Right to Choose – ADHD and Autism Frequently Asked Questions

Waiting times are different for each service and provider. There is not one waiting time that applies to everyone.

We are improving how we share clear and accurate waiting time information for the services we commission. We are also working to understand the full picture across local NHS services and Right to Choose providers. This includes checking that people are only on one waiting list for the same type of assessment. 

Right to Choose providers often publish their own waiting times on their websites. Please check the provider’s website for the most up-to-date information.

If ADHD medication is needed after assessment, there is usually a process to start and adjust medication safely and this can vary between providers. For adults with an ADHD diagnosis, psychoeducational interventions will be offered to most people prior to commencement of ADHD medication

We understand that waiting can be hard. You do not need to wait for a diagnosis to ask for help, advice or support

Please visit the following page to explore a range of services available to support you on your journey. You do not need a formal diagnosis or to be on a waiting list and you can self-refer into these services at any time. 

Right to Choose - Support at every stage: before, during, after, or without an assessment

Please visit the following page to explore a range of services available to support you on your journey. You do not need a formal diagnosis or to be on a waiting list and you can self-refer into these services at any time.

Right to Choose - Support at every stage: before, during, after, or without an assessment

The adult Autism and ADHD Community Hub offer is available across Hampshire and the Isle of Wight. The hubs are linked to the wider Autism and ADHD Information, Advice and Guidance service, led by Autism Hampshire and delivered with local partners. This partnership also works very closely with the Portsmouth Community Hub, Room One. 

Current Hub locations are:
•    Andover / North Hampshire 
•    Havant / South East Hampshire 
•    Southampton 
•    Isle of Wight 
•    Portsmouth – support is available through Room One
 

Community hubs & peer support - Autism Hampshire
Room One - Portsmouth City Council
 

At the hubs, people can get information, advice and guidance, learn about local support, connect with other and access peer, one-to-one or group support where available.

This is an adult support offer. Families looking for support for children and young people can still seek advice and explore local support options. A diagnosis is not needed before asking for help.
 

Indicative Activity Plans (IAPs) set out how much activity a provider is expected to deliver within a financial year - they help manage demand, capacity and align services with population need. They include a shared understanding of:

-    How many assessments a provider can carry out
-    The maximum amount of time people should be waiting for an assessment in their location 
-    What funding is available to support this work

Indicative Activity Plans have been implemented across all Right to Choose providers delivering Autism and ADHD assessments within NHS Hampshire and Isle of Wight. While people who have not yet attended their first outpatient appointment may choose an alternative provider under choice legislation, current capacity constraints mean this is unlikely to result in a shorter wait for assessment.

Please visit the following page to explore a range of services available to support you on your journey. You do not need a formal diagnosis or to be on a waiting list and you can self-refer into these services at any time. Right to Choose - Support at every stage: before, during, after, or without an assessment

Right to Choose means that, in many cases, people can choose where they go for their first NHS outpatient appointment. This may be an NHS service or an independent provider, if the provider is suitable for the assessment needed, has the right NHS contract and has agreed NHS capacity to offer the service.

A locally commissioned service is planned and funded by the local Integrated Care Board for people living in the local area.

Both are NHS-funded routes. They may have different waiting times, appointment types, locations, referral routes and support offers.
 

Yes. If ADHD medication is clinically appropriate, people assessed through the NHS Right to Choose pathway can still access ADHD medication through NHS-funded care.

Medication is usually started and adjusted by the specialist service that completes the assessment. This is sometimes called titration. It means finding the right medication and dose safely.

Once medication is stable, the specialist service may ask for prescribing to be shared with primary care through a shared care agreement. Shared care means the specialist service and primary care work together, with clear information about prescribing, monitoring and who to contact if advice is needed.

If there is no shared care agreement in place, the specialist service that started the medication remains responsible for prescribing and monitoring.
 

People can only be on one waiting list for the same type of assessment at one time. This applies to locally commissioned NHS services and Right to Choose providers. This helps keep your referral clear and avoids delays. If you are thinking about changing provider, it is important to understand what this may mean for your current referral before making a decision.

