The following guidance summarises the key contractual and professional considerations for Local Medical Committees (LMCs) when advising practices on NHS Right to Choose (RTC), ADHD and ASD referrals, and shared care prescribing arrangements.

What is Right to Choose?

Right to Choose is a patient choice right within NHS England. It allows eligible patients to choose an alternative provider for elective outpatient mental or physical healthcare where:

• the patient is registered with a GP practice in England
• the GP agrees a referral is clinically appropriate
• the chosen provider holds a qualifying NHS contract for the required service

Right to Choose applies in England only and does not apply in Scotland, Wales or Northern Ireland.

The decision to refer remains a clinical decision for the GP. Once a referral is agreed, the patient has the right to choose the provider for that referral.

Exclusions

RTC does not apply where patients are:

• already receiving care for the same condition following an elective referral
• accessing urgent or crisis care
• detained under the Mental Health Act
• in secure settings including prisons and immigration detention
• accessing services commissioned directly by local authorities
• serving members of the armed forces

ADHD and ASD Services

Many Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) assessment services are now delivered by independent sector organisations providing NHS-funded care under NHS contracts.

Patients may therefore request referral to:

• NHS trusts
• independent providers commissioned under NHS Standard Contracts
• providers commissioned by another ICB or NHS England

Patients cannot choose providers that do not hold a qualifying NHS contract.

Commissioner Responsibilities

Under the NHS Choice Framework and associated regulations, commissioners have legal obligations to:

• fund eligible patient chosen providers
• fund on a Non-Contractual Basis. Commissioners must arrange payment under an NHS Standard Contract to the chosen provider if the provider holds a written contract with any NHS commissioner in England for that specific service.
• permit referrals to any qualifying provider in England
• avoid imposing local vetoes or prior approval systems
• establish clear processes for qualification and contracting
• ensure patient information on choice is publicly available
• secure quality and safety oversight through NHS Standard Contracts at the earliest opportunity

Importantly:

• commissioners are still required to fund care even where there is no pre-existing local contract
• the absence of a local contract does not invalidate a lawful RTC referral

The full guidance document is available here: Right to Choose and Shared Care

Please note that participation in shared care is not mandatory.