ADHD waiting lists ‘clogged by patients returning from private care to NHS’ | Attention deficit hyperactivity disorder

Waiting lists for people with attention deficit hyperactivity disorder (ADHD) in England are being clogged with patients returning to NHS care after difficulties with private assessments, a trust has warned.

The leading NHS trust said people referred by GPs to private clinics using health service funding were increasingly asking to be transferred after care stopped.

These include cases where private clinics are able to diagnose ADHD but their assessments do not always comply with National Institute for Health and Care Excellence guidelines, or where providers lack staff with the appropriate qualifications to support continued prescribing.

The consequences for patients can be serious. Some are facing prescription costs of more than £200 a month after GPs said they could no longer work with private clinics under shared care arrangements.

The father of a man whose shared care arrangement was terminated after three years said: ‘Without warning, the GP practice announced they would stop prescribing within six months because the provider was ‘out of area’. They referred my son to the local NHS service, MPFT. [Midlands partnership university NHS foundation trust]but waiting times exceed six months – guaranteeing interruption of treatment.

“My son has a responsible job and bought his own house. None of this would have been possible without medication. Without them, he struggles to concentrate at work, cannot manage his daily routine and experiences overwhelming anxiety. His consultant has warned of ‘foreseeable harm’ if treatment stops.”

In a letter shared with the Guardian, MPFT admitted it was struggling to cope with the growing number of patients referred to the trust from private clinics. This trend contributes to longer waiting lists, reduced capacity to handle new and complex cases, and increased risks of delays and gaps in care.

The warning comes after the Guardian revealed that in England the NHS was spending £164 million a year on ADHD services, with a growing proportion of this spending going on poorly regulated private assessments.

Demand for assessments has reached record levels as awareness of the disease has increased. NHS services have become overwhelmed, with more than 500,000 people now waiting to be assessed.

On Thursday morning, Wes Streeting, the Health Secretary, admitted that the government was failing to manage the number of autism and ADHD cases during an interview with BBC Radio Oxford.

To cope with demand, the NHS pays private providers to carry out assessments and, in some cases, provide treatment by prescription. This is often done via the ‘right to choose’ route, which allows patients in England to select a private provider for assessment, diagnosis and initial treatment. Patients can then request a shared care arrangement, where their GP continues to prescribe alongside the private provider.

However, the system is often fragmented and lacks clear clinical standards. The MPFT letter, written in December 2025 by Megan Cann, the trust’s customer service facilitator, was based on comments from Upkar Jheeta, mental health transformation manager at the MPFT.

It was sent in response to a patient whose shared care agreement had been withdrawn after several years of treatment. The patient’s GP said he could no longer continue to prescribe and withdrew from the arrangement.

MPFT acknowledged that the sudden cessation of prescribing had caused significant distress and raised concerns about the risk of destabilization after years of treatment.

Although the provider was chosen under the right to choose, the letter said: “This specific provider was selected by [the patient]but unfortunately, they can only provide a diagnosis and cannot prescribe medication. This situation highlights the challenges and limitations associated with the right to choose ADHD services.

The letter adds: “There is limited regulation regarding private ADHD providers, and this case highlights the problems we often see. Private providers can establish services and apply to be providers of ADHD diagnostics. However, it has been found that sometimes their assessments do not comply with Nice guidelines, and it can be difficult to ensure the availability of qualified staff to support prescribing.”

He said the local integrated care board had introduced the right to choose a monitoring service in response to these concerns.

A spokesperson for NHS Staffordshire and Stoke-on-Trent ICB said they were “committed to ensuring patients receive the care and medicines they need”, adding: “We are working with our partners to review this case and our wider processes of working with private providers.