Frontline clinicians working in England's private ADHD assessment sector have painted a picture of a system in chaos, overwhelmed by soaring demand and buckling under administrative strain. They describe a critical disconnect between detailed clinical work and the reports eventually sent to patients and GPs, leading to unsustainable workloads and potential risks for those seeking help.
A System Stretched Beyond Its Limits
One clinician, Craig (a pseudonym), who joined a private ADHD clinic in spring 2023, initially praised the organisation's high clinical standards and thorough training. "The training and clinical supervision there were the best I've ever experienced," he recalled, noting consultant paediatricians would often observe assessments. However, he soon discovered a fundamental flaw: the meticulous clinical work did not translate into the final documentation.
Craig revealed that over 13 months, he never saw a report that appeared to be his own, despite them being issued under his name. "I believe that was the core issue," he stated, explaining that administrative staff often compiled highly templated letters to save time, a practice that eroded the personal nuance of each assessment.
This experience is echoed across the sector. Alice, another clinician using a changed name, worked for a different provider from 2023 to 2024. She described annotating detailed PDFs only to see them turned into impersonal letters. "They didn't always feel personal or fully reflective of my input," she said.
Unmanageable Workloads and Patient Safety Risks
The pressure on clinicians is immense. Craig reported handling "easily 20 patients" alongside an additional 30 prescription requests, on top of reviews and admin. Contracted for eight hours, he routinely worked double. "I remember sitting at my desk in tears, physically and emotionally exhausted," he described, calling the situation "chaotic and unsustainable."
Brian, a third clinician, recalled colleagues seeing patients from 6am until 8pm, potentially squeezing in eight new assessments daily. This volume crippled administrative systems, leaving calls unanswered, emails piled up, and prescription requests stalled. "Access was extremely poor," Alice confirmed, "leaving patients upset."
The strain reached a critical point where clinicians felt compelled to hand-deliver prescriptions to patients when delays became unsafe. "On several occasions, I even hand-delivered prescriptions to patients myself, and other clinicians did the same," Craig admitted.
The Broken Bridge to NHS Care
The system's failures become starkly visible when patients attempt to transition from private diagnosis to NHS shared care agreements with their GPs. Clinicians described promises of a smooth handover followed by weeks or months of delays. "GPs would take ages to reply, often only to say they wouldn't take the patient on," Alice told the Guardian.
This creates a dangerous limbo where patients need ongoing medication but lack proper oversight. Craig recounted parents calling to say medication wasn't working, only for him to realise "they'd never been reviewed." The problem is compounded by the variable quality of private assessments entering the NHS system. One NHS clinician estimated that "around 70–80% of private assessments do not meet the required standards."
The consequence is a wave of distress. "People have paid money, waited months, and then have to go back on the NHS waiting list," the clinician explained. Despite this, frontline staff are not blamed for bad intentions. "Most patients have a good experience by and large," Brian noted, attributing the issues to a sector expanding faster than its structures can support.
The clinicians unanimously point to a backdrop of desperation, with families borrowing money or using savings to bypass years-long NHS waits. "People who self-fund aren't buying a diagnosis, they're buying an assessment process," Craig said. "Often they're desperate." With the sector overwhelmed, the focus now turns to the government's ADHD taskforce, as clinicians warn "there aren't enough resources to fix the problem."
