Waiting lists for people with attention deficit hyperactivity disorder (ADHD) in England are being clogged by patients returning to NHS care after difficulties with private assessments, a trust has warned.
The major NHS trust said people referred by GPs to private clinics using health service funding were increasingly asking to be transferred back after care stalled.
These include cases where private clinics are able to diagnose ADHD but their assessments do not always comply with guidelines from the National Institute for Health and Care Excellence, or where providers lack staff with the appropriate qualifications to support continued prescribing.
The consequences for patients can be severe. Some are 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The father of one man whose shared care agreement was withdrawn after three years said: “With no warning, the GP practice announced they would stop prescribing within six months because the provider was ‘out of area’. They’ve referred my son to the local NHS service, MPFT [Midlands partnership university NHS foundation trust], but waiting times exceed six months – guaranteeing a treatment gap.
“My son holds down a responsible job and has bought his own home. None of this would have been possible without medication. Without it, he struggles to focus at work, can’t manage daily organisation and experiences overwhelming anxiety. His consultant has warned of ‘predictable harms’ if treatment stops.”
In a letter shared with the Guardian, MPFT acknowledged it was struggling to cope with the growing number of patients being sent back to the trust from private clinics. It said the trend was contributing to long waiting lists, reduced capacity for new and complex cases, and increasing risks of delays and gaps in care.
The warning comes after the Guardian revealed that in England, the NHS is overspending by £164m a year on ADHD services, with a growing proportion of that spending going to poorly regulated private assessments.
Demand for assessments has reached record levels as awareness of the condition has increased. NHS services have become overstretched, with more than 500,000 people now waiting to be assessed.
On Thursday morning Wes Streeting, the health secretary, admitted the government was failing to cope with the number of referrals for autism and ADHD during an interview with BBC Radio Oxford.
To cope with demand, the NHS is paying private providers to carry out assessments and, in some cases, provide treatment through prescribing. This is often done via the “right to choose” pathway, which allows patients in England to select a private provider for assessment, diagnosis and initial treatment. Patients can then apply for a shared-care agreement, under which their GP continues prescribing alongside the private provider.
However, the system is often fragmented and lacks clear clinical standards. The letter from the MPFT, written in December 2025 by a customer service facilitator at the trust was based on comments from a senior mental health practitioner 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.”
