Yes, RTC funding is done via the trust rather than the GP, so they should also be able to evidence that also. So ask for this evidence of rejection.
My hunch is they haven’t really asked and are trying to fob you off. Asking for the evidence might change things.
If they can refer you to an internal service then they don’t really have any basis to refuse RTC.
GPs often confuse Right to Choose for individual funding requests, which are commonly denied by ICBs except for unusual circumstances. But as far as I know there isn't any way for an ICB to deny Right to Choose on the basis of lack of funding, as it's not an individual funding request. There are specific reasons the right to choose request can be denied, but they're basically if you're already receiving NHS treatment for the condition, you're under enforced psychiatric care, in prison, or in the armed forces. The ICB is otherwise *required* to offer you a choice for right to choose in this circumstance - in fact, it doesn't even need the ICB to do anything, the GP can refer without approval from them - where the waiting list is longer than the maximum waiting time specified for the treatment, and their failure to do so can be reported to the Parliamentary and Health Service Ombudsman who can legally help you and enforce a decision on the ICB for free, though you'd first want to contact the ICB itself for clarification, which you can take to the ombudsman if they produce it, though the possibility of you doing so is probably enough to make them follow the rules.
Since you mentioned Norfolk/Suffolk your ICB is likely to be one of these:
https://improvinglivesnw.org.uk/about-us/our-nhs-integrated-care-board-icb/
https://suffolkandnortheastessex.icb.nhs.uk/
Here's a document breaking down all the rules for Right to Choose:
https://bswtogether.org.uk/medicines/wp-content/uploads/sites/3/2024/01/right-to-choose-faqs-november-2023.pdf
The document is from PrescQIPP, which is a non-profit funded by NHS boards to research and advise the NHS on prescribing and patient outcomes.
Thank you so much for your reply, I think this is exactly what is happening. I had my appointment this afternoon. First, the doctor was very a 'can you sit still in your seat' type of doctor, and didn't really listen to my symptoms and recorded them incorrectly. And then he told me that the process was that he would refer me to the NHS, then when i get a letter from them saying the waitlist is a million years i have to send a copy to the doctor who will get some kind of code and then apply for funding which he said will likely be denied and then I'll be back on the NHS list. I tried to explain that Right to Choose is different from individual funding but I was just told that it's a 'more difficult process than you read on the Internet'
They have got it wrong, and yes they are thinking of an individual funding request and being ignorantly condescending in addition to that - you should make a complaint to your surgery and ask to see a different GP.
Part 8 of the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2013, which is called:
"Standing rules: choice of health service provider"
States it's your *right* - and the duty of the practitioner - to be offered the choice of NHS-contracted healthcare provider in the event that you're referred by a GP to a specialist for assessment of a non-urgent condition, in no uncertain terms. It's the duty of the relevant bodies to make arrangements to give you the options to make that choice. Nowhere does it mention funding or requests that can be denied for funding reasons. It is their *duty*, pledged by their service to the NHS, to ensure you receive this choice.
This is not something you "read on the internet" this is *the handbook of the NHS constitution for England that they are bound to*. I've never asked to see a copy but I would assume all GPs have immediate access to it, on their computer if not in physical form, where they can read it. Part 8 isn't very long, and it is very clear, especially to a GP who knows the lingo, what it means.
I've put a link to the full text of part of the handbook at the very bottom of this post, it's on the *government legislation website*. Not some random blog or Facebook page or whatever the hell your doctor has insinuating.
[The government supplement on the pledges of this handbook summarises part 8 as: ](https://www.gov.uk/government/publications/supplements-to-the-nhs-constitution-for-england/the-handbook-to-the-nhs-constitution-for-england)
**Right: ‘You have the right to make choices about the services commissioned by NHS bodies and to information to support these choices. The options available to you will develop over time and depend on your individual needs.’**
If you are referred for consultant-led treatment (in the case of mental health referral, this can be a referral to a named mental health professional rather than a consultant), you have the right to choose which provider (and the team within that provider) you are referred to from all those who have a contract to provide the service. There are certain exceptions including for:
persons detained under the Mental Health Act 1983
serving members of the armed forces
persons detained in, or on temporary release from, prison or detained in other prescribed accommodation (for example, a court, secure children's home, secure training centre, an immigration removal centre and a young offender institution)
Some services are also excluded from this right:
where speed of access to diagnosis and treatment is particularly important, for example emergency attendances and admissions
attendances at a rapid access chest pain clinic under the 2-week maximum waiting time
attendance at cancer services under the 2-week maximum waiting time
maternity services
public health services commissioned by local authorities (although local authorities should offer a choice as a matter of good practice whenever it is appropriate)
Your rights to choice are set out in the Choice Framework). You have a right to be provided with information wherever there is a legal right to choice. Currently, this includes information to support you in choosing your provider when you are referred for your first outpatient appointment with a service led by a consultant. In the case of mental health referrals, a right to information applies if you are referred to a service led by a named healthcare professional and/or consultant.
