NHS or private assessment: what should we weigh up?

Long waits can make the fastest available appointment feel like the only question. It is not. The assessment has to answer the right clinical question, produce a usable explanation and connect safely with whatever follows.

Compare three routes separately: an ordinary local NHS pathway, an NHS-funded choice provider where that right applies in England, and a self-funded private provider.

Name the route accurately

An independent company may deliver both NHS-funded and self-funded work. The route determines who pays, which contract applies and what follow-up is included.

Ask:

• Is this funded by the NHS or paid by the family?
• If NHS-funded, under which referral and patient-choice arrangement?
• Which ages, diagnoses and geographic areas are covered?
• Who holds clinical responsibility during and after assessment?
• What happens if the provider closes or the clinician leaves?

NHS England says some remotely delivered ADHD and autism services may be subject to the legal right to choice of provider and team. The referrer remains responsible for deciding whether referral is clinically appropriate ^[1]. Patient choice does not mean every private clinic becomes an NHS provider.

The rules are not UK-wide. Wales, Scotland and Northern Ireland have their own arrangements.

Check who will assess

Ask for the professionals' names, roles, registrations, diagnostic training and experience with children of your child's age and profile. Verify registration with the relevant professional regulator.

For ADHD, NICE says diagnosis should be made by a specialist psychiatrist, paediatrician or another appropriately qualified healthcare professional with training and expertise in ADHD diagnosis ^[2]. The assessment should include full clinical and psychosocial assessment, developmental and psychiatric history, observer reports and impairment across settings.

For autism, ask how the team meets NICE expectations for relevant competencies and access to multidisciplinary expertise ^[3]. A branded tool or short appointment does not replace clinical judgement across sources.

Compare assessment scope

Give each provider the same questions:

• How do you gather developmental history?
• How do you obtain and interpret school or nursery information?
• How is the child involved?
• Which questionnaires, observations or tasks may be used, and what does each contribute?
• How do you assess physical health, mental health, learning and other explanations?
• What happens when home, school and clinic information differ?
• How are risk and safeguarding handled?
• Who makes and signs the conclusion?

NICE says neither ADHD rating scales nor autism-specific tools should be used alone to make diagnosis ^[2][3]. Be cautious if marketing centres on one test, guaranteed outcome or speed without explaining the full assessment.

Ask about every possible result

The provider should explain what happens if:

• diagnostic criteria are met;
• criteria are not met;
• another condition may be present;
• more information is needed;
• the team remains uncertain;
• the family disagrees.

Ask whether feedback is included, how your child is involved and whether the report explains strengths, needs, reasoning, alternatives, uncertainty and recommendations. NHS autism information says reports should state what the team found, diagnosis, strengths, support needs and other conditions identified ^[4]. A private report should not be held to a lower explanatory standard because the family paid for it.

Check downstream acceptance without seeking a guarantee

A valid diagnosis is a clinical conclusion, but other organisations make their own decisions about education support, treatment and benefits. Ask the relevant organisation what it requires.

Before paying, contact:

• the GP about records, referrals and any future shared-care request;
• the local NHS ADHD service about medication assessment and transfer;
• the school or authority about how it uses independent clinical reports;
• the provider about responding to requests for clarification.

Do not ask whether a private diagnosis is "accepted everywhere." Ask whether the assessment follows relevant standards and what the specific downstream service needs. A school should consider needs and disability duties independently of diagnostic route, but a report does not order a particular provision.

ADHD medication needs a separate plan

An ADHD diagnosis does not itself start medication. NICE sets separate requirements for discussing treatment, baseline assessment, initiation by an appropriately trained clinician, titration and monitoring ^[2].

Ask:

• Does the quoted price include a medication appointment?
• Who performs baseline checks?
• Who prescribes during titration?
• What are appointment and medicine costs?
• How often is monitoring required?
• What happens during shortages or adverse effects?
• Will the clinician request shared care, and what if the GP declines?
• Who provides annual specialist review?

