‘People are desperate’: ADHD clinicians in England on a system in chaos
When Craig, not his real name, started as a clinician for a private ADHD (attention-deficit hyperactivity disorder) clinic in the spring of 2023, he was pleased by how thorough the training was and how seriously the organisation seemed to take clinical standards.“The training and clinical supervision there were the best I’ve ever experienced in any organisation,” he said.“They truly invested in developing their staff … a consultant paediatrician would often sit in on assessments to observe and provide detailed feedback.”But issues at the company emerged over time: the workload was massive and the quality of the clinical work did not seem to carry through into the reports sent to patients and GPs, which were often done by administrative staff to save time.“Over the 13 months I was there, I never actually saw a single report that appeared to have been written by me, even though they were sent out under my name,” he says.
“I believe that was the core issue,”Other clinicians, working across different providers, describe the same disconnect,Alice, whose name has been changed, worked for a clinic from 2023 to 2024, and recalls annotating PDFs only to see them turned into highly templated letters,“They didn’t always feel personal or fully reflective of my input,” she said,The assessments were detailed; the documentation often wasn’t.
She said: “Diagnoses were only made when there was clear evidence of symptoms being current and pervasive since childhood.We were not pressured to diagnose but once you took a patient on, you had them until they were stable, which means the case load could grow quite big.”Craig said he had dealt with “easily 20 patients … and an additional 30 prescription requests” on top of reviews and admin.He was contracted for eight hours but routinely worked double that.“I remember sitting at my desk in tears, physically and emotionally exhausted, knowing I simply couldn’t do it all.
” He described it as “chaotic and unsustainable”.Brian, another clinician using a different name, who left a clinic this year, recalled colleagues working from dawn to evening.“You could see patients from 6am to 8pm.Some people did.Potentially you could squeeze in eight new assessments a day.
”Administrative systems struggled under the volume: calls went unanswered, emails piled up and prescription requests stalled.“Access was extremely poor,” Alice said.“Calls and emails weren’t always answered promptly, leaving patients upset.”Some clinicians resorted to delivering vital medication to patients themselves when delays became unsafe.Craig said: “The back-office systems often failed us – prescriptions could be hard to obtain or delayed, and administrative staff were stretched too thin.
Sometimes patients would call on the day saying they’d run out of medication,On several occasions, I even hand-delivered prescriptions to patients myself, and other clinicians did the same,”The strain became most visible when patients tried to move from private treatment into NHS shared care,Clinicians recalled promises that the transition would be smooth, followed by weeks or months of delays,“GPs would take ages to reply, often only to say they wouldn’t take the patient on … Meanwhile, the patient needed medication and I was asked to write prescriptions for people I’d never met,” Alice told the Guardian.
Craig said: “Parents would ring up saying the medication wasn’t working and I’d realise they’d never been reviewed.”NHS clinicians who handle incoming referrals see the broader consequences.“Around 70–80% of private assessments do not meet the required standards,” one clinician said.“People think they’re getting an NHS-equivalent assessment, but they’re not.” The result is a wave of complaints from people who thought they had completed the process.
“People have paid money, waited months, and then have to go back on the NHS waiting list,” he said.Yet none of the clinicians working for private companies described bad intentions from frontline staff.“Most patients have a good experience by and large,” Brian said.“Some people got lost in the system … they [clinicians] were trying to cope with a massive increase in workload.”Staff talked of desperation, families borrowing money, using savings or waiting years for NHS assessments.
“People who self-fund aren’t buying a diagnosis, they’re buying an assessment process,” Craig said,“Often they’re desperate,”The picture is the same across all accounts, the Guardian has heard: a sector overwhelmed by demand, expanding faster than its administrative and clinical structures can safely support,“We’re waiting to see what the ADHD taskforce is going to do,” Brian says,“Right now, there aren’t enough resources to fix the problem.
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Peter Mandelson declines to apologise for association with Jeffrey Epstein
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