It happens constantly. You sit across from your GP having done everything right — researched your symptoms, written things down, gathered yourself enough to talk about something deeply personal — and they say something like: "But you're clearly intelligent," or "You managed to get through school fine," or "You don't seem hyperactive."
Or, the particular favourite: "Have you tried cutting back on screens?"
You leave feeling stupid for asking, unsure whether you imagined the whole thing, and with no idea what to do next.
Here's what to do next.
First: Your GP Is Not an Expert in ADHD
This is not a criticism of GPs. They're generalists managing an overwhelming volume and complexity of conditions. ADHD is genuinely underrepresented in standard medical training — a 2019 survey of UK medical schools found that ADHD received minimal curriculum time compared to its prevalence and impact. Your GP may have outdated ideas about what ADHD looks like (hint: not just hyperactive eight-year-old boys). They may be following a referral-cautious local commissioning approach. They may simply not have time.
Their opinion on whether you "look like you have ADHD" is worth less than you might think. Diagnosis requires a comprehensive specialist assessment, not a gut read from a ten-minute appointment.
The NHS Right to Choose Pathway: What It Is
Under NHS England regulations, you are entitled to choose your provider for a specialist service if your GP agrees to refer you and there's a qualifying provider available. For ADHD assessments, this is enormously significant.
Under Right to Choose, your GP can refer you to an NHS-funded specialist ADHD assessment with a qualified provider of your choice — rather than you waiting for whatever your local trust's waiting list serves up. Local NHS ADHD waiting lists currently run between three and seven years in most parts of England. Right to Choose providers — private services operating under NHS contracts — typically offer assessments within weeks or a few months.
How to use it:
- Go to ADHD UK's website (adhduk.co.uk) — they maintain a list of approved Right to Choose providers.
- Choose a provider that accepts NHS patients in your region.
- Tell your GP: "I'd like to be referred for an ADHD assessment under my NHS Right to Choose entitlement, to [provider name]."
- Your GP is required to refer you if you meet the basic criteria (symptoms affecting daily function, present since childhood). They cannot refuse simply because they don't personally think you have ADHD — the assessment is not their job.
If your GP is resistant, you can ask them to document their reason for refusal. That tends to concentrate minds.
What to Say to Your GP
Many people struggle to articulate their symptoms in clinical terms. Here's how to frame it:
Talk about function, not feelings. Don't say "I'm all over the place." Say: "I've missed bill payment deadlines on multiple occasions despite knowing they existed. I've started tasks and been unable to complete them even when consequences were severe. I frequently lose essential items — keys, phone, important documents — and this has been a pattern throughout my adult life."
Establish childhood onset. ADHD requires symptoms to be present before age 12. Think back: were you always like this? School reports that said "bright but easily distracted"? A reputation for daydreaming? A history of nearly-finished projects? Mention this. It's clinically relevant.
Bring notes. Bringing a written summary to a GP appointment is one of the most useful things you can do. It signals you're serious, it keeps you from forgetting what you wanted to say (ironic, but real), and it gives the GP something to put in your notes.
If you've been previously diagnosed with anxiety or depression — note that while those conditions may be real, ADHD frequently produces anxiety and low mood as secondary effects, and you'd like ADHD ruled in or out.
Private Assessment: What to Expect
If Right to Choose isn't working or isn't right for you, private assessment is the other route.
Costs range from approximately £700 to £1,500 for a full assessment in the UK. Some providers offer payment plans. ADHD UK and ADHD Foundation both have guidance on what to look for.
A proper private assessment should include:
- A clinical interview (typically 60-90 minutes)
- Standardised rating scales (Conners, DIVA, ASRS, or similar)
- Collateral information from someone who knew you in childhood where possible
- A review of previous mental health history
- A formal report and diagnosis if criteria are met
Be cautious of very fast or very cheap assessments. If someone is promising a diagnosis in 20 minutes via a form, that's not a proper assessment. You want something that would hold up to scrutiny, because you may need the documentation for your employer, your university's disability services, or your ongoing prescriber.
After a private diagnosis, you can often access a shared care agreement with your GP for ongoing prescription management — meaning you get diagnosed privately but aren't paying private prescription costs indefinitely. Ask about this before committing to a provider.
If You're Outside England
The Right to Choose pathway is specifically an NHS England mechanism. In Scotland, Wales, and Northern Ireland, the landscape differs:
- Scotland: Refer to Scottish Government ADHD guidance; local health board waiting lists apply; private assessment is available but shared care arrangements vary by health board.
- Wales: Similar to Scotland; ADHD Cymru is a useful resource.
- Northern Ireland: Waiting lists are particularly long; private assessment is often the practical route.
A Note on Being Your Own Advocate
Nobody wants to have to fight for their healthcare. You deserve a system that takes you seriously the first time. The current system frequently doesn't, and that is not your fault and not a reflection of the validity of what you're experiencing.
But the fight is worth it. A diagnosis — and the understanding and support that flows from it — can change everything. And once you have it, you don't have to have this conversation again.
Find out what you're entitled to. Ask for it. Document when it's refused. And if your GP won't engage, request a different GP. That's also your right.
You know your own brain. You're not imagining this.
ADHD UK Right to Choose list: adhduk.co.uk | NICE guidelines on ADHD (NG87): nice.org.uk