The NHS is grappling with a growing crisis in ADHD care, as waiting lists are clogged by patients returning from private care. This issue is not only causing significant distress for patients but also highlighting the challenges and limitations of the current system. The problem stems from patients being referred by GPs to private clinics using health service funding, only to later request a transfer back to the NHS due to stalled care or non-compliance with guidelines. This trend is contributing to long waiting lists, reduced capacity for new and complex cases, and increasing risks of delays and gaps in care. The consequences for patients can be severe, with some facing prescription costs of more than £200 a month after GPs said they could no longer work with private clinics under shared care agreements. The situation is further complicated by the fact that the NHS is overspending by £164m a year on ADHD services, with a growing proportion of that spending going to poorly regulated private assessments. The demand for assessments has reached record levels as awareness of the condition has increased, and NHS services have become overstretched, with more than 500,000 people now waiting to be assessed. The government is failing to cope with the number of referrals for autism and ADHD, and the NHS is paying private providers to carry out assessments and, in some cases, provide treatment through prescribing. However, the system is often fragmented and lacks clear clinical standards, and the right to choose pathway, which allows patients in England to select a private provider for assessment, diagnosis and initial treatment, has its own set of challenges and limitations. The letter from the MPFT, written in December 2025 by Megan Cann, a customer service facilitator at the trust, was based on comments from Upkar Jheeta, the head of mental health transformation at the MPFT. It was sent in response to a patient whose shared care agreement had been withdrawn after several years of treatment. The patient’s GP said they could no longer continue prescribing and pulled out of the arrangement. MPFT acknowledged the sudden withdrawal of prescribing had caused significant distress and raised concerns about the risk of destabilisation after years of treatment. Despite the provider having been chosen through the right to choose pathway, the letter said: "This specific provider was selected by [the patient], but unfortunately, they are only able to provide a diagnosis and cannot prescribe medication. This situation highlights the challenges and limitations associated with the right to choose for ADHD services." The letter added: "There is limited regulation surrounding private ADHD providers, and this case highlights the issues we often encounter. Private providers can establish services and request to be providers of ADHD diagnoses. However, it has been found that at times their assessments do not comply with Nice guidelines, and there may be challenges in ensuring the availability of appropriately skilled staff to support prescribing." It said the local integrated care board had introduced a right to choose vetting service in response to these concerns. A spokesperson for NHS Staffordshire and Stoke-on-Trent ICB, said it was "committed to ensuring that patients receive the care and medication they need", adding: "We are working with our partners to review this case and our wider processes for working with private providers." But here's where it gets controversial... The right to choose pathway is often seen as a solution to the growing demand for ADHD assessments, but it may not be the best approach. The system is fragmented and lacks clear clinical standards, and patients may not be fully aware of the limitations and challenges associated with private providers. This could lead to patients being misdiagnosed or not receiving the care they need. And this is the part most people miss... The government and the NHS need to take a step back and re-evaluate the current system. While the right to choose pathway may have its merits, it is not a sustainable solution for the growing demand for ADHD assessments. A more comprehensive and integrated approach is needed, one that takes into account the needs of patients, the limitations of private providers, and the challenges of the current system. So, what do you think? Do you agree with the MPFT's concerns about the right to choose pathway? Or do you think it's a necessary and effective solution to the growing demand for ADHD assessments? Share your thoughts in the comments below!