Shared care is an agreement, not an entitlement created by paying for assessment. Do not begin a pathway assuming the GP will take over prescribing.

Price the full course

Request a written quotation covering:

• triage and assessment appointments;
• questionnaires or school liaison;
• report and feedback;
• additional tests or consultations;
• letters requested later;
• medication assessment and titration;
• prescriptions and monitoring;
• follow-up and review;
• cancellation and refund terms.

Ask whether the provider charges if the assessment cannot be completed or concludes that a different service is needed.

Check information governance and complaints

Read how records are stored, shared and corrected. Ask whether the report is sent to the GP automatically or only with consent, and how the child's views and confidential information are handled.

Request the complaints procedure and identify the professional regulator, service regulator and contractual body relevant to the route. An NHS-funded provider may have both provider and NHS complaints routes. A self-funded contract may add consumer questions; obtain specific advice if a dispute arises.

Notice warning signs

Pause if a provider guarantees diagnosis or a prescription, advertises one test as definitive, will not identify the diagnosing professionals, or does not seek developmental and multi-setting information. Be cautious if it cannot explain differential diagnosis, promises universal acceptance, pressures the family to pay immediately, or gives no written terms, complaints process or follow-up plan.

A polished website and positive reviews do not answer clinical-governance questions. Verify professional registration and ask for the assessment protocol in writing.

Consider the report's future use

Ask whether the report records sources, criteria, clinical reasoning, uncertainty, strengths, needs and recommendations. Check whether the provider will answer reasonable clarification requests from the GP, school or another clinician and whether this is included in the price.

A brief certificate may confirm diagnosis but offer little help with later care. A long report can still be weak if it contains generic descriptions without explaining the child's evidence. Request an anonymised outline or contents list rather than another family's confidential sample.

Ask how records are retained if your child needs adult-service transition or treatment review years later. Future services may need more than the diagnostic label.

Plan an exit before beginning

Know who provides care if the family cannot continue paying, moves area or chooses to stop. For medication, ask how prescriptions and clinical monitoring continue during a transfer. Never stop prescribed medicine abruptly based on financial or administrative advice; speak to the prescriber.

If a provider says NHS transfer is expected, ask for the named pathway and confirm it with that service. A handover aspiration is not an agreement.

Compare wait and burden honestly

Include travel, time off school, parent work, forms, repeated appointments and the child's capacity. Remote assessment may improve access for one child and make communication harder for another. Ask how the provider adapts the format without reducing the evidence needed.

Continue current support whichever route you choose. Faster assessment does not make an inaccessible school day wait safely, and staying on an NHS list does not prevent needs-led adjustments.

Ask about accessibility before booking

Find out whether the provider can meet communication, sensory, mobility, language and health needs without reducing the assessment to an unsuitable format. Ask about interpreters, waiting areas, breaks, remote platforms, parent attendance and alternative communication.

If the child has a learning disability, complex language need, significant mental-health condition or sensory or motor impairment, ask whether the team has the relevant expertise. NICE autism guidance expects access to additional competencies for complex circumstances ^[3]. A provider should explain when it would seek another professional or refer elsewhere.

Make the decision with your child

Explain the routes and their practical differences in a form the child can use. A faster provider may involve remote appointments or travel; a local route may involve a longer wait. Ask which features matter to them without making them responsible for the family finances.

Tell them who will see their information and whether changing provider means completing forms again. For a teenager, ask the provider how consent and confidential discussion work.

Use a decision table

Fill it from written provider information, not testimonials alone. The assessment process guide helps test whether each route describes a complete clinical assessment.

The best route is the one that is clinically appropriate, accessible to the child, transparent about its standards and connected to realistic next care. Speed matters, but it is one row rather than the whole decision.

Sources

1. NHS England, Patient choice guidance
2. NICE, Attention deficit hyperactivity disorder: diagnosis and management
3. NICE, Autism spectrum disorder in under 19s: recognition, referral and diagnosis
4. NHS, Autism assessments