Right to Choose and ADHD Titration: What Patients and Commissioners Need to Know
For adults in England seeking an ADHD diagnosis and medication, the NHS Right to Choose (RTC) pathway can dramatically shorten waiting times while keeping care free at the point of use. Yet once a diagnosis is made, the titration phase—finding the right medication and dose—often reveals gaps between policy, commissioning, and everyday practice. This guide explains how RTC works for ADHD, where titration fits in, what patients should expect, and what commissioners and GP practices need to know to deliver safe, compliant care.
What is NHS Right to Choose for ADHD?
Right to Choose is a statutory right under the NHS Constitution that allows patients in England to choose any clinically appropriate, NHS-contracted provider for their first outpatient appointment, including for ADHD assessment. In practice, this means you can ask your GP to refer you to an approved independent provider with shorter waits, rather than only your local NHS trust.
Key features of the RTC ADHD pathway:
The assessment is funded by the NHS; you pay nothing for the appointment or diagnostic report.
If you are diagnosed, the same clinical standards (including NICE guidance) apply as in local NHS services.
Some RTC providers include medication initiation and titration within their NHS contract; others do not.
Once you are stable, the goal is usually to transfer ongoing prescribing to your GP under a shared-care agreement.
Where does titration fit into the Right to Choose pathway?
Titration is the structured process of starting ADHD medication at a low dose and gradually adjusting it under specialist supervision until you reach the lowest effective dose with acceptable side effects. In an ideal RTC pathway, titration is a seamless continuation of the assessment:
Assessment confirms ADHD and suitability for medication.
The RTC provider initiates medication and begins titration.
You attend regular reviews (every 2–4 weeks) while the dose is adjusted.
Once stable (often after 8–12 weeks), the provider writes to your GP requesting shared care.
However, not all RTC contracts include titration. Some providers offer diagnosis only, meaning you may need a separate referral to your local NHS service for medication initiation and monitoring. This is a critical detail to clarify before accepting an RTC referral.
What patients need to know before using Right to Choose
If you are considering RTC for ADHD, these points will help you avoid delays and unexpected costs:
Confirm titration inclusion. Ask the provider explicitly: “Is medication initiation and titration included in your NHS Right to Choose contract for ADHD?” Get this in writing if possible.
Check shared-care track record. Ask whether the provider routinely secures shared-care agreements with GPs in your area and what documentation they supply.
Understand the timeline. Current RTC waits for assessment are often 6–18 months; if titration is included, it may add a further 3–6 months before shared care.
Know your prescription costs. If titration is NHS-funded, you pay standard NHS prescription charges (£9.90 per item in 2026) or nothing if exempt.
Prepare for GP conversations. Shared care is voluntary for GPs. Even with an RTC diagnosis, some practices may hesitate to prescribe without robust specialist documentation.
Quick checklist for patients
Identify an RTC provider that includes titration (if you expect to start medication).
Book a GP appointment and request an RTC referral by name.
Ask the provider about their shared-care process and typical timelines.
Keep records of all communications with your GP, provider, and ICB.
If your GP refuses shared care, follow a structured escalation path (practice → ICB → NHS England).
What commissioners and GP practices need to know
For Integrated Care Boards (ICBs), primary care networks, and GP practices, RTC for ADHD creates both opportunities and commissioning challenges.
Commissioner responsibilities
Ensure referral pathways exist. ICBs must ensure that qualifying RTC providers hold the necessary contractual arrangements and that GPs know how to refer.
Clarify titration coverage. Where RTC contracts cover assessment only, commissioners should specify how post-diagnostic medication initiation and titration will be commissioned locally.
Support shared-care protocols. ICB medicines management teams should maintain up-to-date shared-care protocols for ADHD stimulants and non-stimulants, aligned with NICE NG87.
Monitor care gaps. Commissioners should track cases where patients are diagnosed and titrated via RTC but cannot secure GP shared care, as this creates clinical and financial risk.
GP practice considerations
Shared care is voluntary but expected. While GPs are not legally obliged to accept shared care from any specific provider, NICE NG87 expects primary care to prescribe under shared-care agreements once a patient is stabilised by a specialist service.
Clarify monitoring responsibilities. Shared-care agreements should specify that the specialist service retains responsibility for specialist monitoring, with the GP handling routine prescribing and basic observations.
Document refusals clearly. If a practice declines shared care, it should provide a written rationale and outline alternative arrangements (e.g., continued specialist prescribing, referral to another service).
Use RTC strategically. For patients with private diagnoses where GPs are hesitant, an RTC referral can provide an NHS-funded second diagnostic confirmation and a clearer route to shared care.
Common friction points and how to resolve them
Titration not included in the RTC contract
Some RTC providers diagnose but do not titrate. In this scenario:
Ask your GP for a separate referral to your local NHS ADHD service for medication initiation.
Request that the RTC provider share their diagnostic report and treatment recommendations with the local service.
If local waits are long, ask the ICB whether alternative RTC providers that include titration are available.
GP refuses shared care after RTC titration
This is increasingly common and can leave patients stranded between specialist and primary care. Recommended steps:
Ask the GP practice in writing whether they will accept shared care for your specific medication and provider.
Request a clinical review by the senior GP partner and ask whether they will apply to the ICB medicines management team for a shared-care protocol.
Ask your specialist to write formally to the GP, setting out the clinical case and monitoring plan.
If refused, raise a formal NHS complaint to the practice.
Escalate to your ICB medicines management team or commissioning team.
Contact the NHS England National Contact Centre (0300 311 22 33) if the ICB does not act.
As a last resort, consider the Parliamentary and Health Service Ombudsman.
Cross-border and devolved nation issues
RTC applies only in England. Welsh, Scottish, and Northern Irish patients may face additional complexities if their GP is commissioned under different rules. In these cases, confirm your commissioning position first and seek local advice before pursuing an English RTC referral.
FAQs: Right to Choose and ADHD titration
Is Right to Choose available for ADHD in 2026?
Yes. For NHS patients in England, Right to Choose remains an option for ADHD assessment in 2026, though some ICBs have attempted to restrict or pause it.
Does Right to Choose cover medication titration?
It depends on the provider’s NHS contract. Some RTC providers include titration and initial prescribing; others offer diagnosis only, requiring a separate NHS referral for medication.
Do I have to pay for an RTC assessment or titration?
No. The assessment and any included titration are funded by the NHS. You pay standard NHS prescription charges for medications unless exempt.
Can my GP refuse to prescribe after RTC titration?
Yes. Shared care is voluntary for GPs, though NICE guidance expects prescribing once a patient is stabilised by a specialist. If your GP refuses, follow a structured escalation path via the practice, ICB, and NHS England.
What if I already have a private diagnosis and can’t afford private titration?
You can ask your GP for an RTC referral to a provider that accepts transfer of care for titration. Some services will review your private diagnosis and, if appropriate, continue titration under an NHS-funded pathway.
Ready to start your ADHD journey?
If you’re considering an ADHD assessment—whether via Right to Choose or a private route—having a clear, specialist-led pathway makes all the difference. Focus Gently offers streamlined, UK-based assessments with transparent processes and specialist oversight, helping you move from uncertainty to a personalised treatment plan.
Book your ADHD Assessment today at focusgently.com and take the first step toward a clearer diagnosis, faster access to titration support, and a sustainable long-term care plan.
