GP Refused Right to Choose for ADHD? Here's Exactly What to Do

When "No" Is Not Actually the Final Answer

Let me start by saying: if your GP has refused your Right to Choose referral for ADHD, I know how frustrating and demoralising that feels. You have probably spent weeks or months building up the courage to ask. Maybe you researched the policy, wrote a letter, rehearsed what you were going to say. And then the person who is supposed to help you says no.

I want you to know two things. First, this happens more often than it should. Second, a GP refusal is almost never the end of the road. There are clear, practical steps you can take to get your referral processed, and most people do not need to go beyond the first couple of steps.

Let me walk you through exactly what to do.

Why GPs Refuse Right to Choose Referrals

Before we get into the "what to do" part, it helps to understand why GPs refuse. In my experience working with clients navigating this process, the reasons almost always fall into a few categories.

They genuinely do not know about it

This is the most common reason, and honestly, it is not the GP's fault. Right to Choose is not well covered in GP training. Many GPs have never processed a Right to Choose referral for ADHD and are unfamiliar with the policy. When a patient asks for something the GP has not heard of, the default response is often to say no.

They confuse it with private healthcare

Some GPs think Right to Choose means you want them to refer you to a private clinic at your own expense. They do not realise that the NHS funds the assessment. This is a simple misunderstanding that is usually resolved by explaining the policy.

They do not think you need an ADHD assessment

This is a slightly different problem. If your GP does not believe assessment is warranted, that is a clinical judgement issue rather than a Right to Choose issue. Your GP does not need to think you have ADHD. They just need to agree that your symptoms are significant enough to justify an assessment. A GP is a gatekeeper, not a diagnostician.

They have had negative experiences with specific providers

Some GPs have had frustrations with certain Right to Choose providers, perhaps around shared care agreements or communication. While understandable, this is not a valid reason to deny you your legal right. You are entitled to choose your provider; the GP's preference does not override that.

They believe you must use the local NHS pathway first

This is factually incorrect. Right to Choose applies at the point of referral. You do not need to be on an NHS waiting list first, and you do not need to "try the local pathway" before exercising your right. You can request Right to Choose as your first and only referral.

Your Legal Rights: The Key References

When you are in the room with a GP who is saying no, it helps to know the specific policies that support your position. You do not need to quote legislation at your GP, but knowing it exists gives you confidence.

The key phrase to remember is: "I am exercising my legal right to choose my healthcare provider for my first outpatient appointment, as set out in the NHS Choice Framework."

You do not need to be confrontational. Clear, calm, and specific is much more effective.

Step-by-Step: What to Do When Your GP Refuses

Step 1: Ask Why and Document It

Before escalating, ask your GP to explain their specific reason for refusing. Listen carefully, because the reason determines your next move.

If they say they do not know about Right to Choose, you can explain it on the spot. Bring a printed copy of the NHS Choice Framework summary or point them to the NHS England website.

If they give a reason that does not make sense (like "we don't do that here" or "you need to try the local pathway first"), politely explain that Right to Choose is a national NHS England policy and applies to all GP practices in England.

Important: Make a note of what was said, who said it, and the date. If you need to escalate later, having a clear record is invaluable.

Step 2: Ask to See a Different GP

This is the simplest and most effective step. Different GPs within the same practice can have very different levels of familiarity with ADHD and Right to Choose. Ask the receptionist to book you with a different GP, and explain that you are requesting a specific referral pathway.

Many people find that a second GP at the same practice processes the referral without any issue. The first GP's refusal may simply have been about unfamiliarity.

Step 3: Put It in Writing

If a face-to-face appointment did not work, try a written request. A well-structured letter is harder to dismiss than a conversation. I have written a full guide on how to write a Right to Choose letter to your GP, which covers exactly what to include.

Your letter should reference the NHS Choice Framework, name your chosen provider, briefly describe your symptoms and their impact, and politely request the referral be processed. Keep it to one page, clear and firm.

Step 4: Contact the Practice Manager

If individual GPs are not cooperating, the practice manager is your next point of contact. Practice managers handle complaints and operational issues. They can often resolve the situation by:

• Speaking with the GP about the policy
• Assigning a different GP to process your referral
• Implementing the referral themselves if it is a straightforward administrative task

Write to the practice manager explaining the situation. Include the date of your original request, the reason given for refusal, and a reference to the NHS Choice Framework. Be polite but clear that you are requesting a resolution.

