The NHS in England is struggling to keep up with the rising demand for ADHD assessments and treatment, leaving patients stuck in a system that wastes public money and fails to provide timely, consistent care.
Under the “right to choose” policy, patients with a GP referral can opt for a private provider for assessment and initial treatment, with the NHS covering the costs. However, the NHS is increasingly rejecting these private diagnoses, deeming them non-compliant with national guidelines. This creates an inefficient cycle, as patients are sent back into the overburdened NHS system.
Sameer Modha, who has personal experience navigating the ADHD care system, describes being “caught between the private and state system”, with GPs reluctant to engage in shared care. His daughter’s private diagnosis was rejected by the NHS, forcing him to go through the process again to get it reconfirmed.
The Midlands Partnership University NHS Foundation Trust acknowledged the structural weaknesses of the “right to choose” scheme, noting that private providers can establish services and request to diagnose ADHD, but their assessments don’t always comply with guidelines from the National Institute for Health and Care Excellence (NICE).
This trend is contributing to long waiting lists and reduced capacity for new and complex cases within the NHS. In Greater Manchester, adult ADHD referrals have risen by over 400% in the past two years, with more than 25,000 adults now waiting for assessment. The NHS estimates it would cost at least £30 million a year to fund the current level of “right to choose” diagnostic requests, without having enough clinicians to deliver them.
In response, NHS Greater Manchester is introducing a central triage hub to reduce the number of full diagnostic assessments by 70-80%, while also expanding community-based and non-clinical support to help patients access assistance earlier. However, the overarching challenge remains a long-standing lack of capacity and unacceptably long waiting times for ADHD diagnosis and treatment.
As one father shared, his son’s GP practice stopped working with a private provider, leaving him with a treatment gap of over six months, despite warnings of “predictable harm” if the care was interrupted. Patients are caught in a frustrating cycle, unable to find a clear path to timely, coordinated ADHD support.
