral routes and a request to choose another provider.

The NHS funds the care when the referral meets the rules. You should not receive a private bill for an eligible NHS assessment or treatment. The provider receives payment through the NHS commissioning arrangements, which usually involve the relevant Integrated Care Board.

Who qualifies for Right to Choose?

You must meet several conditions before you can use this route. Meeting one condition alone is not enough.

Requirement	What it means
Your GP	You must be registered with an NHS GP in England
Referral	An NHS GP, dentist or optometrist must refer you
Type of care	The referral must be planned, non-urgent and consultant-led
First appointment	The choice normally applies to your first appointment
Clinical need	Your GP must agree that the referral is clinically appropriate
Provider	The provider must hold a qualifying NHS contract for that service
Funding	The chosen pathway must be NHS-funded, rather than self-pay

Physical health services usually need consultant-led care. For a mental health service, the relevant pathway may involve a consultant or another qualified mental health professional. The exact rule depends on the service and the provider contract.

Right to Choose does not allow self-referral. You can research a provider yourself, but you must secure a formal GP referral to initiate the process. You also cannot use the scheme to request a particular medicine, diagnosis or outcome. The clinician remains responsible for assessment and treatment decisions.

Some situations fall outside the scheme. These include emergency care, urgent cancer pathways, maternity services and primary care. Local authority services are also separate. A referral for support commissioned by the council does not become an NHS Right to Choose referral.

You may also be excluded if you are already receiving elective care for the same condition, have self-referred to the provider, or are receiving care in circumstances covered by special rules. People detained under the Mental Health Act or held in secure settings have different arrangements. Serving members of the armed forces also have separate NHS provisions.

For ADHD, an existing assessment or active treatment pathway can prevent a second Right to Choose referral for the same condition. Tell your GP about previous referrals, assessments and medication. Leaving out that information can create delays or duplicate records.

The NHS explanation of patient choices provides the wider framework, including circumstances where a patient cannot choose. Rules can change, so check the current information before asking for a referral.

How to request a referral from your Durham GP

A clear request gives your surgery the information it needs. It also creates a record if the referral later needs checking.

Start by booking a GP appointment, either in person, by telephone or through your practice’s online system. Explain the symptoms or health problem, how it affects daily life and why you think specialist assessment is needed. Your GP must assess the clinical need before discussing the provider.

Once the GP agrees that a referral is appropriate, ask to use Right to Choose. Name the provider and service rather than making a general request for a faster appointment.

A short written message can help:

“I would like an NHS referral under Right to Choose to [provider name] for [service]. Please confirm whether the provider accepts NHS referrals for my age group and condition.”

You can send this request through your GP’s online form or practice email, if available. Keep a copy. If the provider requires a referral form, ask the surgery to complete that form rather than sending you to book a private appointment.

Before naming a provider, check its current NHS pathway. Look for the following details:

• It accepts NHS Right to Choose referrals from County Durham or any GP in England.
• It offers the assessment or treatment you need.
• It accepts patients in your age group.
• It can assess your presentation, including any relevant co-existing conditions.
• It explains whether appointments take place online, in person or through a mixture of both.
• It has a current NHS Standard Contract for the service.
• It explains what happens after assessment, including treatment and follow-up.

Provider websites can use similar language for very different services. “Private assessment” may mean that you pay yourself. “NHS-funded assessment” may mean the provider accepts referrals under an NHS contract. Check the funding route before agreeing to anything.

Your GP should record the choice clearly on the official GP referral. Ensure this is processed through the NHS e-Referral Service (e-RS) so that your chosen provider is correctly identified. Ask whether the referral has been marked as Right to Choose and request the booking reference where one is available. Depending on the provider, you may book the appointment yourself using that reference, or the provider may contact you.

The usual process is:

1. Discuss your symptoms and referral need with the GP.
2. Ask for a Right to Choose referral to your named provider.
3. Confirm that the provider accepts the relevant NHS-funded pathway.
4. Give the surgery the provider’s referral form or details.
5. Check that the referral records your chosen provider and route.
6. Obtain the booking reference or confirmation.
7. Complete any screening forms and attend the assessment.

