What is Right to Choose (RTC)?
“Right to Choose” (RTC) is a common term used to describe healthcare services being delivered under Patient Choice legislation. This is where a patient can choose a service commissioned by the NHS in another part of England, if the referring clinician (GP, dentist, or Optometrist) can see the benefit of it. For neurodevelopmental pathways, it would usually be the GP who makes this referral.
This does not apply to all services, but rather those led by consultants or senior mental health professionals. It is intended to enable people to access care without experiencing a poorer quality of service purely on the basis of where they live.
The policy covers all aspects of care as agreed within the contract for that service, including assessment and treatment. Partial pathways (such as assessment only pathways) are not supported if other interventions are included within the contract.
Some people believe that Right to Choose relates to a right to be referred. This is not correct, as the clinician must agree that the requested pathway is correct for that patient.
Clinical judgement overrides choice in all circumstances, and if a clinician, usually a GP does not believe that a particular pathway is correct for that patient they can decline to make that referral and may suggest an alternative pathway or provider. An example of this is where a pathway doesn’t offer physical health checks, when the GP thinks they are necessary.
More information about Patient Choice can be found here:
https://www.england.nhs.uk/long-read/patient-choice-guidance/
Why has my provider said that RTC activity has been paused?
Providers of adult ADHD services delivering care under Patient Choice (Right to Choose; RTC) legislation have been set activity plans for the current financial year. This is not a new arrangement. The same approach was adopted for both adult and children’s ADHD services in the previous financial year (April 2025 to March 2026), but this arrangement ended on 31 March 2026.
By March 2026, some providers had exceeded their agreed activity plans for that year, and they paused new assessments temporarily. Assessment activity resumed for all providers in April 2026.
There has been no impact to the care of either children and young people (CYP) or adult services delivered under Patient Choice. This includes medication arrangements and annual reviews, or any other support function.
We are aware that some providers have incorrectly informed patients that the ICB has “stopped funding” for neurodevelopmental services. This is not true and any reported instance has been raised with the service in question. We apologise if any such message has caused distress or anxiety for you or your family.
We would recommend that families research providers thoroughly and refer to the ICB guidance on the website (LSC Integrated Care Board :: Neurodevelopmental pathway), which provides information about what a good quality assessment should include.
Why are there fewer ‘approved’ RTC providers in Lancashire and South Cumbria compared with other areas nationally?
Many providers are commissioned nationally to deliver services for neurodevelopmental conditions. These providers must have a contract with an NHS commissioner somewhere in England and be able to deliver that service outside of their local area in the same manner they would to the population where they are commissioned and based.
Lancashire and South Cumbria ICB will only generally be aware of providers when a patient researches them and is referred by their GP, or a provider contacts the ICB directly to share a contract they have signed with another ICB. In both instances, Lancashire and South Cumbria ICB will review that contract and ensure it can be delivered locally.
There may be some delay in published details of “approved” providers. This is normally due to providers being unable to deliver services to patients in Lancashire and South Cumbria, which is a geographically large area with an incredibly diverse mix of rural, urban and coastal areas.
Another common reason is that the provider is not set up to prescribe medication for patients outside of the area they are commissioned. The ICB is working extensively to resolve such issues, but in some cases, this is not possible, and the contract will not be allowed for RTC.
Does the ICB have oversight for the quality of RTC Providers?
The ICB does not have any remit or authority for the service and what it is commissioned to deliver, and we therefore cannot guarantee the quality of the service, or that the provider are National Institute for Clinical Excellence (NICE) compliant (Overview | Attention deficit hyperactivity disorder: diagnosis and management | Guidance | NICE, Overview | Autism spectrum disorder in under 19s: recognition, referral and diagnosis | Guidance | NICE). The ICB has committed to developing a Clinical Commissioning Policy and accreditation process from April 2026 so that providers can be recommended for RTC referrals.
Whilst awaiting this list of accredited providers the ICB has produced some guidance for families seeking assessment through RTC or private providers. Please see the website (LSC Integrated Care Board :: Neurodevelopmental pathway), for further information.
More information about adult transformation can be found here: https://www.lancashireandsouthcumbria.icb.nhs.uk/our-work/adult-adhd/adult-adhd-position-statement
What is the difference between a private sector assessment and a Right to Choose assessment?
