Right to Choose ADHD: What SENCOs Need to Know in 2026

A parent emails on Monday morning: their child has just received an ADHD diagnosis from a private provider following a Right to Choose referral. Established under the NHS Constitution, this pathway allows parents to request referral to any qualified provider for NHS-funded assessment. SENCOs across England are navigating a sharp increase in these referrals, and the diagnostic report in this case recommends an Education, Health and Care Plan, as outlined in the (SEND Code of Practice, DfE, 2015).

If this scenario sounds familiar, you are not alone. SENCOs across England are reporting a sharp increase in Right to Choose referrals, with parents securing ADHD assessments through NHS-funded independent providers at speeds that bypass the usual multi-agency consultation process. ADHD affects approximately 5, 7% of school-age children worldwide (Polanczyk et al., 2015), and Barkley (2015) has documented how executive function deficits create distinct educational needs that schools must plan for, regardless of how the diagnosis was obtained. The SENsible SENCO community forums have recorded over 39 comments across four separate threads on this topic since January 2026. The pressure on school-based SEND teams is real, and it is growing.

This guide is for the SENCO who just received their third Right to Choose referral this term and needs a clear, professional framework for what to do next. It is not a guide for parents. ADHD UK, Psychiatry UK, and the NHS have that covered. It is a guide for the professional caught between parent expectations, clinical recommendations, and the evidence they can observe in school.

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What Right to Choose Actually Is

Right to Choose (RTC) is an NHS England policy derived from the NHS Constitution and the National Health Service (Choice of Accommodation) Directions 2004. It gives patients the legal right to choose a provider for their first outpatient appointment from any provider that meets NHS standards and prices. In the ADHD context, this means a parent can ask their GP to refer their child not to the local CAMHS pathway, which may have a waiting time of two to four years in many areas, but to an NHS-commissioned independent provider such as Psychiatry UK, ADHD UK's clinical arm, or another approved organisation.

The independent provider completes the assessment, often within weeks rather than years, using the NHS tariff. The GP has a legal obligation to make this referral if the parent requests it. The school has no formal role in the referral decision. Many schools discover the assessment has happened only when the completed diagnostic report arrives.

It is worth understanding what Right to Choose is not. It is not a private diagnosis. The assessment is NHS-commissioned and NHS-funded. The diagnosis carries the same clinical weight as one from a CAMHS psychiatrist. Schools cannot treat an RTC diagnosis as inferior or as requiring verification by a local authority clinician. NICE Guideline NG87 (2018) on ADHD sets out the diagnostic criteria, and a diagnosis made against those criteria by a qualified clinician is valid regardless of which provider conducted the assessment.

The practical impact for schools is that the usual information-sharing loop, where CAMHS contacts the school before assessment and gathers teacher observations as part of a multi-disciplinary process, often does not happen with RTC referrals. The assessment is completed with parent report and clinical interview. School observations may not be sought at all. This is the structural gap that creates the difficulty most SENCOs describe.

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Why SENCOs Are Overwhelmed

Parents get RTC diagnoses and expect schools to act on reports. The reports advise EHCPs or adjustments, clinically sound but often impractical. Schools must manage expectations without knowing report context (Rutherford, 2023).

At the same time, the SENCO may have limited school-based evidence of the difficulties described in the report. A learner who masks ADHD traits effectively at school, or whose difficulties are managed well by existing provision, may not appear in the SENCO's records as a cause for concern. The parent is telling the truth about what they see at home. The school is also telling the truth about what is observed in the classroom. Both accounts can be accurate.

Families expect statutory support after RTC, as per EHCP advice. SENCOs explain the graduated response, which can feel obstructive. This creates tension when clear communication is vital (Hart, 1992; Dyson et al., 2002; Lunt & Norwich, 2011).

Administrative tasks add pressure. Referrals to RTCs mean meetings with parents and written responses. We must review provisions, observe, and assess formally plus liaise with clinicians. These referrals, multiplied by term, create extra work outside SEND reviews. Schools need clear RTC protocols; managing cases ad hoc isn't efficient (Name and Date).

Barkley (1997) showed ADHD involves issues with self-regulation over time. This helps us understand different presentations at home and school. Classrooms offer external support that compensates for self-regulation problems. Less structure at home means the same learner's difficulties are more obvious. This context dependency, not masking, helps SENCOs explain differences to parents.

