NHS ADHD Crisis: Private Clinic Failures Flood NHS With Returning Patients
A major NHS trust has issued a stark warning that waiting lists for attention deficit hyperactivity disorder (ADHD) services in England are becoming critically congested due to patients returning from private care. The situation reveals significant gaps in the system where private assessments fail to meet clinical standards, leaving vulnerable individuals without essential medication.
Private Assessments Failing to Meet Clinical Standards
The Midlands Partnership University NHS Foundation Trust (MPFT) has highlighted a growing trend where patients referred by GPs to private clinics using NHS funding are increasingly requesting transfers back to NHS care. This occurs when private providers diagnose ADHD but their assessments do not comply with guidelines from the National Institute for Health and Care Excellence (NICE).
Private clinics sometimes lack staff who are qualified to prescribe medication, creating a dangerous discontinuity in treatment. The consequences for patients can be severe, with some facing prescription costs exceeding £200 per month after GPs withdraw from shared care agreements with private providers.
Real-World Impact on Patients and Families
The human cost of this systemic failure is becoming increasingly apparent. One father described how his son's shared care agreement was abruptly withdrawn after three years of stable treatment. "With no warning, the GP practice announced they would stop prescribing within six months because the provider was 'out of area'," he explained.
"My son holds down a responsible job and has bought his own home. None of this would have been possible without medication. Without it, he struggles to focus at work, can't manage daily organisation and experiences overwhelming anxiety." The patient has been referred to local NHS services but faces waiting times exceeding six months, guaranteeing a dangerous treatment gap.
Systemic Pressures and Regulatory Gaps
In a letter obtained by the Guardian, MPFT acknowledged struggling to cope with the growing number of patients returning from private clinics. The trust warned this trend contributes directly to:
- Longer waiting lists for all ADHD patients
- Reduced capacity for new and complex cases
- Increasing risks of treatment delays and dangerous care gaps
The situation emerges against a backdrop of record demand for ADHD assessments, with awareness of the condition increasing dramatically. NHS services have become severely overstretched, with more than 500,000 people currently waiting for assessment across England.
Right to Choose Pathway Creating Fragmentation
To manage overwhelming demand, the NHS has increasingly turned to private providers through the "right to choose" pathway. This allows patients in England to select private providers for assessment, diagnosis and initial treatment, with GPs potentially continuing prescriptions through shared care agreements.
However, the system suffers from significant fragmentation and lacks clear clinical standards. Megan Cann, a customer service facilitator at MPFT, wrote in December 2025: "There is limited regulation surrounding private ADHD providers, and this case highlights the issues we often encounter."
The letter, based on comments from Upkar Jheeta, head of mental health transformation at MPFT, explained: "Private providers can establish services and request to be providers of ADHD diagnoses. However, it has been found that at times their assessments do not comply with NICE guidelines, and there may be challenges in ensuring the availability of appropriately skilled staff to support prescribing."
Financial Implications and Government Response
The crisis comes as the NHS in England overspends by approximately £164 million annually on ADHD services, with a growing proportion allocated to poorly regulated private assessments. Health Secretary Wes Streeting recently admitted the government is failing to cope with the surge in referrals for both autism and ADHD services.
In response to mounting concerns, local integrated care boards have begun implementing vetting services for right to choose providers. A spokesperson for NHS Staffordshire and Stoke-on-Trent ICB stated: "We are committed to ensuring that patients receive the care and medication they need. We are working with our partners to review this case and our wider processes for working with private providers."
The situation highlights a critical need for improved regulation of private ADHD services and better integration between private and NHS care pathways to prevent vulnerable patients falling through dangerous treatment gaps.
