"Desperation is palpable among patients seeking help": Insights from ADHD professionals in England on a disarrayed system
When Craig, a pseudonym for a clinician, began his journey at a private ADHD clinic in the spring of 2023, he was initially impressed by the extensive training provided and the organization's commitment to upholding clinical standards.
He remarked, "The training and clinical oversight were unparalleled compared to any other organization I've been a part of. They genuinely prioritized staff development... A consultant pediatrician frequently observed assessments, offering thorough feedback."
However, as time progressed, significant issues within the company began to surface. The sheer volume of work was overwhelming, and this heavy workload seemed to compromise the quality of the clinical output reflected in the reports sent to both patients and general practitioners (GPs). These reports were often generated by administrative staff in an effort to save time. "During my 13 months there, I never came across a report that I could confidently say was authored by me, even though they bore my name," he explained. "I believe this was at the heart of the problem."
Other clinicians echo Craig's sentiments about this disconnect. Alice, a pseudonym for another clinician who worked at a different clinic from 2023 to 2024, shared her experience of annotating detailed PDFs only to have them transformed into generic template letters. "They often lacked a personal touch and didn’t fully capture my contributions," she said. While the assessments were comprehensive, the documentation frequently fell short.
She elaborated, "Diagnoses were only assigned when there was clear evidence of symptoms being persistent and pervasive since childhood. There was no pressure to diagnose hastily; however, once a patient was taken on, you were responsible for their care until they reached stability, which often led to a substantial caseload."
Craig recounted managing "at least 20 patients... alongside an additional 30 prescription requests", all while juggling reviews and administrative tasks. Initially contracted for eight hours, he often found himself working double that amount. "I remember moments sitting at my desk in tears, completely drained physically and emotionally, realizing I simply could not handle it all." He characterized the environment as "chaotic and unsustainable."
Brian, another clinician who also used a different name and left his clinic this year, recalled witnessing colleagues working excessively long hours, often from early morning until late at night. "You could see patients from 6 am to 8 pm. Some clinicians did just that. It was theoretically possible to conduct eight new assessments in a single day."
The administrative systems became overwhelmed by the high volume of work: phone calls went unanswered, emails accumulated, and prescription requests were delayed. Alice noted, "Access to services was incredibly poor. Calls and emails weren’t always addressed promptly, which understandably left patients feeling frustrated."
In some cases, clinicians took it upon themselves to deliver critical medication directly to patients when delays posed safety concerns. Craig recounted, "The back-office systems often let us down—medications could be difficult to obtain or delayed, and the administrative staff were stretched too thin. There were instances when patients would call on the same day, saying they had run out of medication. On several occasions, I personally hand-delivered prescriptions to patients, and so did some of my colleagues."
This strain became particularly apparent when patients attempted to transition from private treatment to shared care under the NHS. Clinicians often recalled assurances that the transition would be seamless, only to face weeks or even months of delays. "GPs would take an eternity to respond, often just to inform us that they wouldn’t accept the patient... Meanwhile, the patient required medication, and I was compelled to write prescriptions for individuals I had never met," Alice shared with The Guardian.
Craig added, "Parents would call expressing concern that the medication wasn’t effective, and I would realize they had never actually been reviewed."
NHS clinicians dealing with incoming referrals are aware of the wider repercussions of this situation. "Approximately 70–80% of private assessments fail to meet the necessary standards," one clinician explained. "Patients often presume they’re receiving a service equivalent to that of the NHS, but that’s not the case." This has resulted in a surge of complaints from individuals who believed they had completed the evaluation process. "People have paid a significant amount, waited for months, and then find themselves back on the NHS waiting list," they asserted.
Despite the challenges, clinicians working for private companies do not attribute malice to frontline staff. "Generally, most patients have a positive experience," Brian stated. "Some individuals unfortunately get lost in the system... the clinicians were simply trying to manage an overwhelming increase in workload."
Reports indicate a climate of desperation, with families resorting to borrowing money, depleting savings, or enduring lengthy waits for NHS assessments. "Those who self-fund aren't merely purchasing a diagnosis; they’re buying into a process of assessment," Craig emphasized. "In many cases, they are truly desperate for help."
Across various accounts, a common theme emerges: a sector inundated by demand, expanding rapidly without the necessary administrative and clinical support to maintain safety and efficacy. "We’re waiting to see what actions the ADHD task force will undertake," Brian commented. "Currently, there simply aren’t sufficient resources to remedy the situation."
But here’s where it gets controversial: Can we truly expect the system to improve without addressing the root causes of this chaos? What changes would you advocate for to ensure that patients receive the timely and effective care they desperately need? Share your thoughts in the comments!