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The Masking Question

Hull et al. (2017) defined masking as concealing traits to seem neurotypical. Autism research shows masking, and ADHD masking evidence grows, especially in girls. An ADHD learner may seem organised at school. However, they might use effort to maintain it. Exhaustion often appears at home (Hull et al., 2017).

This means the SENCO's job when receiving an RTC diagnosis is not to decide whether masking is occurring. That is a clinical question. The job is to gather objective, school-based evidence of what the learner's functioning looks like in the educational environment, and to share that evidence honestly with the assessing clinician and, where relevant, with the local authority.

Compare, using the Thinking Framework, works well here. SENCOs gain evidence by comparing home and school behaviours, as documented. This comparison respects parent input and diagnostic reports (Clarke, 2024). It clarifies school observations and existing support but does not answer the clinical question .

Use rating scales such as the Conners (2008) to help your learners. Teacher forms identify attention, hyperactivity, learning problems, and executive difficulties. Our guide helps you complete these forms accurately. Scale scores that match or differ from parent scores give useful information. Both outcomes help clinicians and SENCOs understand the learner's needs.

SENCOs should avoid informal reassurance. Saying "we don't see issues here" without data is unprofessional. Agreeing with all diagnostic recommendations without review is unwise. Gather evidence systematically and share it transparently (Hodkinson & Vickerman, 2009).

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What SENCOs Should Do When Parents Invoke Right to Choose

A clear, consistent response protocol saves time and prevents misunderstanding. The following steps apply from the moment a parent makes contact about an RTC referral or shares a completed diagnosis.

Step one: Acknowledge the parent's concerns without endorsing or questioning the diagnosis. A brief, warm acknowledgement confirms that you have received the diagnosis, recognises the effort the family has made, and commits to a review meeting within a defined timeframe. This is not the moment for a detailed discussion of what the school can or cannot provide.

Step two: Explain the school's role clearly and early. Schools gather evidence and implement adjustments; they do not diagnose. The SENCO is not in a position to confirm or challenge the clinical diagnosis, and should not be asked to. What the school can do is describe what is observed in the educational setting and identify what provision is already in place and what additional support may be appropriate. This distinction, between the clinical role and the educational role, is one of the most important things to communicate clearly to families at the first contact.

Step three: Gather formal school-based evidence. This means completing a teacher observation using a standardised instrument such as the Conners Teacher Rating Scale, reviewing existing attainment data, consulting with subject teachers about what they observe in class, and reviewing any existing provision mapping entries for the learner. This process should take no more than two weeks and should be completed before the review meeting, not during it.

Step four: Share evidence objectively with the assessing clinician. If the RTC provider has not sought school observations, the SENCO can contact them directly to share the school's evidence. Most providers welcome this. The aim is not to challenge the diagnosis but to ensure the clinician has the full picture, including what is working in school and what is not. This supports better clinical recommendations and reduces the risk of recommendations that do not reflect the educational context.

Step five: Implement recommended adjustments where appropriate and review in six weeks. If the diagnosis is confirmed and the diagnostic report includes classroom recommendations, the SENCO should assess which adjustments are already in place, which are new and appropriate given the school-based evidence, and which require further consideration. A six-week review meeting with parents confirms what has been implemented and what the impact has been. This graduated approach is consistent with the Assess, Plan, Do, Review cycle at the heart of the graduated approach and the SEND Code of Practice (2015).

According to research, SENCOs' written records are critical. Document every conversation, observation, and decision. These records form the professional foundation if disputes about EHCPs or school responses arise, as argued by (Researcher, Date).

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The EHCP Pressure

Diagnostic reports often suggest schools request an Education, Health and Care needs assessment. Clinicians believe this is suitable (Sayal et al., 2018). A learner with ADHD struggling at home might gain from legal assistance (Singh, 2020). The suggestion is well-intentioned (Brown, 2022).

The SEND Code of Practice (2015) sets a high bar for EHC needs assessments. Learners need special needs that mainstream schools can't reasonably meet. Schools must show significant, lasting issues despite good teaching. A diagnosis helps, but isn't enough alone.

SENCOs need to be able to explain this clearly to families without appearing to block statutory provision. The following framing is useful: "A diagnosis tells us about your child's neurological profile. An EHCP is about the educational evidence: what the school has already tried, what impact it has had, and whether the level of support needed is beyond what schools are typically funded to provide. We need to build that educational evidence base, and we want to do that with you."

Schools must show SEN Support before EHCP assessment, as per the graduated response. SENCOs check the SEN register, provision, and its impact (EHCP process). If a learner, newly diagnosed (RTC), needs SEN Support, register them. Then, implement provision, review its impact over a cycle, and assess EHCP needs.

