Video-Only ADHD Consultations for Children Labelled 'Unsafe' by Medical Experts
Doctors are raising urgent alarms over poorly regulated private clinics that are endangering children with ADHD through widespread and unsafe practices. A significant surge in video-only consultations has led to children being diagnosed and prescribed powerful stimulants without essential physical examinations, according to clinical warnings.
Risks of Remote Assessments Highlighted
Rashad Nawaz, a consultant paediatrician with clinics in Manchester and Liverpool, has written to national regulators and health bodies, expressing grave concerns. He reported treating young patients with potential underlying heart conditions who had been prescribed stimulants by national online providers without any in-person checks. In one alarming case, a child received medication via video link despite a family history of congenital heart disease, a critical detail omitted from the private provider's report.
Nawaz identified three children in the past year with previously unknown heart murmurs, one of whom was already on ADHD medication prescribed by a large national provider. After referrals to paediatric cardiology, two had innocent murmurs, but one was diagnosed with a ventricular septal defect, commonly known as a hole in the heart. "None of them had symptoms, but the one with a VSD may do in the future," Nawaz stated. "Based on feedback from parents and reports I have seen ... children are not having thorough physical assessments prior to medication. This worries me greatly. It is serious clinical risk and negligent."
NHS Struggles and Regulatory Gaps
The NHS is grappling with record demand for ADHD services, leading many families to use the "Right to Choose" scheme to access private care funded by the NHS. However, senior clinicians argue that some private companies, which often hold lucrative NHS contracts, lack the necessary infrastructure to ensure patient safety. Prof Marios Adamou, an NHS psychiatrist, noted that reliance on online-only providers has created a dangerous clinical vacuum, with local GPs frequently pressured to perform checks or start treatment on behalf of private services, placing them in a legally and clinically precarious position.
Nawaz also warned of a "deskilling" of the workforce, as health professionals trained primarily in adult care are medically treating children without adequate paediatric experience. He highlighted that many large national private providers do not see children face-to-face, instead relying on simple measurements like blood pressure and weight provided by parents, along with health check tick lists, without proper physical exams.
New Safety Measures Implemented
In response to these warnings, health authorities in Greater Manchester have overhauled prescribing rules to mandate face-to-face assessments. Prof Manisha Kumar, the region's chief medical officer, emphasized that "children's safety has to come first." The new "safety first" pathway requires physical health checks before ADHD medication is prescribed, effectively barring providers from initiating treatment in the region unless they can prove a robust, in-person clinical assessment has occurred.
While the new system maintains the right to choose, it aims to protect vulnerable children by ensuring thorough evaluations. This move underscores the critical need for regulatory oversight in the rapidly expanding field of remote healthcare, particularly for conditions like ADHD that require careful medical supervision.
