If your GP has declined to refer you for an ADHD assessment, it can feel like the door has slammed shut. It hasn't. Most refusals come down to misunderstanding or local policy that doesn't actually have legal force — and there is a clear escalation ladder you can climb. Here are your options, in the order you should try them.
Step 1: Ask for the refusal in writing
Before you do anything else, write to the practice (email is fine) and ask for the reason for refusal in writing, with the clinical justification. Be polite and brief.
Two things tend to happen. Either the practice sends a written reason — which becomes the document you escalate with — or they quietly send the referral instead. About half of refusals never make it to step 2.
Timeline: allow two weeks for a response.
Step 2: Request a second opinion at the same practice
You have the right to ask another GP at the same practice for a second opinion. Phone reception and say you would like a routine appointment with a different GP about an ADHD referral.
Different GPs have different thresholds. The one who refused may not be representative of the practice's overall approach. Bring the same materials — completed ASRS, symptom impact summary, Right to Choose letter naming a provider.
Timeline: usually 1–3 weeks to get the second appointment.
Step 3: Contact PALS
PALS (Patient Advice and Liaison Service) is the NHS team that handles complaints and queries. You contact the PALS team at your local ICB. Send them: a brief account of what happened, the written refusal from the GP, and the legal basis for your Right to Choose referral.
PALS will correspond with the practice on your behalf. They are not advocates, but they do prompt practices to revisit decisions that look out of line with NHS guidance. Many cases resolve at this stage.
Timeline: 2–6 weeks for a response.
Step 4: Contact NHS England
If PALS doesn't resolve it, you can escalate to NHS England's complaints team. This is a formal complaint, which the practice and ICB are required to respond to in writing within a set period.
Timeline: NHS England usually acknowledges within 3 working days and responds substantively within 6 months — but most cases settle long before then because the practice does not want a formal finding against it.
Step 5: Change GP practice
If none of the above works, or if your relationship with the practice has broken down, you can register at a different practice that operates within the same ICB. There is no need to give a reason.
Timeline: typically 1–2 weeks to register, then you can book an appointment with the new GP and start the conversation fresh.
What to expect overall
Most adults who follow this ladder get their referral sent within 4–8 weeks of the first refusal. The single biggest accelerator is getting the refusal in writing early — it converts a vague conversation into a document the practice has to defend, and many quietly choose to refer instead.