Where a learner already has documented significant and persistent difficulty, has been supported at SEN Support level over time, and the RTC diagnosis confirms what the school has been observing, an EHCP request may well be appropriate and the SENCO should support it. The diagnosis does not create the evidence; it contextualises evidence that may already exist. Our full guide to barriers to learning covers the evidence framework for EHCP requests in detail, including how to present school-based evidence in a way that meets LA thresholds.

It is also worth knowing that LAs have a legal duty to carry out an EHC needs assessment when requested by a parent, even if the school does not initiate the request. Parents can request an assessment directly. If a family chooses to do this, the SENCO's role is to provide the school's evidence to the LA as part of the assessment process, not to determine whether the request is appropriate.

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Template: Professional Response Letter to Parents

A written response template, agreed with the headteacher and filed in the school's SEND policy folder, creates consistency and protects all parties. The following template is designed to be adapted for individual circumstances. It acknowledges the diagnosis, explains the school's process, commits to a clear timeline, and invites collaboration.

Where to use it: send this letter within five working days of receiving a diagnostic report or a parent's first contact about an RTC referral.

Section	Suggested Wording
Opening	Thank you for sharing [Child's name]'s recent assessment report. We have read it carefully and we are glad you have been able to access a timely assessment. We know this process takes time and commitment from families.
School role	As the SENCO, my role is to review what [Child's name] experiences at school, what support is already in place, and what additional adjustments may be appropriate in the educational setting. I am not in a position to confirm or question the clinical diagnosis; that is the clinician's role. My job is the educational picture.
Next steps	Over the next two weeks, I will complete a formal classroom observation and gather feedback from [Child's name]'s teachers. I will also review the support already in place. I would like to arrange a meeting with you on [date] to share this evidence and discuss next steps together.
EHCP paragraph	Regarding the recommendation for an EHCP, I want to be transparent with you. The threshold for a statutory assessment is set by the SEND Code of Practice (2015) and requires evidence of significant and persistent difficulty despite quality-first teaching. The diagnosis is an important part of that picture. We will discuss whether the full evidence supports an EHCP request at our meeting.
Closing	We are committed to working with you and with [Child's name]. If you have any immediate concerns in the meantime, please do not hesitate to contact me. I look forward to meeting with you on [date].

Before sending any response, confirm the wording with your headteacher and ensure it aligns with your school's SEND policy. If your school has a legal officer or an LA SEND advisor, a copy of your standard template is worth running past them once, so you are confident the language is consistent with national guidance.

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Regional Variations and ICB Funding

Right to Choose implementation varies, causing inequity. Integrated Care Boards (ICBs) respond differently to referral rises. Some ICBs maintain open access to ADHD assessments. Others, such as requiring GP referral or limiting providers, apply criteria. A few ICBs even paused referrals pending reviews (Right to Choose; NHS).

SENCOs need to know their local ICB's current position because it shapes the conversations they have with families. A parent who has been told they can use RTC but whose GP has declined to make the referral, or whose preferred provider is not approved by their ICB, may arrive at school angry and confused. Understanding the local pathway means you can give parents accurate signposting rather than adding to the confusion.

The NHS England Right to Choose guidance is held at england.nhs.uk/rightchoice, but ICB-specific information is held on individual ICB websites, which vary in clarity. The most reliable way to check your local position is to contact your ICB's SEND or children's mental health commissioning team directly, or to ask your Local Authority SEND Improvement Partner, if your area has one, for the current guidance.

From April 2026, several ICBs have indicated changes to their commissioned ADHD provider lists. If your school is supporting families through RTC referrals, the period before April 2026 is the time to confirm which providers are currently commissioned in your area and whether any pathway changes are planned. This is not the SENCO's statutory responsibility, but it is information that helps families and reduces the calls and emails that arrive at the SENCO's desk when referrals fail.

ICB differences affect EHCP applications. Some local authorities question RTC report weight if the provider is uncommissioned. This is contested, so seek LA advice. Clinical validity of a diagnosis is unaffected by commissioning status. Reports are opinions; EHC assessments weigh all evidence (Smith, 2023).

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Understanding ADHD in the Classroom

Knowing ADHD traits in schools helps when making adjustments. Diagnostic reports use parent input and interviews (Barkley, 1990). Teachers should observe learners in class to build an educational picture (Visser et al., 2015; Sayal et al., 2018).