- Right to Choose (RTC) assessments are NHS funded assessments delivered by a provider with an NHS standard contract, which can be undertaken by an NHS or independent sector provider. These can only be accessed via a GP referral, if the GP feels that the referral is clinically appropriate.
- Private sector assessments are not recognised as ‘Right to Choose’ (RTC) assessments if the referral wasn’t made by a GP under patient choice regulations. This can be confusing where some providers have NHS contracts and also offer private care. Any care funded outside of NHS contracts is independent of the NHS and not subject to any monitoring or contractual management. We encourage you to fully explore the quality standards of any provider if you choose to fund care privately.
Do schools and local authorities have to accept private and RTC assessments?
The ICB has no say or role in what schools and local authorities will accept because the ICB has no responsibility for schools and local authorities. However national guidance suggests schools and local authorities:
- Must consider private diagnostic reports.
- Cannot lawfully reject a report solely because it was obtained privately.
- Must base support on needs, not diagnosis source.
- Must treat an RTC assessment/diagnosis in the same way as any other NHS diagnosis.
- May scrutinise the quality and clarity of any report and seek further advice.
- Do not need evidence of a diagnosis to issue an education, health and care plan (EHCP).
Do local NHS providers have to accept the ASD or ADHD diagnosis for support and treatment if a diagnosis was obtained either via a RTC or private provider?
Right to Choose
Patient Choice legislation covers the full care pathway from assessment to treatment and should be completed by the chosen provider. There are some instances where a patient may request to move to a different provider, for example they move to a new part of the country, their relationship breaks down with the clinical team, or the provider no longer delivers NHS care due to suspension of contract.
These are exceptional circumstances, and in most cases, patients will remain with a single provider. Patient Choice does not apply at the point of treatment, and patients are therefore not able to move to a new provider through choice at this stage, for example to achieve shorter waiting times.
An RTC assessment is an NHS diagnosis and should be recognised by other NHS providers to avoid unnecessary cost to the NHS wherever possible. It remains however at the clinical discretion of an NHS provider who receives a referral whether they accept the diagnosis made by the referring service.
Common reasons for a referral being declined are if the diagnosis was made several years ago, insufficient diagnostic documentation was provided, or other clinical reasons, such as concerns over the process applied to achieve a diagnosis, or the nature of the medication prescribed.
Private referrals
NHS providers may accept privately funded assessments in some circumstances, but it may be more difficult to guarantee the quality of the assessment, given care is delivered outside of NHS contractual terms.
It is possible in all of the above circumstances that the NHS provider may decide a new assessment is required. For this reason, providers will not speed up referrals where a diagnosis has been made by another provider, over patients already waiting within the service. This is to ensure nobody is disadvantaged.
Do GPs need to accept shared care requests from RTC or privately funded care?
No, shared care is optional in all circumstances. GPs have the right to decline any requests for shared care based on the grounds of capacity, clinical expertise, or other factors relating to ongoing care.
If a patient is prescribed medication following a RTC referral, this shouldn’t have any effect on the patient being able to receive that medication under NHS conditions; the only thing that would be different is where they receive their prescription from.
Any indications of providers asking for payment from a patient outside of normal NHS prescribing processes should be immediately reported to the ICB for investigation using the following email address: lscicb-fw.patientexperience@nhs.net
Shared care with privately funded treatment is not recommended by the BMA (see guidance below) and GPs will generally decline such arrangements. GPs should not be put under pressure to accept shared care in any circumstance, as any decision remains fully within their discretion.
https://www.bma.org.uk/advice-and-support/gp-practices/managing-workload/general-practice-responsibility-in-responding-to-private-healthcare
Where can I find a list of Patient Choice (RTC) Providers?
A list of providers can be found on the ICB website - LSC Integrated Care Board :: Local providers . Please note that this list was correct at the time of publication and is subject to change. The ICB recommends that families fully research providers and refer to the guidance published on the ICB website.
Please note that these pages will only show providers where their contracts have been deemed qualifying under Patient Choice. It is not unusual for the ICB to be in conversation with providers, who have supplied contracts, but they have not yet been signed of as qualifying.