A GP can decline a referral if the clinical threshold has not been met or if the selected service isn’t suitable. A refusal based only on the fact that the provider is independent is not a complete explanation, because eligible independent organisations can deliver NHS-funded care.

ADHD and autism assessments under the scheme

Many County Durham patients request Right to Choose specifically for an ADHD assessment or an autism assessment. These services are a common reason for seeking a different provider, particularly when local waiting lists for neurodevelopmental diagnostic assessments are extensive.

The process follows the standard legal framework. You require an NHS GP referral, the service must be clinically appropriate, and the provider must hold a valid NHS contract. Simply being a private mental health service does not mean a provider can accept NHS referrals. Well-known national organisations frequently chosen for neurodevelopmental diagnostic assessments include Psychiatry UK, ADHD 360, Clinical Partners, and Problem Shared. Please note that availability changes frequently, as each provider manages its own clinical and administrative requirements. Some focus on specific age groups, while others support both children and adults.

The ADHD-360 Right to Choose information provides a useful example of the documentation a provider may require. However, it should not be treated as a guarantee that every patient qualifies or that every Durham referral will be accepted.

You may need to complete a screening questionnaire before your referral progresses. For an ADHD assessment, providers often require detailed evidence regarding symptoms at home, school, or work, alongside a history of how long these traits have been present. A screening score is a helpful starting point for triage, but it is not a formal diagnosis.

An autism assessment often involves multiple appointments and may require supporting input from a parent, partner, teacher, or another individual who knows you well. Always ask your chosen provider which specific evidence is required, as a missing form can cause significant delays.

Treatment after a diagnosis requires careful planning. While the NHS pathway should include clinically appropriate follow-up, not every provider offers ongoing management. For ADHD medication, this may involve a period of titration to find the correct dosage, followed by a transition to a shared care protocol with your GP. Always confirm who will handle your initial prescriptions, who will provide ongoing monitoring, and what the process is if you eventually move back to local NHS care.

Finally, a diagnosis does not automatically grant a specific support package. Education, employment, and social care adjustments often involve different organisations. NHS Right to Choose facilitates the referral route, but it does not dictate every service connected to your ongoing needs.

For a local view of current waiting lists and referral routes, see the County Durham ADHD assessment guide. Please use this alongside current provider information, as commissioning arrangements and local waiting times are subject to change.

What happens after your referral?

After the provider receives the referral, it checks the information against its pathway. It may ask the GP for missing medical details or request a completed form. Respond promptly, but do not pay for an appointment unless you have deliberately chosen private care.

The provider should explain how it will contact you. Check your phone, email and post, including spam folders. Tell the surgery and provider if your address or contact details change.

Once accepted, you enter that provider’s NHS pathway. This can include assessment, diagnosis where appropriate, treatment, follow-up, medication prescribing and an onward referral if another specialist is needed. Your GP should receive relevant clinical information.

You will usually remain with the selected provider for the episode of care. Switching back to the local service is not always an immediate option, particularly if the new provider has already started assessment or treatment. Ask about continuity before accepting an appointment.

Waiting times vary by provider, service, age group and capacity. A provider that looks quick on one date may have a different queue several months later. Ask for an estimated wait in writing and check whether it begins when the provider receives the referral or after it accepts the paperwork.

The NHS Constitution includes an 18-week maximum waiting time for many planned pathways. If you are likely to wait beyond this period, ask your GP practice or provider whether another choice is available. The standard does not guarantee that every assessment will finish within 18 weeks, and some pathways have exclusions or different arrangements.

In 2026, Integrated Care Board funding arrangements can affect when a provider can accept patients. A legal right to choose a provider still requires practical capacity. Because local Integrated Care Board policies can influence capacity and waiting times, you should ask your surgery to explain any local restrictions and the basis for them.

What to do if your request is refused

A refusal should come with a clear reason. Ask whether the problem is clinical suitability, the type of referral, the provider’s contract, capacity, or an existing pathway. Each issue needs a different response.

If the GP does not agree that a referral is clinically appropriate, ask what assessment or treatment is recommended instead. You can request a second GP opinion within the practice. Bring a short symptom history and details of how the condition affects your work, education, relationships, or daily tasks.