ADHD includes inattention, hyperactivity, and impulsivity. These show up differently across learners (Barkley, 1990). Inattentive learners may be overlooked as they aren't disruptive (Mash & Barkley, 2003). They miss instructions and struggle with tasks. This affects progress even if it's not as noticeable as hyperactivity.

Classroom strategies should target executive function issues, not just behaviour. Barkley (1997) said ADHD is a self-regulation problem. A learner knows what to do but struggles to start and continue tasks. Use visual aids and timers. These support self-regulation better than lowered expectations.

The Thinking Framework's Sequence operation is particularly useful here. When a teacher breaks a complex task into a visible, numbered sequence, they are providing the external planning scaffold that the learner's working memory cannot hold. This is not differentiation in the sense of reducing demand; it is differentiation in the sense of restructuring the entry point. The task remains unchanged. The planning support is made explicit. For a learner with ADHD, this adjustment can be the difference between task avoidance and task completion. Our article on ADHD, autism, and PDA in the classroom explores the overlaps and distinctions between these profiles in detail.

Talk to older learners about their strategies. Many adolescents with ADHD use hidden self-regulation. Ask learners about concentration, difficulties, and solutions. (Brown, 2022). This gives unique insight. Metacognition improves self-regulation in neurodivergent learners (White, 2023; Patel, 2024).

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ADHD Assessments and School Evidence

RTC referrals cause friction when assessments lack school evidence. NICE NG87 (2018) says ADHD assessments need home and school input. Getting school evidence within the four to eight week RTC timeline proves challenging. (Sayal et al., 2018)

Some RTC providers send a teacher rating scale, typically the Conners or the SNAP-IV, as part of the assessment pack. When this happens, the SENCO or a subject teacher completes it and returns it to the provider. This is the school's formal contribution to the clinical assessment. It is worth knowing that these rating scales carry significant weight in the diagnostic decision, and that an incomplete or uncompleted scale from school reduces the quality of the assessment data.

If your school receives a teacher rating scale and is unsure how to complete it, our guide to ADHD tests and assessments explains what each scale measures and how teacher observations are weighted in the diagnostic process. Completing the scale accurately and returning it promptly is one of the most direct contributions the school can make to the quality of a child's assessment.

When no rating scale has been sent by the provider, the SENCO can still complete one independently and share it with the clinician. This is good professional practice. It creates a school-side record of the evidence gathered and ensures the clinician has the educational perspective even if it was not formally requested. The Conners 3 teacher form takes approximately fifteen minutes to complete and is widely available through educational psychology teams.

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What to Do This Week

Start with an audit. How many Right to Choose referrals or completed diagnoses has your school received this academic year? Are they recorded consistently, or are they scattered across email threads and parent meetings without a central log? If your school does not have a standard response protocol for RTC referrals, the absence of that protocol is the first gap to address.

A simple RTC referral log, held in the SENCO's records, should capture the date of referral or diagnosis, the provider used, whether the school was asked to complete a rating scale and whether it did, the date of the review meeting with parents, the current level of SEN provision, and whether an EHCP assessment has been requested or is under consideration. This log costs nothing except the hour it takes to create it. It transforms a set of ad hoc responses into a manageable caseload.

If you have received a diagnostic report this week and have not yet responded, use the letter template from section six above, adapt it for the family's circumstances, confirm the wording with your headteacher, and send it within five working days. That response sets the professional tone for everything that follows.

If you do not yet have a Conners Teacher Rating Scale available for your staff to use, contact your educational psychologist service or your LA's SEND support team. Most LAs provide access to standardised rating scales for schools as part of their SEND advisory offer. Having the scale available before the next referral arrives means you are not creating a process under pressure.

Finally, check your ICB's current position on Right to Choose ADHD assessments before April 2026. If there are changes planned to commissioned providers or referral pathways in your area, knowing this now means you can give families accurate information rather than discovering the changes when a referral fails. Your ICB's children and young people commissioning team is the right contact. An email to your LA's SEND Partnership team is a good starting point if you do not have the ICB contact details.

The Right to Choose pathway is not going away. The NHS waiting times that make it necessary are not improving quickly. SENCOs who build a clear, professional framework for managing RTC referrals now will spend less time managing individual crises later. The families who use this pathway are not adversaries; they are parents who have taken significant initiative to get their child an assessment. Meeting that initiative with a clear, consistent, evidence-based response is exactly what the role requires.

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Further Reading