A practice in the Milton Keynes area

4. Mrs W complains the Practice denied her request to be referred to her chosen NHS-funded private service for an autism assessment under the Right to Choose pathway. Mrs W said the Practice instead referred her to the locally contracted autism assessment service.

5. Mrs W said being declined her legal Right to Choose has caused her stress and anxiety. She said the service the Practice referred her to would require her to travel to another town for appointments, whereas the service she wanted to be referred to offered online appointments. Mrs W also said she would have to wait up to three years for a diagnosis with the service the Practice referred her to.

6. By bringing this complaint to us, Mrs W would like to be referred to her chosen service for an autism assessment in line with her Right to Choose.

7. Mrs W told us the Practice previously referred her to an NHS-funded private online service for an ADHD assessment. She said the Practice referred her son to the same service for his autism assessment.

8. In March 2025, Mrs W spoke to a GP at the Practice about being referred to the same online service for her autism assessment, in line with her Right to Choose. If a GP needs to refer a patient to a specialist or consultant led service, in most cases, patients have the legal right to choose where they would like to be referred.

9. The GP referred Mrs W to the locally contracted service, not her chosen service. The locally contracted service rejected Mrs W’s referral.

10. In June 2025, Mrs W spoke to a different GP at the Practice and again asked to be referred to the online service under her Right to Choose. The GP asked Mrs W to complete an AQ-10 form, the screening form for autism assessments, and again referred Mrs W to the locally contracted service.

13. Before we decide if we should conduct a detailed investigation of a complaint we look at whether there are signs the organisation has got things wrong. We do this by comparing what should have happened with what did happen. We have done this and have found indications the Practice got things wrong. We have asked the Practice to reconsider Mrs W’s request and are satisfied this action is appropriate to resolve Mrs W’s complaint. Mrs W told us she asked her GP to refer her to her chosen NHS-funded private service for an autism assessment in March 2025. She chose this particular service as it previously completed her ADHD assessment, so had her records, and it has shorter waiting times than her local service.

14. The GP records show Mrs W had a telephone appointment about her request for an autism assessment. The GP said they could only refer Mrs W to a service recognised by the Integrated Care Board (ICB). The ICB is an NHS body responsible for planning, funding and co-ordinating healthcare services in a specific geographical area.

15. The GP referred Mrs W to the service contracted by the ICB, not to Mrs W’s chosen service.

16. In May, Mrs W contacted her the Practice to inform the GP the locally contracted autism assessment service had rejected her referral as it had not been done correctly. The Practice arranged an appointment for Mrs W in June. Mrs W told us she asked to be referred to her chosen service again at this appointment. This request is noted in the GP records. The Practice confirmed it submitted a new referral for Mrs W. It again referred Mrs W to the service contracted by the ICB.

17. Mrs W complained to the Practice in July it was denying her Right to Choose the service she wanted to access.

18. In its complaint response, the Practice said it had referred Mrs W to the autism assessment service currently contracted by the ICB. It said it was aware of the Right to Choose pathway. It said as the referring clinicians, GPs need to be satisfied the service they are referring to is credible and is funded by the ICB. It said it is within its rights to refuse a referral if they cannot be sure of this.

19. We asked the Practice to further explain why it decided not to refer Mrs W to her chosen NHS-funded private service for an autism assessment under the Right to Choose pathway.

20. The Practice told us it had contacted the ICB in February 2025 for advice on the Right to Choose regarding a different, child patient. The Practice asked, the ICB if it referred via the Right to Choose, would the ICB fund that service? The ICB told the Practice the child did not have a Right to Choose option as they had not been identified as needing an assessment. It said the child would need to be accepted on an NHS assessment waiting list to then ask for an alternative NHS service. It said the family could instead pay for a private assessment.

21. The Practice also shared with us a bulletin to GPs in the local area from the ICB which said, as of September 2024, the autism assessment service for people aged 18 and over would be the service contracted by the ICB. It said the service for people aged 16-17 was the service Mrs W had chosen.

22. The Practice told us the ICB had said a patient can only access the Right to Choose if the NHS waiting list is too long. We can see this advice caused the Practice some confusion, but we also note this advice from the ICB was not specific to Mrs W’s case. The Practice also said the only adult autism assessment service approved by the ICB was the one it had referred Mrs W to.

23. We contacted the ICB to ask it about the advice it gives to GPs making Right to Choose referrals. The ICB told us it does not authorise or refuse Right to Choose referrals. It said it is not the decision-maker about Right to Choose referrals and has not role in individual Right to Choose referrals. It said NHS England is the Right to Choose framework owner and the GP Practice makes the referral decision.

24. The Practice also shared with us an email it had received from the Local Medical Committee (LMC) about Right to Choose in October 2024. LMCs are local representative committees of NHS GPs. They represent GP’s interests to NHS health authorities at a local level.

