In April 2014 the English government gave mental health patients the same legal right to choice of provider as had existed for several years in physical health, representing a major step towards ‘parity’ (equality) between physical and mental health care.

‘Patient Choice’ is a type of referral that can be made by a GP to the service of your choice. You can use this referral type to access a round of CBT with ERP from a mental health team outside your local area. This can be for any reason.

For example-

  • If you work outside your local area and having treatment nearby would be more accessible
  • If there is a mental health team nearby that can support you better than your local team
  • If the building of your local mental health team is a particular trigger

The Centre for Anxiety Disorders and Trauma at the Maudsley Hospital also accepts Patient Choice referrals. They offer treatment at all levels, and have a team of highly specialised OCD therapists.

The document below is a recent update of the one published in 2014. It gives clear guidance of the legal rights to everyone involved. It is quite a long document, so on this page we have outlined the main points as they apply to accessing CBT with ERP outside of your area.

If you are an English resident, or a Welsh resident with a GP in England, you have a legal right to choose where you have treatment for your mental health.

The document says:

“Wherever a patient’s choice is clinically appropriate, providers are required to support the patient’s decision in line with the requirements in the NHS Standard Contract.”

If you use Patient Choice, your doctor will not have to secure funding for your treatment. This type of referral is basically a promise from your local area to pay for the treatment if you are accepted after assessment.

If you are deemed to have ‘mental capacity’, which most people with OCD do, your healthcare professionals must, by law, take ‘all practicable steps’ to help you make your own decisions. If you’ve been assessed as lacking mental capacity, you should still be involved as much as possible.

You can use Patient Choice if you have complex care needs and are also receiving social care support. It is important to consider, though, whether a single round of therapy is appropriate, or whether ongoing support from your local team would be more appropriate (see ‘Exclusions’ below).

Patient Choice can be used by patients of all ages. Children who are 16 or over are deemed able to make decisions and choices about their own care. If a child is under 16, the GP or another professional will assess whether they have enough understanding to make a choice about their treatment. If they do not, then the decision goes to their parent/s or legal guardians.

Through Patient Choice, you will be choosing your ‘elective first outpatient appointment’.

  • Elective simply means that you have asked for the treatment at the time you wanted it, rather than it being an emergency or crisis referral
  • Outpatient means that you will be living at home throughout your treatment, and will only visit the service for your appointments
  • After this first appointment, the service you have chosen will provide the rest of that round of therapy unless your needs or diagnosis have changed

A Patient Choice referral must be made by a GP

The service you choose must be ‘clinically appropriate’, which means they must offer the treatment/s recommended by NICE for your condition. For OCD, this is only CBT with ERP.

The service you choose must be led by a mental healthcare professional, even if this is not a consultant. This means that you are able to use Patient Choice to access treatment through Primary level care as well as your local mental health team.

The service you choose must have a contract with the NHS – this can be a national contract with NHS England or a local contract with any area in England. This includes private treatment providers or charities, as long as they also have a contract with the NHS.

A Patient Choice referral is for a single round of therapy. After the referral, the service you have chosen will assess you and should then place you on a waiting list for CBT with ERP. Once you have had treatment through them, they will discharge you back to your GP.

Because this is how it works, the service can’t offer other support while you wait. If you need additional support outside of the CBT with ERP, then a referral to your local Community Mental Health Team would be more appropriate.

You can’t use Patient Choice if:

  • You are already on a waiting list or receiving therapy for OCD from a different NHS service
  • You need emergency or crisis support because you are at high risk of self-harm, self-neglect, or suicide while you wait for the therapy
  • You need more complex support than just one round of treatment, such as if you have another mental health condition that also needs care or monitoring at the moment
  • You need inpatient care (which is when you move in to the hospital for your treatment)
  • You are detained in any way (for example through sectioning or a prison sentence)

You do not already need to be diagnosed with OCD to use Patient Choice. The guidance acknowledges that an assessment might be needed between speaking to the GP and receiving the treatment.

“GPs should have as full a choice conversation with their patients as possible. This may include the need for further clinical assessment to determine the diagnosis and potential care options”

If the service you choose does assessments, then you should be assessed by that service as part of the Patient Choice referral process. When accessing treatment for OCD, this will almost always be the case. Once the service confirms that you have OCD and that they are able to offer you CBT with ERP, you will be placed on a waiting list for this.

Some areas use something called a ‘Single Point of Access’ (or SPA). A GP will refer all patients who want mental health support to SPA. SPA will assess the patient and, usually, refer them to the most appropriate local service. You still have a right to choose an out-of-area service, though, and both your GP and SPA should support you to do so.

If you are using Patient Choice to get a referral to the OCD service at the Maudsley Hospital (CADAT), then your GP just needs to complete CADAT’s online referral form here. This is not a self-referral form and must be filled in by a GP.

For a referral to a primary or secondary care team in a different area from where you live, your GP can either…

  • Send a written referral stating that you are using your right to choice of treatment provider and outlining the condition and treatment that the referral is for
  • Use the NHS e-Referral Service (e-RS)

e-RS is an online database of NHS service providers, which you and your GP can use to find out about what is available, make a referral, and book appointments. It is one of the most helpful tools for choice and is becoming more and more popular.

If your GP isn’t confident on using e-RS, they can look at guidance from the NHS about how to use it and mental health e-referrals.

Although it has been available for over 7 years, many professionals are still unaware that the right to choose applies to mental health treatment or get confused about what you are entitled to.

All of the information in this page is taken directly from the document below, so you can show this to your GP to help them understand your rights. There is also further guidance for GPs on pages 16-20 of the document below.


Alongside this information, you can also signpost your GP to a further communication by the NHS, which specifically outlines the legal rights and explains that your GP must facilitate your choice of mental health service. It also includes information about where you can complain if this doesn’t happen.
You can view or download this here

Your GP is also welcome to contact ourselves, NHS Improvement, or the service you have chosen if they have any questions about making a Patient Choice referral.