Step 5: Contact PALS

PALS stands for Patient Advice and Liaison Service. Every NHS Trust has one. PALS teams are specifically designed to help patients resolve concerns about NHS services, and they deal with situations exactly like this regularly.

You can find your local PALS service by searching "PALS" on the NHS website along with your area. Contact them by phone or email and explain that your GP has refused a Right to Choose referral for ADHD. They can:

• Advocate on your behalf with the GP practice
• Explain the policy to the practice
• Help you navigate next steps if the practice remains uncooperative
• Direct you to the formal complaints process if needed

Most PALS teams respond within a few working days, and many issues are resolved at this stage.

Step 6: Escalate to Your Integrated Care Board (ICB)

Your Integrated Care Board (formerly Clinical Commissioning Group/CCG) is the regional NHS organisation that funds Right to Choose assessments. They have a direct interest in ensuring patients can access this pathway, because it is their legal obligation to provide it.

Contact your ICB explaining that your GP practice is refusing to process a Right to Choose referral. Include:

• Your name and NHS number
• The GP practice name
• A summary of what happened
• The dates you requested the referral
• The reason given for refusal

ICBs can and do intervene in these situations. They can contact the GP practice directly and instruct them to process the referral. You can find your ICB on the NHS England website by searching your postcode.

Step 7: Submit a Formal Complaint

If you have reached this point, something has gone genuinely wrong. A formal complaint creates an official record and triggers a structured review process.

You can submit a formal complaint through:

• Your GP practice's complaints procedure (ask the practice manager for the process)
• Your local ICB (they handle complaints about primary care services)
• NHS England (for complaints about ICBs themselves)

Formal complaints must be acknowledged within 3 working days and responded to within a set timeframe (usually 25-40 working days depending on the organisation).

Step 8: Write to Your MP

This might sound extreme, but writing to your MP is genuinely effective and more straightforward than you might think. MPs have dedicated casework teams that handle healthcare issues, and they can apply pressure that individuals simply cannot.

To contact your MP:

1. Find your MP at theyworkforyou.com by entering your postcode
2. Write a brief email explaining the situation
3. Include key facts: your GP practice, the dates of your requests, the refusals, and the steps you have already taken
4. Ask them to intervene on your behalf with the ICB or NHS England

Most MPs respond within 1-2 weeks, and their involvement often resolves the issue quickly. Healthcare access is a constituency issue that MPs take seriously.

What to Say When Your GP Pushes Back

Here are specific responses to the most common objections, so you do not freeze in the moment:

When the Problem Is Not Right to Choose

Sometimes the real issue is not Right to Choose at all. Sometimes the GP is refusing to refer you for ADHD assessment at all, regardless of which provider you want. This is a different problem.

If your GP does not think an ADHD assessment is appropriate, they should explain why. Common reasons include:

• They believe your symptoms are better explained by another condition (anxiety, depression, thyroid problems)
• They want to rule out other causes first through blood tests or other investigations
• They do not understand adult ADHD and think it is a childhood condition

If you believe assessment is warranted and your GP disagrees, you still have options:

• See a different GP at the same practice
• Ask for a referral to a general psychiatrist or mental health team, who can then consider ADHD
• Take our free ADHD screening test and bring the results to your appointment as supporting evidence
• Bring examples of how your symptoms affect your daily functioning, based on the DSM-5 criteria

For a full overview of the diagnosis process, read my guide on getting an ADHD diagnosis in the UK.

You Should Not Have to Fight This Hard

I want to acknowledge something. Having to escalate, complain, and advocate for yourself just to access a basic healthcare pathway is exhausting. It is especially exhausting when you have ADHD, the very condition that makes navigating bureaucracy, writing letters, and handling confrontation harder than it is for most people.

This is one of the reasons I offer a Help With Forms service. I sit with you through the process, help you structure your thoughts, and support you in writing a clear, confident request. I do not write the letter for you or give medical or legal advice, but I can help you feel less alone in the process.

If you have already been through the wringer and just want practical support managing your ADHD while things get sorted, ADHD mentoring is available whether or not you have a diagnosis. You do not need to wait for the system to catch up before you start building strategies that work.

Book a free 15-minute discovery call and let's talk about what you need right now. No judgement, no pressure.