GPs Express Concern Over Adult ADHD Over-Diagnosis Amid Rising Private Referrals

A substantial seven in ten general practitioners (GPs) believe adult Attention Deficit Hyperactivity Disorder (ADHD) is over-diagnosed, with some GPs reporting they have never encountered a private provider who has rejected an ADHD diagnosis. This sentiment emerges as increased awareness of ADHD has led to longer waiting times for assessments within the National Health Service (NHS), prompting a shift towards private clinics.

Patients seeking private assessments may pay upwards of £1,000 for a consultation. Alternatively, some patients can secure an NHS referral to a private assessor of their choice, with the costs covered by taxpayers. A diagnosis of ADHD can be instrumental in benefit claims, such as personal independence payments, which have seen a notable increase in recent years.

Family doctors surveyed estimated that more than 80% of patients referred for specialist ADHD assessments ultimately receive a diagnosis. However, respondents to a poll conducted by GP publication Pulse raised concerns regarding the perceived superficiality of some assessments. They also warned that other mental health conditions, such as trauma, might be overlooked in the diagnostic process.

One GP from Berkshire noted that out of over 1,000 patients they had referred, only one did not receive a positive ADHD diagnosis. Other GPs responding to the survey indicated a perception that the diagnosis rate is higher for referrals made through private routes compared to NHS channels. A GP based in Dorset stated, “Occasionally NHS services do not make a positive diagnosis, but I don’t think I have ever seen a private provider not give a positive diagnosis.”

These concerns precede the release of a government-commissioned review examining the escalating demand for ADHD, autism, and broader mental health services. Professor Peter Fonagy, a clinical psychologist leading this review, is expected to propose a model that offers support based on individual needs rather than requiring a formal diagnosis.

Health officials have previously warned that the financial burden of meeting the soaring demand for autism and ADHD services in England has become unsustainable. The NHS Alliance reported that in some areas, spending on ADHD and autism has increased up to tenfold within a year. One integrated care board (ICB) saw its monthly expenditure rise from £146,000 in 2024/25 to £1.5 million in the subsequent year. Another ICB's spending on adult ADHD services reportedly surged from £11 million in 2023/24 to a projected £51 million for the current financial year.

The rapid increase in demand has been fueled by the "Right to Choose" policy, which permits individuals seeking a diagnosis for themselves or a child to select any qualified provider. However, the NHS Alliance has also voiced concerns from ICBs about the quality assurance and regulation of the rapidly expanding number of new providers.

Rebecca Gray, the NHS Alliance’s mental health network director, described local health leaders as being in a difficult position. She acknowledged the significant frustration caused by long waiting times for assessments, treatment, and support, but highlighted the unsustainable and escalating costs associated with trying to meet demand. Gray stated, “The current situation is unsustainable and delivers a bad deal for patients and taxpayers.”

One ICB reported having 80 providers within its operational area, while another noted that the number of providers from which it received invoices had increased from 12 to 14 two years ago to 48 currently. Concurrently, the Parliamentary and Health Service Ombudsman (PHSO) has reported a more than 200% rise in complaints related to ADHD and autism services over the past five years.

The Pulse survey, which polled 829 GPs, found that 410 considered adult ADHD to be "very over-diagnosed," with an additional 173 viewing it as "slightly over-diagnosed." A GP from Devon commented, “ADHD seems to be considered a more socially acceptable diagnosis than, for example, PTSD. I am stunned by how superficial some assessments are, and how little reference is made to some patients' significant history of trauma or adverse childhood experiences, which would in themselves be an adequate explanation for the patient’s difficulties.”

Dr. Liz Clarke, a Greater Manchester GP partner, suggested that the current system, which often focuses on single diagnostic pathways for single conditions, does not facilitate a holistic patient assessment and heightens the risk of overdiagnosis. She also raised concerns about potential harm to patients if they are prescribed incorrect medications or undergo inappropriate psychological interventions due to a lack of neurodiversity recognition, or conversely, if neurodiversity is identified without appropriate support.

The government has stated that Professor Fonagy’s final report will be published shortly and will inform its new national approach to these services.