The ADHD No-Man’s Land: Why Private Diagnosis Doesn't Guarantee NHS Support.

For many people in England grappling with Attention Deficit Hyperactivity Disorder (ADHD), securing a diagnosis does not automatically lead to timely, reliable treatment. Caught between severely strained NHS waiting lists and the high cost of private assessment, patients frequently find themselves in a "grey zone" where a private diagnosis fails to translate into accessible NHS support. While NHS England’s “Right to Choose” policy was intended to speed up access to specialist assessment by funding referrals to NHS-approved private providers, its effectiveness is often undermined in the follow-up phase. Recent reports indicate that even after obtaining a faster private diagnosis, NHS clinicians may reject, downgrade, or require a re-assessment of the diagnosis when it comes to initiating treatment or prescribing medication.

The strain on the system is evident in multiple areas. Crippling NHS waiting lists remain severely stretched, with a 2025 Healthwatch England analysis estimating that up to 549,000 people were waiting for an ADHD assessment, often for several years, which is the primary driver for private care. This surge in diagnostic activity and the need to manage complex pathways back into the NHS have also contributed to budget overruns, with figures suggesting an overspend of around £164 million a year on ADHD services. This pressure has led to a "Postcode Lottery," where some Integrated Care Boards (ICBs) have paused Right to Choose referrals for ADHD and autism, citing capacity concerns and service sustainability, creating inconsistent access across England.

Barriers to Treatment After Private Diagnosis

A major obstacle to seamless care is the “shared care” requirement for ongoing treatment. Private providers typically expect the patient's NHS GP to take over the prescribing and monitoring of medication via a shared care agreement. However, GPs are not obliged to enter these agreements following a private diagnosis. Growing numbers of GP practices are withdrawing from shared care agreements with private clinics. This trend, criticised by advocacy groups, leaves patients without a clear route to NHS prescriptions, often forcing them to continue paying privately for medication even after diagnosis. Even when a referral is made, patients face hidden costs and barriers, potentially having to pay for prescriptions during the medication titration phase if a shared care agreement is not in place.

The outcome of these fractured pathways is that many individuals with ADHD are left diagnosed but untreated. Patients who utilised Right to Choose often find their private report alone is insufficient to secure medication or care, effectively sending them back to join the lengthy NHS wait list for a duplicated assessment or reinterpretation. This undermines the policy's intent and causes significant delay, financial burden, and detrimental effects on individuals' education, employment, and mental wellbeing.

Looking forward, in late 2025, the government launched an independent review to examine how mental health, ADHD, and autism services are delivered and how to meet demand that far outstrips capacity. The review aims to streamline pathways and improve the integration of private and NHS provision. Until national standards are clarified and a genuinely seamless transition from private diagnosis to NHS care is established, the ADHD treatment gap will persist. Patients, clinicians, and commissioners are urgently calling for better policy alignment, expanded shared-care frameworks, and increased NHS capacity to ensure timely diagnosis leads reliably to appropriate, accessible treatment.