Through our community engagement events people have told us where an assessment for both ADHD and Autism (combined) is required this should happen at the same tim. We have listened to this feedback and combined assessments will be included in the new service specification

If you are worried about your child’s health, wellbeing or support needs while they are waiting for an assessment, you do not need to wait for a diagnosis before asking for help.

Information about support available while waiting can be found on the Hampshire and Isle of Wight ICB website: Autism and ADHD Assessment Services, and through the Right to Choose waiting list support links. These resources include support that may be helpful before, during, after, or without an assessment.

If your child’s needs change or you are worried about their wellbeing, please seek advice from a professional involved in their care.
 

If a young person turns 18 while waiting for an Autism or ADHD assessment, their referral will either continue with the same provider or move to an adult pathway. The provider will explain clearly what will happen next.

This is because assessment pathways for children and young people and assessment pathways for adults are often arranged separately and may work in different ways. Your provider will either continue the assessment or transfer it to an adult pathway. 

If anything changes, the provider should explain clearly who is responsible for the referral, what happens next and who to contact with questions. The move to an adult pathway should be clearly explained and supported. 
 

If ADHD medication is recommended, the specialist provider that completed the assessment is usually responsible for starting medication and adjusting the dose safely. This is called titration.

What happens next depends on where the young person is in the medication process. If medication has not started yet, the provider should explain who will start it and what the next steps are.

If medication has already started and the young person is still in titration, this should not stop just because they turn 18. The provider that started titration should continue to support this safely until medication is stable, unless there is a clear and agreed plan for another service to take over.

Once medication is stable, the provider should explain the ongoing prescribing arrangements. This may include shared care with primary care, or support from an adult ADHD pathway, depending on local arrangements and the provider involved.

The young person and their family should be told who is responsible for prescribing, what happens next and who to contact with questions.
 

You can ask to be referred to a different NHS provider if your assessment hasn't started yet. However, due to high demand across all services, this may not result in a shorter wait. If you stay with your current provider, you will remain on their waiting list and be seen according to their process. If a clinician believes you need to be seen urgently, there are plans in place to make sure this happens. 

Shared care means a specialist ADHD service and a GP practice work together to support someone with ADHD medication.

How does ADHD medication usually start?
•    A specialist service usually starts the medication
•    They adjust the dose slowly to find what works best
•    This is called titration

What happens when the medication is stable?
•    The specialist may ask a GP practice to take over prescribing
•    This is called a shared care agreement

Why might shared care happen?
A GP practice may agree if:
•    They have clear information from the specialist and ongoing support
•    They know how to monitor the medication
•    They feel able to prescribe safely

Why might shared care not happen?
A GP practice may not agree if:
•    The medication is still being adjusted
•    The information is not clear
•    There is no clear monitoring plan
•    They do not feel able to prescribe safely

What if shared care is not agreed?
•    This does not mean care will stop
•    The specialist service will keep prescribing and monitoring the medication

What about private assessments?
•    A private diagnosis is not always accepted by the NHS
•    NHS services may need their own assessment first
•    A GP practice does not have to prescribe medication recommended by a private provider. 
•    If shared care is not agreed, medication may need to be paid for privately

What should you be told?
You and your family should be told:
•    Who is prescribing your medication
•    What happens next
•    Who to contact if you have questions
 

Shared care means a specialist service and a GP practice agree to share responsibility for ADHD medication. This usually happens once medication has been started by the specialist service and the dose is stable.

A GP practice may agree to shared care when they have clear information from the specialist, understand what monitoring is needed, and feel able to prescribe safely.

A GP practice may decline shared care if the information is not clear, if the medication is not yet stable, if monitoring arrangements are not in place, or if the practice does not feel able to take on prescribing safely if the information / outcome report provided following diagnostic assessment / current provider is not clear.

If there is no shared care agreement in place, the specialist service that started the medication remains responsible for prescribing and monitoring.
 

Not receiving a diagnosis does not mean that your experiences are not real or important. It simply means that based on the information available at the time of your assessment, it did not identify a neurodevelopmental profile that matches the current diagnostic criteria. 

