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Adult ADHD and ASD Referral Update
April 2026
Due to very high demand across the NHS, new rules have been introduced by NHS Thames Valley Integrated Care Board.
From April 2026, adult patients (aged 18 and over) can only be referred for an Attention Deficit Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD) assessment if specific criteria are met.
This applies to:
- Local NHS ADHD services
- Right to Choose providers
The revised criteria are intended to address the significant increase in demand for ASD/ADHD diagnoses in recent years, prioritising individuals with the most severe functional impairment and those most likely to benefit from pharmacological treatment. Please see the letter from the ICB.
The Oxfordshire Adult ADHD service and adult Autism service on the NHS are still closed to new referrals and therefore the only way to be referred for an ADHD/ASD assessment on the NHS is via right to choose.
In order to proceed with a referral to a right to choose provider you will need to meet criteria 1,2, 3 AND one of criteria 4.
- You are aged 18 or over AND
- You do not have a contraindication to ADHD Medication. For example:
a) Cardiovascular issues. In the event you have a family history of sudden death or cardiomyopathy in younger age group, or history of exertional chest pain or shortness of breath or palpitations we would need to ensure this has been fully investigated and, if seen by cardiologist, we would require confirmation from them that it would be safe to prescribe ADHD medication.
b) Existing hypertension has been appropriately investigated. In those age < 45 years we would require authorisation from a specialist that it is safe for you to use ADHD medication.
c) Any other severe physical condition or medication which might interact with ADHD medication or be adversely affected by a potential side effect – if this is the case we will need to seek advice from a specialist before a referral can be made.
d) You have no history of significant substance and/or alcohol misuse in last 6 months OR you if this is the case you are actively engaging with substance misuse agencies
3. You are not under another service who would better meet your needs. For example:
a) Patients with a learning disability (LD) and under the LD team can be seen for a holistic assessment by a LD consultant to diagnose ASD/ADHD and review treatment options.
b) Patients with a long-term mental health condition under the adult mental health team (AMHT). If the AMHT believe a diagnosis of ASD or ADHD would significantly help the patient with the mental health condition they are dealing with they can either make their own referral to the adult ADHD service or make the diagnosis and treat with support from local Adult ADHD services.
AND 4. You can provide written evidence of one of the following:
- You or a child in your care is open to a safeguarding team and it has been identified that you possibly have ASD/ADHD and that treatment has been identified as a need. In this situation we will need a signed letter from adult social care detailing the reasons they believe you have ASD/ADHD, how it affects the way you live/impacts the safeguarding situation and that treatment has been identified as a need.
- You are open to Criminal Justice Liaison and Diversion/street triage/link/ probation, and ASD/ADHD treatment has been identified as a need. In this situation we will need a signed letter from your solicitor or probation officer detailing the reasons they believe you have ASD/ADHD, how it affects the way you live/has contributed to your conviction and that treatment has been identified as a need. Please note this does not include family law or medicolegal assessments.
- You have a long-term physical health condition e.g. diabetes, epilepsy, and you are struggling to manage your care plan for this condition due to ASD/ADHD symptoms and ASD/ADHD treatment has been identified as a need. For example, you have epilepsy and due to memory issues associated with possible ADHD you frequently forget your medication and experience seizures.
- You are enrolled on an academic/vocational course and have difficulties associated with ASD/ADHD (such as focus, submitting work, communication) which has led to risk of failing/non-completion/exclusion. In this situation you will need to speak to the student support service (or SEND) and ask for reasonable adjustments to be implemented. If these have failed to improve your difficulties after one full term please speak to the student support service and ask them for a signed letter which details the reasons they believe you have ASD/ADHD, how it affects your studies as well as confirming the reasonable adjustments they implemented consistently for at least one full term. The letter will also need to confirm that a referral for an ASD/ADHD assessment is needed e.g. for medication or to access Disabled Students' Allowance (DSA) funded adjustments.
- You have a pattern of repeated loss of employment due to symptoms of ASD/ADHD or you are at risk of losing your current job due to symptoms of ASD/ADHD despite implementation of reasonable adjustments AND treatment is considered essential to access or maintain employment. This could include unpaid employment. In this situation we will need a signed letter from your current employer confirming the symptoms that are impacting your job, the reasonable adjustments that have been tried and their opinion that treatment is essential to maintain employment. If you are unemployed, we will require a signed letter from your old employer confirming the symptoms of possible ASD/ADHD that you had, how this contributed to you losing your job and the reasonable adjustments they implemented which failed to improve the situation.
- You are an unpaid carer and you can provide evidence that you’ve been unable to fulfil your caring responsibilities due to symptoms of ASD/ADHD and that treatment is considered essential to continue your role. Evidence could include a signed letter from a social worker or other agency involved in the care of the person you care for. The letter should detail the reasons they believe you have ASD/ADHD, how it impacts your ability to provide care, how this impacts the person being care for and that treatment has been identified as a need.
- You have an existing and evidenced (child or adult) diagnosis of ADHD approved by an NHS service (based on NICE compliance) or equivalent according to the health system where the diagnosis was made which was consistent with the NHS NICE guidance AND you:
- Meet above criteria OR
- You are on ADHD medication provided by these services and can show objective evidence of your past behaviour that indicates significant risk of meeting criteria above if the medication is stopped (e.g. loss of job, discontinued education, imprisonment) OR
- You were previously on ADHD medication (provided by one of these services) which you found beneficial and had to top on medical advice (e.g. due to pregnancy or health condition) and you wish to restart treatment.
If you believe that you satisfy all of the necessary referral criteria, please send the practice an e-consult via our website confirming the criteria you meet and that you can provide the evidence needed for criteria 4. We will then send you a reply in which you can upload the written evidence. This information will then be passed on to your GP. Assuming all the criteria are met your request will be passed on to our secretaries who will send you information on the right to choose providers you can be referred to. Please note for criteria 2, please tell us if you think you’re unsure if you have a contraindication and your GP will double check this and seek advice where appropriate.
If you do not satisfy the necessary referral criteria then we will not be able to refer you on the NHS for an ASD or ADHD assessment. In this situation you can still access support services as detailed in the letter from the ICB above.
It is important to emphasise that a diagnosis of ADHD should not influence the reasonable adjustments that can be put in place by your employer/university etc. A decision on the required adjustments should be made based on your symptoms alone regardless of any diagnosis.
Please note that you as the patient are responsible for collecting the evidence needed to process your referral. We will be unable to contact the relevant professionals or services on your behalf. If you are unable to provide the necessary evidence, we will be unable to proceed with your referral.
Patients not meeting the criteria for a referral on the NHS can still go private for an assessment and to consider medication. Before proceeding with a private assessment please read our policy on shared care prescribing with private providers particularly if you are hoping we can take over prescribing of your medication on the NHS. Please contact us prior to proceeding down this route so we can advise you on private services that we are familiar with and usually consider shared care prescribing agreements with.
We recognise that this news may be a considerable blow to our patients who were hoping for an NHS referral for an ADHD/ASD assessment and/or treatment. The situation is out of our hands as a GP surgery and the ICB have needed to introduce these measures due to the unprecedented demand and finite resources available.
Please note if you are concerned about availability of an assessment through Right to Choose you can contact the NHS Thames Valley Patient Advice and Complaints Team (contact details below). Please do not complain to the GP surgery.
- Phone: 0300 561 0250
- Email: scwcsu.palscomplaints@nhs.net
- Post: Patient Advice and Complaints Team (PACT) Ground Floor, Mallard Court Express Park Bristol Road Bridgwater TA6 4RN