In England, ADHD clinicians are grappling with a system that is in a state of chaos, leaving them overwhelmed and desperate. When Craig, a pseudonym, began working at a private ADHD clinic in the spring of 2023, he was initially impressed by the thorough training and commitment to clinical standards. However, as time passed, issues began to surface. The workload was immense, and the quality of clinical work did not consistently translate into the reports sent to patients and GPs, which were often prepared by administrative staff to save time. This disconnect between clinical assessment and report preparation became a central issue. Other clinicians working across different providers echoed this sentiment, describing a similar lack of personal touch in the reports and assessments.
Alice, another pseudonym, worked for a clinic from 2023 to 2024 and noted that while the assessments were detailed, the documentation often lacked the same level of detail. She highlighted that diagnoses were only made when there was clear evidence of symptoms being present since childhood, and once a patient was taken on, they were typically seen until they were stable, leading to a growing case load. Brian, another clinician, recalled colleagues working from dawn to dusk, with some managing to see patients from 6 am to 8 pm, squeezing in eight new assessments a day.
The strain on administrative systems was evident in the form of unanswered calls, piled-up emails, and stalled prescription requests. Some clinicians resorted to delivering vital medication to patients themselves when delays became unsafe. The transition from private treatment to NHS shared care was particularly challenging, with promises of a smooth transition followed by weeks or months of delays. This led to patients needing medication while waiting for prescriptions from GPs, and clinicians being asked to write prescriptions for people they had never met.
The broader consequences of these issues are seen in the form of complaints from people who thought they had completed the process. NHS clinicians handling incoming referrals note that around 70-80% of private assessments do not meet the required standards, leading to a wave of complaints from people who thought they had received an NHS-equivalent assessment. Despite these challenges, none of the clinicians working for private companies described bad intentions from frontline staff, attributing the issues to a massive increase in workload and a lack of resources to cope with the demand.
The picture that emerges is one of a sector overwhelmed by demand, expanding faster than its administrative and clinical structures can safely support. Staff speak of desperation, with families borrowing money, using savings, or waiting years for NHS assessments. The clinicians emphasize that people who self-fund are not buying a diagnosis but an assessment process, and often they are desperate for a solution.
