NHS or Private Psychiatry: How to Choose

Choosing between the NHS and a private psychiatrist is not a choice between adequate care and good care. Both are staffed by doctors on the same General Medical Council register, following the same national guidance. What differs is the wait, the say you get over who sees you, and who pays. This page sets out both routes plainly, including when staying with the NHS is the better decision.

How to get NHS mental health care

For most people the first step is the GP. The NHS says you will need to talk to your GP to use some mental health services, and the GP can refer you to a community mental health team, a specialist clinic or a hospital service — see how to access mental health services.

There is one significant exception in England. You can refer yourself to NHS Talking Therapies for anxiety and depression without seeing a GP at all. The NHS says you can use it if you live in England and are 18 or over, or 16 or 17 in some areas, and that it helps with persistent low mood, generalised anxiety, panic attacks, phobias, social anxiety, health worries, OCD and PTSD. You can find your local service and refer yourself online. It offers talking therapy, not a diagnosis or medication — the right door for some problems, the wrong one for others.

Anything needing a psychiatrist — a diagnosis primary care cannot make, medication that has stopped working, suspected adult ADHD or autism — means a referral into secondary care.

Waits are the honest sticking point. Consultant-led NHS services in England come under the commitment to be seen within 18 weeks of referral, but mental health waits vary a great deal between areas, and adult ADHD and autism assessments are usually the longest. Your local NHS trust or integrated care board website is the only reliable guide to the wait where you live, and your GP will know what they are seeing locally.

If you need help now rather than in weeks, private booking is not the answer. If a life is at risk, call 999 or go to A&E. For urgent mental health help, call 111 and choose the mental health option. Samaritans are on 116 123, free, at any hour — see where to get urgent help. Happy Clinic is not a crisis service.

What the Right to Choose does and does not cover

The Right to Choose comes up constantly in ADHD forums, and is widely misdescribed, so it is worth being precise. NHS England’s patient choice guidance says that for a mental health referral — an elective referral for a first outpatient appointment with a consultant, or another healthcare professional or their team — you can choose any clinically appropriate provider that holds a qualifying NHS Standard Contract with an integrated care board or NHS England. The choice applies at the point of referral and extends to treatment that follows from it.

What that means in practice:

• It is NHS care, and free. You choose who delivers it, not whether to buy it.
• The provider must hold a qualifying NHS contract. An ordinary private clinic is not a Right to Choose option, however good it is.
• You still need a referral, so your GP is still involved.
• It applies in England only. Scotland, Wales and Northern Ireland differ.

The limits matter just as much. The guidance says the duty to offer choice does not apply to urgent, emergency or crisis care, maternity services, cancer services under the Faster Diagnosis Standard, or services commissioned by local authorities. Nor does it apply if you are already receiving care and treatment for the condition you are being referred for, or if you are detained under the Mental Health Act 1983, in prison, or serving in the armed forces.

The commonest misunderstanding is about time. It is a right to choose a provider, not a right to be seen by a particular date — a provider with a short list this month may have a long one by the time your referral lands.

What going private actually buys you

Three things, mainly.

Speed. Booking is direct, with no referral needed. At Happy Clinic appointments are often available within a few days, depending on clinician availability.

Choice of clinician. You pick the consultant and the time, rather than being allocated whoever is next.

Continuity. You can keep the same psychiatrist through assessment, starting a medicine and reviewing it. That matters most while a dose is being adjusted — see medication reviews.

Consultations are provided by Happy Clinic, which is registered with the Care Quality Commission (CQC), and are carried out by GMC-registered consultant psychiatrists by video for adults aged 18 and over, anywhere in the UK. How online psychiatry works explains the format.

What going private does not buy you

This is the part most clinics leave out.

It does not move you up an NHS waiting list. Department of Health and Social Care guidance on NHS patients who wish to pay for additional private care is explicit that such patients should not be put at any advantage or disadvantage in the NHS care they receive, and are entitled to NHS services on exactly the same basis of clinical need as anyone else. Your NHS referral keeps its place — it does not improve, and it does not disappear.

