Referral Guidance: What we can and can’t accept when you’ve already had an ADHD diagnosis

We understand that navigating NHS and private care can be confusing, especially when it comes to conditions like ADHD. We hope the following guidance helps clarify what kinds of referrals we’re able to accept - and why certain rules limit what we can do.

• Full NHS Referrals for Assessment and Treatment

  • We welcome referrals where we provide the entire episode of care - that means both the assessment and any treatment / medication that follows.

  • This ensures we meet the requirements of the NHS Choice Framework and national policy, which only allows referrals for the full care pathway.

• Referrals for Treatment / Titration Only (e.g. medication), where assessment was done privately or via NHS/RTC

  • Unfortunately, we cannot accept referrals just for ADHD medication if the assessment was done elsewhere, whether privately or via the NHS under Right to Choose.

  • This is not a decision made by Care ADHD, but a requirement under NHS England policy, which does not allow a patient to receive only part of their care on the NHS when the other part was delivered by a different provider for the same condition.

  • This is based on national guidance from the Department of Health (2009 ‘top-up’ guidance), which still applies.

• Mixed NHS and private care in the same episode

  • NHS rules explicitly prohibit mixing care across providers within a single treatment episode. For example, having a private assessment and then seeking NHS-funded medication from a different provider is not permitted.

  • These are NHS England regulations, not internal Care ADHD policies, and we are legally required to follow them.

Note: Unless we have a specific contract in place with your local Integrated Care Board (ICB) that allows for an alternative arrangement, these national rules will apply in full. To find out if we have a specific contract in place with your local ICB, please see ICB Referral Guidance.

You can still be referred to us (or another NHS provider) for a new NHS assessment. Having gone private does not mean you lose your right to NHS care.

However:

• The NHS provider will usually need to carry out their own assessment from the beginning, to comply with NHS clinical governance standards.

• We understand this can feel frustrating — especially after investing in a private assessment — but we are obligated to follow NHS England rules.

• At Care ADHD, we’re happy to review your private assessment and diagnosis report. If it meets appropriate standards and is from a registered, reputable provider, we may be able to streamline the process with a shorter revalidation assessment — helping you move more quickly to treatment.

We understand how difficult long NHS waits can be — especially when you’ve already received a diagnosis but can’t yet begin treatment.

However, NHS England rules state that once you’ve had an ADHD assessment via NHS or Right to Choose, you are considered to be in an active treatment episode. At that point:

• Your GP cannot refer you to a second provider for the same episode of care (e.g. for just medication).

• Care ADHD cannot accept a referral just for the medication stage, even if the original provider cannot start treatment right away.*

These are national policies set by NHS England to ensure fairness and to avoid duplicate referrals that could slow down care for others. This is not a decision made by Care ADHD.

*Unless we have a specific contract in place with your local ICB for alternative arrangements - see ICB Referral Guidance.

• 💷 Self-fund your treatment at Care ADHD

  Many people choose this route to avoid delays. If you already have a recent diagnosis from a reputable provider, we may be able to offer a shorter assessment and get you started on medication more quickly.

• 🏥 Continue with your current NHS provider

  If you were referred via Right to Choose - they are responsible for the full ADHD care pathway - diagnosis and treatment. While the wait may be long, the NHS only funds one provider per care episode.

• 📩 Appeal to your ICB for a new referral

  You can request that your GP appeal to your local Integrated Care Board (ICB) to fund a referral to Care ADHD. However, the referral must be for the entire ADHD episode of care (assessment and treatment), not just for medication. Your GP would also need to confirm it's clinically appropriate.

Yes, we can usually accept a referral under the NHS Right to Choose (RTC) if a person has a previous diagnosis of ADHD from childhood or adolescence.

However, in line with NICE Guideline NG87 (Attention deficit hyperactivity disorder: diagnosis and management), a new adult ADHD assessment is still required before any treatment can begin. NICE guidance states:

'Adults who were diagnosed with ADHD in childhood or adolescence and present with symptoms suggestive of continuing ADHD should be referred for assessment by a specialist in ADHD.' (NICE NG87, recommendation 1.7.1)

This is because the presentation of ADHD in adulthood can differ from childhood, and it is important to confirm that diagnostic criteria are still met in the adult context. From an NHS perspective, this is treated as a new episode of care, rather than a continuation — and that’s why the RTC referral must be for a full diagnostic assessment and treatment pathway, not for treatment only.

We are therefore happy to accept these referrals under RTC, as long as the GP is referring for both assessment and treatment.

Even if your local NHS commissioner (ICB) supports split referrals, we as a provider also have to follow national NHS and CQC rules. If we accepted referrals only for treatment after a private assessment, we’d be:

• Breaching NHS England guidance (by delivering a partial, split episode of care)

• At risk of regulatory action (e.g. from the Care Quality Commission)

• Creating inequality in access to care (e.g. prioritising patients who could afford private assessments)

We’re committed to delivering safe, fair and legally compliant care. That’s why we have to follow these rules - even when it’s disappointing for individual patients.