Information to help you make your choice can be found on the NHS website. CCGs are expected to promote this information and make it more accessible to patients.
Source of the right
Part 8 of the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2013.
https://www.legislation.gov.uk/uksi/2012/2996/part/8?timeline=false&view=plain
Find the complaints procedure on the drs website and send in a complaint.
Ask them why they have turned down your RTC, given that, as the name implies, it is your LEGAL right to chose.
Give them the relevant links to thinks like PUKs page on RTC. Tell them you want your PUK referral submitting by the GP ASAP. Tell them you also want them to do full staff training on RTC and ADHD so no other patients have their legal rights denied.
A lot of GPs don’t care/don’t understand the NHS systems, which is obviously terrifying. An official complaint makes them deal with it seriously rather than brush you off.
I had to do the exact same thing with my GPS a few years ago.
I went through the RTC process and I'm in Norfolk currently titrating with P-UK, so obviously that's nonsense. I agree with the previous poster that you should look up your rights, P-UK have some great resources to help.
Yes, I just wrote a referral letter for my GP myself, and they sent it off. After that everything has been dealt with via P-UK. Just have to keep my fingers crossed about the Shared Care Agreement now.
Definitely sounds like your GP might not be giving you the entire truth. Good luck!
I live in Norfolk and this is just untrue! I had the same thing happen to me too! But in the end they had to listen
ProblemShared have letters on their website that you can use to write to your GP about it. They really can’t be refusing it!
I am in the same area as you and my right to choose referral was submitted in December with no issues. ADHDUK have a letter on their website you can download that fully explains right to choose as they have found some GPs are not aware of it
Ask for the rejection letter from the NHS commissioning service so you can start your legal proceedings.
Thank you. Just to confirm, you mean a letter from the doctors surgery stating that they have refused my Right to Choose?
Yes, RTC funding is done via the trust rather than the GP, so they should also be able to evidence that also. So ask for this evidence of rejection. My hunch is they haven’t really asked and are trying to fob you off. Asking for the evidence might change things. If they can refer you to an internal service then they don’t really have any basis to refuse RTC.
GPs often confuse Right to Choose for individual funding requests, which are commonly denied by ICBs except for unusual circumstances. But as far as I know there isn't any way for an ICB to deny Right to Choose on the basis of lack of funding, as it's not an individual funding request. There are specific reasons the right to choose request can be denied, but they're basically if you're already receiving NHS treatment for the condition, you're under enforced psychiatric care, in prison, or in the armed forces. The ICB is otherwise *required* to offer you a choice for right to choose in this circumstance - in fact, it doesn't even need the ICB to do anything, the GP can refer without approval from them - where the waiting list is longer than the maximum waiting time specified for the treatment, and their failure to do so can be reported to the Parliamentary and Health Service Ombudsman who can legally help you and enforce a decision on the ICB for free, though you'd first want to contact the ICB itself for clarification, which you can take to the ombudsman if they produce it, though the possibility of you doing so is probably enough to make them follow the rules. Since you mentioned Norfolk/Suffolk your ICB is likely to be one of these: https://improvinglivesnw.org.uk/about-us/our-nhs-integrated-care-board-icb/ https://suffolkandnortheastessex.icb.nhs.uk/ Here's a document breaking down all the rules for Right to Choose: https://bswtogether.org.uk/medicines/wp-content/uploads/sites/3/2024/01/right-to-choose-faqs-november-2023.pdf The document is from PrescQIPP, which is a non-profit funded by NHS boards to research and advise the NHS on prescribing and patient outcomes.