Support, advice and guidance can still be accessed without needing a formal diagnosis. Further information of support available can be found here - Right to Choose - Support at every stage: before, during, after, or without an assessment

If a patient already has an ADHD diagnosis and is seeking NHS-funded prescribing, shared care, or to restart treatment, this may be considered ongoing management, where the Right to Choose does not always apply. However, if a new referral to a specialist ADHD service is required (for example, for medication titration or reassessment), patients may still be able to exercise their Right to Choose, provided eligibility criteria are met. Shared care arrangements remain subject to GP agreement and are not a legal right.

For Adults who have been prescribed psycheducational intervention following diagnosis, there is an expectation this will be completed prior to ADHD medication being prescribed.

You will not be discharged from your provider while you are receiving treatment, and any reviews of medication will continue. 

No formal, standardised prioritisation criteria are held centrally by the Integrated Care Board.
•    Prioritisation criteria for Right to Choose referrals are set by individual providers and may vary.
•    Practices should direct specific queries about eligibility or prioritisation to the relevant provider.
 

The contractual basis for NHS Right to Choose Indicative Activity Plans (IAPs) is outlined in the NHS Standard Contract 2026/27, which grants Integrated Care Boards (ICBs) authority to set Indicative Activity Plans.

The below principles were considered in making this decision: 

• The legal requirement for Integrated Care Board’s to achieve financial balance over the year 2025/26 and to set affordable Indicative Activity Plans (IAPs) accordingly
• Understanding the impact these decisions will have on waiting lists and patient risk and working collaboratively with providers to mitigate risks
• Completion of a Quality Impact Assessment supported by the Mental Health, Learning Disability & Autism, and Children’s Care Senior Leadership Team
• Reviewing the system transformation plan to ensure it supports the reduction of waiting lists and patient risk in the longer term
• Keeping new developments under review and revisiting this decision should there be any material changes

NHS Hampshire and Isle of Wight has applied a consistent approach to the development of Indicative Activity Plans across all providers. A Quality Impact Assessment formed a key part of the decision making process, ensuring that the impact on patient access, equity, and service quality was fully considered. This assessment highlighted that access rates within our locally commissioned services significantly exceed those available through the Right to Choose pathway.

We recognise that providers have been unable to meet the access times they previously advertised due to the introduction of these plans, and we apologise for the frustration and uncertainty this has caused. We are working closely with providers to ensure that future plans are agreed and communicated clearly ahead of the financial year, enabling patients to receive timely and transparent information. We remain committed to keeping our website updated so that individuals can make informed choices about their care.

Private assessment can speed up diagnosis, but NHS-funded treatment is not guaranteed afterward.

A private diagnosis is not automatically accepted by the NHS. NHS clinicians may require an NHS assessment before starting treatment, even if you have a private report. This is because the NHS clinician takes legal responsibility for prescribing and ongoing care. Some GPs will accept a private diagnosis under a Shared Care Agreement, but this is at their discretion, and not guaranteed.

Private providers may offer diagnosis only, leaving medication titration and monitoring to the NHS. NHS services, including GPs, are not required to prescribe medication recommended by private providers. This decision will always be based on clinical judgement and NHS prescribing guidelines. If the GP declines Shared Care, you may need to pay privately for prescriptions and follow-up care, which can be costly. NHS guidance states that private and NHS care should remain clearly separate — NHS resources cannot subsidise private care.

NHS Hampshire and Isle of Wight Integrated Care Board (ICB) follow national rules that make sure more money is spent on mental health services as overall NHS funding increases. This means there is a protected budget each year specifically for mental health care.

Autism is only included in the Mental Health Investment Standard (MHIS) when there is a co-occurring mental health need. Services for autistic people without a diagnosed mental health condition are not counted under MHIS spending and therefore do not receive the same level of ring-fencing.

As part of the NHS planning cycle we will review all of our priority areas to ensure available funding is allocated to where it is needed most. In addition to diagnostic assessment services, supporting patients prior to their diagnosis and after diagnosis is a key priority area and we have a number of transformation programmes underway to greater meet these needs.