GPs raise alarm over ICB limits on Right to Choose ADHD and autism assessments
Exclusive GP practices have raised concerns about ADHD and autism assessment waiting times, after one ICB decided to limit activity for Right to Choose (RTC) providers.
North East and North Cumbria ICB said it has implemented ‘activity plans’ for RTC providers following ‘exceptionally high levels of demand’ for autism and ADHD assessments.
It said that to manage this pressure the ICB has ‘temporarily agreed revised activity plans’ and that as a result, people referred during 2025/26 may experience longer initial waiting times with RTC providers.
Gateshead LMC chair Dr Paul Evans told Pulse that practices in his area are reporting distressed patients as the new activity plans meant some providers are declining new referrals.
He said that the plans have ‘essentially put a pause’ on Right to Choose assessments until the end of the financial year.
Dr Evans said: ‘What this means for GP perspective is that referrals can be made, but some providers are declining them because the activity plan prevents them progressing these referrals to assessments at the present time, and there is no end date for this freeze on activity.
‘Providers have actively started refusing referrals on the grounds that they don’t have any faith that it’s worth accepting them because of the ICB’s current stance, the fact that they’ve not made it clear they will resume at some point. So some providers are simply not taking the risk of accepting these patients at all.
‘Essentially, it’s put a pause on Right to Choose assessments across north east and north Cumbria, so some providers have responded by saying “we’re not taking any referrals for North East North Cumbria ICB patients for the time being”. We’ve had practices reporting distressed patients.’
The ICB said that providers will ‘continue to see anyone with a booked appointment’ and prioritise and assess anyone considered ‘clinically urgent’.
A spokesperson for the ICB told Pulse: ‘There has been a huge increase in people being referred for autism and/or ADHD assessment, which is a positive step that indicates people are seeking support.
‘This increase has resulted in NHS autism and ADHD services in our area experiencing significant pressures which are now having a direct impact on assessment waiting times. This reflects a national picture driven by increased awareness and changes in how people seek and access support.
‘During 2025/26 the number of people receiving an assessment through a Right to Choose (RTC) provider has doubled compared to the previous year. This means that more people than ever before are accessing assessment and support.
‘However, it also means that there is pressure on demand and waiting times. To help manage this pressure in a fair and responsible way, the ICB has agreed activity plans with RTC providers for new autism and ADHD assessments between January and March 2026. The plans do not affect NHS Trust services and children under the age of six are not impacted.’
The ICB added that the approach is designed to protect ‘existing services’ and ensure that people already in the system ‘continue to receive safe and appropriate care’.
‘New referrals are not being stopped or paused and will continue as normal,’ the spokesperson added. ‘We fully recognise the frustration and distress that longer waits cause for patients and families. Alongside this temporary approach and the immediate actions we are taking, we are working closely with NHS providers and partners to redesign autism and ADHD services so they better meet the needs of our population.’
It comes after a report warned that the NHS has become ‘heavily dependent’ on private ADHD providers, who are pushing ICBs massively over budget with little oversight.
Last month, the Government launched an independent review into rising diagnoses of ADHD and autism, as well as other mental health conditions in England.
It will look at the reasons behind the growing prevalence and the knock-on demand for services in both adults and children.
Pulse exclusively revealed in March that the review would take place, when the Government said it would crack down on ‘unregulated private sector’ therapists and counsellors.
Visit Pulse Reference for details on 140 symptoms, including easily searchable symptoms and categories, offering you a free platform to check symptoms and receive potential diagnoses during consultations.
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READERS' COMMENTS [7]
Please note, only GPs are permitted to add comments to articles
Utterly pointless referrals.
Most everyone eventually gets the diagnosis they want.
Meaningless.
This is not a hill to die on. We have significant problem with RTC providers, ranging from concerns about quality of diagnosis (not yet had a patient seen by a RTC who has not been diagnosed with ADHD), to issues with prescriptions/shared care (not providing scripts at all, or not agreeing to reasonable shared care arrangements) to transfer of unfunded work (expecting practices to do preliminary physical checks and then monitoring during treatment).
Similar to Online access and NHS policies generally -we see patients encouraged to access services which effectively don’t exist to meet the actual specific need in totality , to be prescribed treatment they cannot afford privately and cannot be provided for years via the NHS, to thereby increase the anxiety and frustration of patients and staff , to overload an already collapsing overburdened service , advised to refer to providers who in some cases appear not to have sufficient oversight or questionable assessments as above-.
It interesting to note that the collapsing services of the NHS are to a noticeable degree caused by the common factor of NHSE,DHSC and ICBs and reckless behaviour of managers requiring subsequent back tracking or remediation- this has become their hallmark.
It is a real shame that money has been pouring into the RTC providers without any cap or restriction, whilst at the same time the local services are desperately deprived of any resources and have many year long waiting list.
I wonder what would happen if you stopped RTC altogether and plowed all that money/resource back into the local NHS psychiatry services?
There is a Danish study which says that the cost to society as a whole from not treating ADHD is about £20k pa per patient (in lost income & taxes, extra benefits, policing, social costs, health care costs etc.). This is every year, long term average. the idea that we cannot afford to assess and treat £1k pa to save society £20k pa PER PATIENT, illustrates that government sees the NHS as a cost, not an investment- which is utterly short sighted in my view.
When Right to Choose was introduced into the NHS constitution in 2009, online remote clinics were not a thing. RTC was envisioned as applying to the occasional patient who wished to travel “out of area”, not to huge numbers of patients seeking remote consultations. This causes two problems:
1. Budgetary. If I understand correctly, ICBs cannot limit their spending on RTC services.
2. Distributive justice. RTC rewards young tech-enabled populations and penalises older, disadvantaged, digitally excluded populations.
I would love to see RTC scrapped but scrapping it might prove politically difficult.
Correction – clearly from the article I am mistaken and ICBs CAN limit RTC spending!