‘People are desperate’: ADHD clinicians in England on a system in chaos | Attention deficit hyperactivity disorder

When Craig, not his real name, started as a clinician in a private ADHD (attention deficit hyperactivity disorder) clinic in the spring of 2023, he was pleased with the rigor of the training and how seriously the organization seemed to take clinical standards.

“The training and clinical supervision there was the best I have ever experienced in an organization,” he said. “They really invested in the development of their staff…a consultant pediatrician was often involved in assessments to observe and provide detailed feedback. »

But problems emerged over time in the business: the workload was enormous and the quality of clinical work did not seem to be reflected in the reports sent to patients and GPs, which were often written by administrative staff to save time. “In the 13 months I was there, I never saw a single report that looked like it was written by me, even though they were sent under my name,” he says. “I think that was the central problem.”

Other clinicians, working with different providers, describe the same disconnect. Alice, whose name has been changed, worked for a clinic from 2023 to 2024 and remembers annotating PDFs only to see them transformed into highly modeled letters. “They didn’t always seem personal or fully reflect my contribution,” she said. The assessments were detailed; the documentation often was not.

She said: “Diagnoses were only made when there was clear evidence that symptoms were current and pervasive since childhood. We weren’t required to make a diagnosis, but once you took on a patient, you kept them until they were stable, which meant the workload could get quite heavy.

Craig said he handled “easily 20 patients…and 30 additional prescription requests” in addition to exams and administration. He had an eight-hour contract, but he usually worked double that. “I remember sitting at my desk in tears, physically and emotionally exhausted, knowing that I just couldn’t do it all.” He described it as “chaotic and unsustainable”.

Brian, another clinician using a different name who left a clinic this year, remembers his colleagues working from dawn until dusk. “You could see patients from 6 a.m. to 8 p.m. Some people did. Potentially, you could do eight new assessments a day.”

Administrative systems struggled to cope with the volume: calls went unanswered, emails piled up and prescription requests were blocked. “Access was extremely difficult,” Alice said. “Calls and emails were not always answered promptly, which upset patients. »

Some clinicians have had to deliver life-saving medications to patients themselves when delays became dangerous. Craig said, “The back-office systems often failed us: prescriptions could be difficult to obtain or delayed, and administrative staff were overstretched. Sometimes patients called the same day to say they were out of medications. On several occasions, I even handed out prescriptions to patients myself, and other clinicians did the same.”

The tension became more visible as patients attempted to move from private treatment to shared NHS care. Clinicians recalled promises that the transition would be smooth, followed by weeks or months of delays. “GPs were very slow to respond, often only to say they would not take care of the patient… Meanwhile, the patient needed medication and I was being asked to write prescriptions for people I had never met,” Alice told the Guardian.

Craig said: “Parents were calling to say the medication wasn’t working and I realized they had never been looked at. »

NHS clinicians who manage incoming referrals see the wider consequences. “Approximately 70-80% of private assessments do not meet the required standards,” said one clinician. “People think they get an assessment equivalent to the NHS, but that’s not the case.” The result is a wave of complaints from people who thought they had completed the process. “People have paid money, waited months and then have to get back on the NHS waiting list,” he said.

Yet none of the clinicians working for private companies reported bad intentions on the part of front-line staff. “Most patients have a good experience overall,” Brian said. “Some people get lost in the system…they [clinicians] were trying to cope with a massive increase in workload.

Staff spoke of desperation, of families borrowing money, using their savings or waiting years for NHS assessments. “People who self-fund aren’t buying a diagnosis, they’re buying an assessment process,” Craig said. “Often they are desperate.”

The Guardian has heard that the picture is the same in all cases: a sector overwhelmed by demand, growing faster than its administrative and clinical structures can safely support it. “We’re waiting to see what the ADHD task force is going to do,” Brian says. “Right now, there are not enough resources to solve the problem.”