25. The LMC told the Practice it can refuse referrals to a service it does not consider safe or reliable. It said GPs must ensure a referral is in the patient’s best interest and be confident that the patient would be safely managed. The LMC also shared a list of points a GP should consider about a service before referring a patient to them.

26. The NHS Choices framework says if patients are referred for consultant-led treatment, or to a mental health professional, they can decide which provider they would like to receive care from as an outpatient.

27. It says the Right to Choose applies at the point of referral from a GP to a provider that has an NHS contract to provide the service the patient needs. It says all referrers should shortlist on average five choices from which the patient may choose, where this is practicable, clinically appropriate and preferred by the patient.

28. The NHS Constitution says patients have a right to choose which provider they are referred to from all those who have a contract to provide the service. We note the provider can have an NHS contract anywhere in the country, not only in the patient’s local area.

29. The NHS Constitution Handbook also says patients have a right to be provided with information wherever there is a legal right to choice, to support a patient in choosing their provider.

30. NHS England guidance says GPs are responsible for determining whether a non-urgent referral is clinically appropriate for a patient.

31. Considering the evidence, the Practice has presented several reasons for not referring Mrs W to her chosen autism assessment service under Right to Choose. It seems there was some confusion amongst staff on how the pathway works and we can see indications of failings in the actions of the Practice.

32. The NHS Choices framework is clear that a patient can choose their provider at the point of referral, providing it has an NHS contract somewhere in the country and is led by a consultant or mental health professional. The NHS Constitution says patients have a right to be provided with information to support them making an informed choice about which provider to be referred to. We have not found evidence the Practice provided Mrs W with information about the provider, or indeed any provider, other than telling her it could only refer her to a service commissioned by the ICB.

33. NHS England guidance says GPs must decide whether a referral is clinically appropriate. The LCM told the Practice it can refuse a referral if it does not think it is in the patient’s best interest or is not confident about the safety of the service. It also provided a list of criteria for GPs to consider when deciding where to refer a patient. We have not found evidence the Practice considered these criteria.

34. The Practice told us it had had some concern about communication with the service Mrs W had requested to be provided for. We appreciate this would be important for the referring GP to consider when deciding if the service was suitable for Mrs W. However, it did not explain this reason to Mrs W. Furthermore, the Practice also indicated in its complaint response and in its earlier correspondence with us it had not referred Mrs W to her chosen service because it was not contracted by the ICB. This is not in line with guidance on Right to Choose.

35. Mrs W told us to resolve her complaint she would like the Practice to refer her to her chosen NHS-funded private service for an autism assessment under her Right to Choose.

36. Our guidance on remedy says when things go wrong, where possible, an NHS organisation should put things right for the person affected. It says an organisation should aim to return them to the position they would have been in, had the failing not happened.

37. We asked the Practice if it would invite Mrs W to discuss and consider her request to be referred for an autism assessment with her chosen service, under the Right to Choose pathway. We asked the Practice to provide Mrs W with information to allow her to make an informed choice about her chosen service, in line with guidance. The Practice has agreed and said it will contact Mrs W to discuss her referral request again.

38. Our NHS Complaint Standards say organisations should take action to make sure any learning from complaints is identified and used to improve services.

39. The Practice told us it will now refer patients to the service of their choice on the understanding the patient is aware the service has not been vetted or approved by the Practice, and the Practice will not enter into a Shared Care Agreement with the Service. A Shared Care Agreement is an arrangement between a specialist service and a GP. It is used when a patient starts a specialist treatment that may need ongoing prescriptions or monitoring from their GP. Shared Care Agreements are not automatic, and a GP will only take over shared care if they feel it is safe and appropriate to do so.

40. We also reminded the Practice while Mrs W has the right to choose her autism assessment service, it is still the GP’s decision whether a referral to this service is clinically appropriate, in line with NHS England guidance.

41. They Practice’s actions align with the outcome Mrs W was seeking when she brought her to complaint to us. The Practice has also assured us of the wider learning it has since taken from this case to ensure it is acting in line with the NHS Constitution and national guidance on patient choice.

42. We are satisfied the actions the Practice has agreed to take are in line with our NHS Complaint Standards and guidance on remedy.

43. We therefore consider this a satisfactory resolution to Mrs W’s complaint, and we do not need to consider her complaint further.

44. We hope the resolution we agreed with the Practice assures Mrs W the Practice have learnt from what has happened and will improve its service for the future. We thank Mrs W for raising her concern and allowing the Practice the opportunity to improve.

1. We have carefully considered Mrs W’s complaint about the Practice. We are sorry to hear of the difficulties Mrs W experienced when trying to assert her Right to Choose an NHS-funded private autism assessment provider and appreciate the stress and anxiety she has experienced.

2. Following our request, the Practice has agreed to further consider Mrs W’s request for a referral to her chosen service in line with her Right to Choose. We are satisfied this action is enough to resolve Mrs W’s complaint. We explain this in more detail below.

3. The Practice has also told us about its updated approach to Right to Choose requests from patients, which is in line with guidance.