Short answer: yes, a GP can decline to refer you for an ADHD assessment — but only on specific clinical grounds. They cannot refuse because the NHS is busy, because your local ICB has 'paused' referrals, or because they personally don't believe in adult ADHD. This guide explains what counts as a valid refusal, what doesn't, and how to push back.
The legal basis for Right to Choose
Right to Choose is a legal right set out in the NHS Constitution and the NHS Choice Framework. It says that for most non-urgent mental health referrals, you can choose any provider in England that holds an NHS contract for that service. ADHD assessment is one of those services.
Crucially, the funding follows the patient. Your GP's local Integrated Care Board (ICB) is required to fund the referral wherever you choose, as long as the provider has an NHS contract. 'We don't have the budget' is not a lawful reason to refuse.
What counts as a valid clinical refusal
A GP can decline to refer you if, in their clinical judgement, the referral is not appropriate. Valid examples include:
• You have not described symptoms consistent with ADHD.
• Your symptoms are more likely explained by an active condition that should be treated first (for example, severe untreated depression or substance misuse).
• You are already under specialist care for the same issue.
These are clinical decisions and the GP must be able to explain them. Even then, you can ask for a second opinion or change practices.
Five common objections — and what to say back
1. 'The waiting list is too long.' That is the point of Right to Choose — it lets you pick a provider with a shorter wait. Ask to be referred to a named Right to Choose provider.
2. 'Our ICB doesn't fund that provider.' Under Right to Choose, the ICB is required to fund any NHS-contracted provider in England. Ask the GP to confirm the refusal in writing so you can escalate.
3. 'You don't seem like you have ADHD.' Ask which symptoms they ruled out and on what basis. The GP is not the assessing clinician — their role is to refer, not diagnose.
4. 'Have you tried therapy/lifestyle changes first?' These are not substitutes for an assessment. Ask whether they would say the same to someone seeking a referral for a suspected physical condition.
5. 'I'll need to check with my colleagues.' That is reasonable, but ask for a clear timeline and a follow-up appointment. If two weeks pass with no answer, call the practice.
Ask for the refusal in writing
If the GP confirms a refusal, ask for it in writing with the clinical reason. You have the right to this under standard NHS complaints guidance, and a written refusal is what you need to escalate.
A polite request — 'Please could you put the reason for declining the referral in writing, so I can take it forward through PALS if needed?' — is usually enough. Many refusals quietly become referrals at this point.
When to escalate to PALS
PALS (Patient Advice and Liaison Service) handles complaints and queries within the NHS. If your GP refuses on non-clinical grounds — funding, waiting lists, ICB policy — you can contact your ICB's PALS team and ask them to review the decision.
PALS will usually correspond with the practice on your behalf. Most cases resolve at this stage without needing a formal complaint.