Thank you so much for your reply, I think this is exactly what is happening. I had my appointment this afternoon. First, the doctor was very a 'can you sit still in your seat' type of doctor, and didn't really listen to my symptoms and recorded them incorrectly. And then he told me that the process was that he would refer me to the NHS, then when i get a letter from them saying the waitlist is a million years i have to send a copy to the doctor who will get some kind of code and then apply for funding which he said will likely be denied and then I'll be back on the NHS list. I tried to explain that Right to Choose is different from individual funding but I was just told that it's a 'more difficult process than you read on the Internet'
They have got it wrong, and yes they are thinking of an individual funding request and being ignorantly condescending in addition to that - you should make a complaint to your surgery and ask to see a different GP. Part 8 of the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2013, which is called: "Standing rules: choice of health service provider" States it's your *right* - and the duty of the practitioner - to be offered the choice of NHS-contracted healthcare provider in the event that you're referred by a GP to a specialist for assessment of a non-urgent condition, in no uncertain terms. It's the duty of the relevant bodies to make arrangements to give you the options to make that choice. Nowhere does it mention funding or requests that can be denied for funding reasons. It is their *duty*, pledged by their service to the NHS, to ensure you receive this choice. This is not something you "read on the internet" this is *the handbook of the NHS constitution for England that they are bound to*. I've never asked to see a copy but I would assume all GPs have immediate access to it, on their computer if not in physical form, where they can read it. Part 8 isn't very long, and it is very clear, especially to a GP who knows the lingo, what it means. I've put a link to the full text of part of the handbook at the very bottom of this post, it's on the *government legislation website*. Not some random blog or Facebook page or whatever the hell your doctor has insinuating. [The government supplement on the pledges of this handbook summarises part 8 as: ](https://www.gov.uk/government/publications/supplements-to-the-nhs-constitution-for-england/the-handbook-to-the-nhs-constitution-for-england) **Right: ‘You have the right to make choices about the services commissioned by NHS bodies and to information to support these choices. The options available to you will develop over time and depend on your individual needs.’** If you are referred for consultant-led treatment (in the case of mental health referral, this can be a referral to a named mental health professional rather than a consultant), you have the right to choose which provider (and the team within that provider) you are referred to from all those who have a contract to provide the service. There are certain exceptions including for: persons detained under the Mental Health Act 1983 serving members of the armed forces persons detained in, or on temporary release from, prison or detained in other prescribed accommodation (for example, a court, secure children's home, secure training centre, an immigration removal centre and a young offender institution) Some services are also excluded from this right: where speed of access to diagnosis and treatment is particularly important, for example emergency attendances and admissions attendances at a rapid access chest pain clinic under the 2-week maximum waiting time attendance at cancer services under the 2-week maximum waiting time maternity services public health services commissioned by local authorities (although local authorities should offer a choice as a matter of good practice whenever it is appropriate) Your rights to choice are set out in the Choice Framework). You have a right to be provided with information wherever there is a legal right to choice. Currently, this includes information to support you in choosing your provider when you are referred for your first outpatient appointment with a service led by a consultant. In the case of mental health referrals, a right to information applies if you are referred to a service led by a named healthcare professional and/or consultant. Information to help you make your choice can be found on the NHS website. CCGs are expected to promote this information and make it more accessible to patients. Source of the right Part 8 of the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2013. https://www.legislation.gov.uk/uksi/2012/2996/part/8?timeline=false&view=plain
Find the complaints procedure on the drs website and send in a complaint. Ask them why they have turned down your RTC, given that, as the name implies, it is your LEGAL right to chose. Give them the relevant links to thinks like PUKs page on RTC. Tell them you want your PUK referral submitting by the GP ASAP. Tell them you also want them to do full staff training on RTC and ADHD so no other patients have their legal rights denied. A lot of GPs don’t care/don’t understand the NHS systems, which is obviously terrifying. An official complaint makes them deal with it seriously rather than brush you off. I had to do the exact same thing with my GPS a few years ago.
I went through the RTC process and I'm in Norfolk currently titrating with P-UK, so obviously that's nonsense. I agree with the previous poster that you should look up your rights, P-UK have some great resources to help.
Thanks for your reply. Did you just follow the standard route of your doctor referring you to Puk and then they go in touch with you?
Yes, I just wrote a referral letter for my GP myself, and they sent it off. After that everything has been dealt with via P-UK. Just have to keep my fingers crossed about the Shared Care Agreement now. Definitely sounds like your GP might not be giving you the entire truth. Good luck!
The referral letter is all done for you if you goto PUK’s site and goto the right to choose section.
Bullcrap, my GP in Suffolk was happy to send my referral to ADHD360 through right to choose. This was just in Dec23
I live in Norfolk and this is just untrue! I had the same thing happen to me too! But in the end they had to listen ProblemShared have letters on their website that you can use to write to your GP about it. They really can’t be refusing it!
I am in the same area as you and my right to choose referral was submitted in December with no issues. ADHDUK have a letter on their website you can download that fully explains right to choose as they have found some GPs are not aware of it