In a concerning report, UK-trained consultant psychiatrist Dr. Vicky Cleak has expressed frustration over the growing issue of unregulated ADHD clinics receiving NHS contracts, despite lacking the proper Care Quality Commission (CQC) registration.
Dr. Cleak, who specialises in adult ADHD assessment and treatment, has been navigating the opaque CQC registration process for the past eight months in order to provide high-quality, fully regulated ADHD assessments in an independent setting. However, she is legally prohibited from seeing patients until this process is complete.
The article highlights the troubling revelation that multiple companies have been awarded NHS ADHD contracts without the necessary CQC registration. Furthermore, some healthcare professionals, such as psychologists working with prescribing pharmacists, can set up practices to “diagnose and treat” ADHD without falling under the CQC’s regulatory remit.
Dr. Cleak’s past experience working for a large private provider that expanded rapidly to deliver NHS ADHD contracts has also raised concerns. She notes that while many clinicians were conscientious, the model was contract-driven and narrowly focused, rather than being patient-need or clinician-led. Clinicians were reportedly under pressure to prioritise throughput, and patients often discovered their clinician could be replaced overnight, which many found deeply upsetting.
These issues, according to Dr. Cleak, are the predictable result of an overstretched public system outsourcing to a fragmented and unevenly regulated market, while placing the greatest regulatory burden on small, expert psychiatrist-led services. She emphasises that high-quality ADHD assessment requires time, expertise and continuity, and that regulations should enable this, not obstruct it.
The article also includes a personal account from a parent whose daughter was prescribed amphetamines by an NHS clinician after a one-hour assessment and questionnaire, despite her self-diagnosis. When the medication didn’t work, the clinician increased the dose and then prescribed antidepressants, seemingly determined to find the answer in a pill. The parent is grateful that the drug interventions did not cause long-term damage or dependency, as they suspect has happened to others.
Mona Sood, another reader, raises concerns about the effectiveness of behavioural interventions and the potential long-term health costs of relying on medication, such as psychostimulants or amphetamines, which are the only treatments recommended by the NHS National Institute for Health and Care Excellence.
The article highlights the urgent need for better regulation and a more comprehensive, patient-centred approach to ADHD care within the NHS, ensuring that high-quality assessments and appropriate, evidence-based treatments are available to those in need.
