A concerning trend has emerged within private healthcare providers in England, where a spike in video-only consultations has led to alarming practices in treating children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). Medical professionals are sounding the alarm, asserting that vulnerable young patients are being prescribed powerful stimulant medications without the requisite thorough physical examinations. This warning has prompted health authorities in Greater Manchester to implement new regulations aimed at safeguarding the welfare of children.
Risky Remote Assessments
The shift towards remote consultations has resulted in what one medical expert describes as “widespread and unsafe practice.” Clinicians argue that the absence of face-to-face evaluations has compromised the integrity of ADHD diagnoses and subsequent treatment plans. Rashad Nawaz, a consultant paediatrician operating in Manchester and Liverpool, has raised significant concerns to national health regulators, highlighting instances where children with undiscovered heart conditions were prescribed stimulants without any in-person assessment.
The medications in question, including methylphenidate—widely recognised under the brand name Ritalin—are known for their efficacy in managing ADHD symptoms. However, established guidelines from the National Institute for Health and Care Excellence (NICE) stipulate that a comprehensive physical assessment, along with a thorough cardiovascular history, is essential prior to initiating treatment. Nawaz’s observations reveal a troubling trend: children are being diagnosed and medicated through virtual consultations, often without the critical evaluations necessary to ensure their safety.
A Clinical Vacuum
In the past year, Nawaz has identified three children with previously undetected heart murmurs, one of whom was already on ADHD medication prescribed by a major online service. While two of these children were determined to have “innocent” murmurs, one was diagnosed with a ventricular septal defect (VSD), commonly referred to as a hole in the heart. Nawaz expressed his grave concerns about the lack of thorough physical assessments prior to medication, labelling the situation as a serious clinical risk that borders on negligence.
The NHS is currently grappling with unprecedented demand for ADHD services, leading many families to turn to the “Right to Choose” scheme to access private care funded by the NHS. However, senior medical professionals have voiced apprehensions regarding the capacity of some private clinics—many of which hold lucrative contracts with the NHS—to ensure the safety and well-being of their patients.
Prof Marios Adamou, an NHS psychiatrist, warned that the increasing reliance on online-only providers has created a perilous gap in clinical care. “Local GPs are frequently asked to perform these checks on behalf of private services or even start treatment,” he explained. “This places clinicians in a difficult position, as the prescribing clinician is fully accountable for the safety of their prescriptions.”
Deskilling of Healthcare Professionals
Nawaz also highlighted a worrying trend of “deskilling” within the healthcare workforce, pointing to instances where professionals trained predominantly in adult care are now treating children without adequate paediatric experience. In one particularly alarming case, a child was prescribed medication through a video consultation despite a concerning family history of congenital heart disease, a critical detail that was overlooked in the private provider’s assessment.
The procedural deficiencies of many leading private providers become evident when scrutinised: they often rely on minimal measurements—such as blood pressure and weight, typically reported by parents—alongside a basic health checklist, eschewing essential physical examinations altogether. In a letter addressed to the Royal College of Paediatrics and Child Health, Nawaz lamented the lack of direct interaction between healthcare providers and their young patients, asserting that many of the prominent national private providers do not conduct face-to-face consultations.
New Measures in Greater Manchester
In response to the pressing concerns raised by medical professionals, NHS Greater Manchester has announced the introduction of a new “safety first” pathway. Prof Manisha Kumar, the region’s chief medical officer, emphasised the necessity of prioritising children’s safety. “We are implementing new pathways that require face-to-face assessments and physical health checks before ADHD medication is prescribed,” she stated.
Though this new system allows families to retain their right to choose, it effectively prohibits providers from commencing treatment in the region unless they can demonstrate that a thorough in-person clinical assessment has been conducted. This shift aims to restore a level of safety and oversight to the prescribing process, ensuring that children receive the care they need without compromising their health.
Why it Matters
The shift towards remote consultations in ADHD treatment raises serious questions about child safety and the quality of care in a rapidly evolving healthcare landscape. With the potential for undiagnosed conditions to go unchecked, the need for rigorous in-person assessments has never been more critical. As health authorities take steps to rectify these practices, the focus must remain on protecting the most vulnerable in our society—our children. Safeguarding their health should always be paramount, ensuring that effective treatments do not come at the cost of their well-being.
