ADHD Shared Care vs Right to Choose: What's the Difference?

In fact, they're quite different. One is about who assesses and treats you, and the other is about who prescribes your medication in the long term. And both work differently from paying for a private assessment yourself.

Right to Choose is part of the NHS choice framework in England. It gives you a legal right to choose which provider you're referred to for your first appointment with many specialist services, including ADHD assessment.

The provider doesn't have to be your local NHS service. It can be an independent organisation, as long as it holds an NHS contract for that service. Your assessment is then funded by the NHS, so you don't pay.

To use Right to Choose:

• you must be registered with a GP practice in England
• your GP needs to agree that a referral is clinically appropriate
• the provider must hold a qualifying NHS contract and follow NICE guidelines
• you can't already be receiving NHS care for ADHD from another service

Right to Choose isn't available in Scotland, Wales or Northern Ireland.

ADHD medication is started by a specialist, who adjusts the dose gradually through a process called titration. Once the dose is stable, the specialist may ask your GP to take over prescribing under a shared care agreement.

Under shared care:

• your GP issues ongoing prescriptions and carries out routine checks, such as blood pressure, heart rate and weight
• the specialist stays involved, with regular reviews, usually at least once a year
• both sides agree in writing who's responsible for what

Shared care isn't specific to Right to Choose. It can follow treatment from a local NHS service, a Right to Choose provider or a private clinic.

The two often form part of the same journey:

• Referral: your GP refers you to a Right to Choose provider.
• Assessment: the provider assesses you for ADHD, funded by the NHS.
• Starting medication: if appropriate, and if the provider offers it, they start medication and manage titration.
• Ongoing prescribing: once you're stable, the provider may ask your GP for shared care.

Right to Choose covers the first three stages. Shared care is about the fourth.

This depends on the provider and on your GP.

During titration, the Right to Choose provider is responsible for prescribing and monitoring.

After titration, there are two possibilities:

• If your GP agrees to shared care, your GP takes over prescriptions, and the provider continues to review your care.
• If your GP declines, the provider that started your medication usually remains responsible. Some Right to Choose providers have contracts that let them keep prescribing. Others may have limits, so it's worth checking.

Being referred through Right to Choose doesn't oblige your GP to prescribe. NHS England has confirmed there's no legal requirement for GP practices to enter shared care arrangements, and some practices have local policies about it.

Right to Choose is also quite different from paying for a private assessment yourself.

Right to Choose (NHS-funded)

• free at the point of use
• requires a GP referral
• available in England only
• waiting times vary between providers, and some local areas have introduced limits on referrals
• some providers offer medication and titration as well as assessment
• GPs may be more familiar with shared care for NHS-contracted providers, but it isn't guaranteed

Self-funded private assessment

• you pay for the assessment yourself
• you can usually book directly, without a GP referral
• available across the UK
• often shorter waits
• medication, if offered, is usually paid for privately
• some local NHS areas limit or don't support shared care with private providers

There's no single best option. It depends on your circumstances, how long you're able to wait, where you live, and what support you're looking for.

Right to Choose providers don't all offer the same services. Some provide assessment only, while others also start medication and manage titration. Some can keep prescribing if a GP declines shared care, and others can't. Local arrangements and limits on referrals can also change.

For anyone weighing up their options, these details can make a real difference to waiting times, costs and continuity of treatment. GP practices are often a good source of information about how Right to Choose and shared care work locally, and many now publish their policies online.

Raiys doesn't currently prescribe ADHD medication, so we don't offer titration or shared care agreements ourselves.

After your assessment, you'll receive a detailed written report, usually within 14 days. You can share it with your GP to talk about next steps, such as a referral for medication. Everyone diagnosed at Raiys can also use BeChange, our digital programme designed to help you build practical, everyday strategies at your own pace.

Raiys works nationwide, offering online adult ADHD assessments across the UK. Our experienced, specialist ADHD team follows NICE guidelines and provides a clear, detailed report you can share with your GP.

If you're in crisis right now, call 999, go to A&E, or call Samaritans free on 116 123, any time of day or night.

Thinking about an assessment? Find out more about our adult ADHD assessment.

Right to Choose and shared care are two different parts of the same journey. Understanding how they fit together makes it easier to choose the route that fits your needs, and to plan ahead for treatment and support.