It does not cost you your NHS care. The same guidance says that where a patient opts to pay privately, their entitlement to NHS services remains and may not be withdrawn.

You cannot part-pay for a single episode of care. The guidance says private and NHS care should be kept as clearly separate as possible, that private care should happen at a different time and place from NHS care, and that the NHS should never subsidise private care with public money, with the patient meeting the costs of the private element. So you cannot buy a quicker private assessment and have the NHS pick up the parts of that same episode you would rather not pay for. Private care runs as its own episode; NHS care carries on separately.

It does not guarantee the diagnosis you expect. A paid assessment buys a thorough independent opinion, which may be that you do not have the condition you came in thinking you had, or that the answer is therapy rather than medication. Happy Clinic does not provide psychological therapy, though it can advise on therapy pathways.

It does not oblige your GP to prescribe. More on that below.

What private care costs

Appointment	Length	Fee
Initial psychiatric assessment, or ADHD assessment	60 min	£400
Follow-up, or ADHD titration review	20 min	£200
ADHD Shared Care Agreement appointment	30 min	£500
Adult autism screening	60 min	£450
Adult autism assessment	—	£1,650
Repeat prescription, existing patients	—	£150

Fees are paid in advance. Prescriptions issued during an appointment are included; pharmacy charges are not, and repeat prescriptions are subject to clinical review. The figure to plan around is rarely the assessment alone — if a medicine is started, expect follow-ups while the dose is settled. Fees checked September 2026 — see the fees page for the current list.

The two routes side by side

	NHS	Private
Cost to you	Free at the point of use	Paid in full, in advance
Getting in	GP referral, or self-referral to NHS Talking Therapies in England	Book directly, no referral
Wait	Varies widely by area; 18-week commitment for consultant-led care	Often a few days, subject to availability
Choice of clinician	Limited; Right to Choose covers the provider at referral in England	You choose the consultant and the time
Continuity	May see different clinicians at different stages	Usually the same consultant throughout
Talking therapy	Available on the NHS pathway	Not provided; advice on pathways only
Crisis and inpatient care	Yes	No
Medication costs after	NHS prescription charge in England; free in the other UK nations	Private prescription, unless the GP takes over

Moving back to NHS care afterwards

Plenty of people use private care once — to get assessed and started — then want the NHS to take over the long-term prescribing. That is a reasonable plan, and it often works, but it depends on your GP.

Your NHS entitlement is untouched by having gone private. The prescribing is what is not automatic. A GP is not obliged to continue a medicine started privately. They may want the clinical summary first, they may ask for monitoring to be done, and they may decline, particularly for controlled drugs or where a local policy applies.

For ADHD the usual route is a Shared Care Agreement. Once treatment is stable, Happy Clinic can propose shared care to your NHS GP, and the practice decides whether to accept. Some accept readily; some have a policy against taking on privately initiated ADHD prescribing. If yours declines, prescribing stays private, turning a one-off cost into a recurring one. That single question — would you accept shared care? — is worth asking your surgery before you book. See prescriptions for how private prescribing works.

How to decide

Stay with the NHS if you are in crisis or at risk; if you may need a crisis team, inpatient care or care under the Mental Health Act; if what you actually need is talking therapy, which you can self-refer for in England; if your local wait is short; or if paying would cause real financial strain. Private care improves none of those situations.

Consider private care if the wait where you live is long and things are getting worse; if you need a diagnosis clarified or a second opinion; if medication is not working and nobody has reviewed it properly; if you need a specialist adult ADHD or autism assessment; or if continuity with one consultant matters to you.

Or do both, deliberately. Keep the NHS referral open, use a private assessment to get answers and a plan now, and aim for NHS prescribing later if your GP accepts it — as two separate episodes, not one mixed together.

If you are leaning private, read what happens in a first appointment, check the conditions covered and book when ready. If you are unsure which route fits, get in touch before paying for anything.

This page is general information and is not a substitute for personal medical advice. Consultations, diagnosis and prescriptions are provided by Happy Clinic, which is registered with the Care Quality Commission (CQC). If you are in crisis, call 999, go to A&E, call NHS 111 or call Samaritans free on 116 123.