If the practice says it cannot refer to a specific service, be aware that a refusal based solely on the status of an independent provider contradicts your legal right to choose. Ask the surgery to check whether the clinic holds the required NHS contract. Some surgeries have outdated lists or do not recognise an independent provider’s current pathway. The service may have a GP referral guide that clarifies the process for them.

When the issue is capacity, ask whether another eligible provider can accept the referral. You can also enquire whether your current waiting time is expected to exceed the NHS standard and whether patient choice applies.

If the matter remains unresolved, contact the clinic first and request confirmation of its NHS eligibility. You can then contact the GP practice manager or the local patient advice and liaison service, known as PALS, for help understanding the referral route. Complaints about NHS treatment or administration follow the formal NHS complaints process.

Keep a simple record containing:

• The date of your GP appointment.
• The provider you requested.
• The reason given for any refusal.
• Referral forms, emails, and letters.
• Your NHS e-Referral reference.
• The date you were added to a waiting list.

A written record turns a confusing conversation into a clear sequence of decisions. It also helps if you need to ask the ICB or PALS to review what happened.

Questions to ask before choosing a provider

A short call or email can prevent weeks of delay. Before making your decision, ask the provider the following questions:

• Does your NHS contract cover my exact assessment or treatment?
• Do you accept referrals from County Durham?
• Do you accept my age group?
• Do you assess people with existing mental health or physical health conditions?
• Will appointments be remote, face-to-face or both?
• What information must my GP include?
• What is the current estimated wait?
• Will you provide follow-up if treatment is recommended?
• Who manages prescriptions and monitoring?
• Are you prepared to enter into a shared care agreement with my local GP for ongoing medication prescribing after titration?
• What happens if I need another specialist?

The provider’s answer should match your GP’s understanding. If the two accounts differ, ask them to resolve the issue before the referral is sent.

Some providers advertise a fast assessment but do not provide ongoing NHS treatment. Others offer a full pathway but have limited capacity. A shorter initial wait may not be beneficial if you then need to start again elsewhere for follow-up care.

Patients also need to distinguish NHS choice from private healthcare. If you book a self-pay assessment, you may not be able to transfer it into the NHS pathway later. Confirm the funding route in writing before sharing payment details.

Readers who want to compare NHS concerns with wider political positions can visit the official Reform UK website. The patient choice rules themselves come from the NHS framework and apply regardless of party membership.

Frequently Asked Questions

Can I use Right to Choose if I have already started a referral with my local service?

You generally cannot use the Right to Choose if you have already started an active assessment or treatment pathway for the same condition. It is important to inform your GP about any existing referrals to avoid duplicate records or administrative delays. If you wish to switch providers, you may need to complete the current process or discuss the possibility of a formal transfer with your GP.

Do I have to pay for an assessment if I choose an independent provider?

No, you should not be charged for an assessment or treatment if you access it via the NHS Right to Choose. The chosen provider must hold a valid NHS contract, meaning your care is funded directly by the NHS commissioning arrangements. Always verify that you are being referred through an NHS pathway rather than a private, self-pay arrangement.

What should I do if my GP is unaware of the provider I have chosen?

If your GP is unfamiliar with a particular provider, you should provide them with the clinic’s details and evidence of their NHS-funded status. You can refer your GP to the provider’s website or their specific NHS referral guidance, which often includes instructions for medical professionals. If the practice remains unsure, you may wish to contact the clinic directly to ask for a letter or document that confirms their eligibility to accept NHS referrals.

Conclusion

For patients in County Durham, the NHS Right to Choose is a vital tool that enables access to an eligible provider anywhere in England. While this route remains free at the point of use, it relies on a suitable NHS referral, an active contract with the chosen provider, and available capacity.

The legal right to choose provides a pathway for those seeking an ADHD assessment or an autism assessment when local waiting times are prohibitive. To navigate this process, start by discussing your options with your GP, explicitly naming the service and provider you prefer, confirming the funding route, and keeping a detailed record of every referral. If your request is refused, you should ask for the reason in writing and challenge any factual errors through your GP practice, the provider, or the Patient Advice and Liaison Service (PALS).

A long local waiting list does not have to be the end of the conversation. Instead, it may be the exact moment to ask your GP about the options available under the national patient choice framework.