The NHS’s official taskforce into ADHD has recommended that general practice takes a greater role in management of the condition, similar to diabetes care.
The first report from the taskforce, commissioned by NHS England last year, recommends a shift to ‘accessible, regulated and generalist models of care in the community, including primary care and other sectors outside the NHS’.
Currently, the report warned, ADHD assessment and treatment in England – as recommended by NICE – are only ‘provided by highly specialised, secondary care clinicians (super-specialists)’ or via ‘private providers that are not regulated’.
The ‘inability to access NHS services’ has led to a ‘significant growth’ in the use of private services, resulting in ‘two-tier access to services, diagnosis and treatment’.
The report added: ‘This drives health inequalities and links to disproportionate impacts and outcomes in the education and justice systems, employment and health.’
To address this, the taskforce recommends that:
- NICE should ‘reconsider its stance and interpretation that ADHD always requires a highly specialised, secondary care workforce (ADHD super-specialists)’
- It should ‘clearly define the meaning of specialist to enable greater involvement of primary care (with training and remuneration), with secondary care support as well as generalist secondary care’
- ADHD management should be aligned with ‘the way other common conditions, such as diabetes, are managed’
- A ‘clear definition of ADHD specialist and monitoring of NICE adherence is also important to regulate non-NHS providers’
The report calls for a ‘holistic, stepped, joined-up, generalist approach’ involving ‘adequately-resourced primary care and secondary health care, local authorities and the voluntary/community sector’ – enabling both initial support and fast-tracking of complex cases to diagnostic assessment and treatment.
The taskforce emphasised that ‘waiting times for NHS ADHD services have escalated and are unacceptably long’. It also pushed back on claims that ADHD is over-diagnosed, stating: ‘In England, recognised rates of ADHD are lower than the expected prevalence of ADHD’, meaning ‘demand on services is very likely to continue to rise’.
The economic costs of unsupported ADHD currently stand at £17bn, due to ‘educational failure, long-term unemployment, crime, substance misuse, suicide, mental and physical illness’. However, the taskforce stressed that ‘when appropriately supported, people with ADHD can thrive and fully engage in a working life’.
The report noted that ADHD is ‘common’, with a population prevalence of 3-5%, and said there is ‘an urgent need’ to ‘address early determinants of adverse outcomes and reduce waiting times in cost-effective, evidence-supported ways’.
It highlighted as a potential model Canada’s Integrated Youth Services (IYS), which provides a one-stop shop for young people aged 12-25, covering neurodivergence, mental health, physical health and social needs. The report said this model has led to faster access and cost savings and may offer lessons for the NHS.
The Independent ADHD Taskforce was set up by NHS England in 2024 in response to serious concerns about poor access to timely ADHD support and the wider risks and costs of leaving the condition unsupported, such as increased rates of suicide, crime and long-term unemployment.
Its remit was to recommend how services across health, education, justice and society at large should be transformed to provide timely and effective support for people with ADHD, and to propose a whole-system approach to managing the condition.
Last week, the Government published a new code of practice to ensure consistency of training for health and social care providers looking after people with a learning disability or autism.
The taskforce recommendations:
- Moving to a ‘generalist model’
- Providing early, needs-based support for ‘possible ADHD’, not just those with a formal diagnosis
- A single, accessible ‘front door’ to ADHD support, with integrated, modernised pathways led by ICSs and local services
- Joined-up care involving primary and secondary care, local authorities, the VCSE sector and private providers
- Adoption of ‘test and learn approaches’ to stepped care across ICSs/Neighbourhood Health Services
- Formal evaluation of these models by the NIHR
Source: NHS England
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READERS' COMMENTS [14]
Please note, only GPs are permitted to add comments to articles
Out of touch and clueless people writing guidelines for people working on the ground. Most practices are declining shared care prescribing! who is part of these committees and why are there no practicing, working on the ground GPs represented????
I don’t think so. Clowns
These clowns clearly are amongst the half of people who think GPs aren’t working hard enough…..
The ‘specialists’ can’t cope and take a wild guess on who becomes ‘ideally placed’
Muppets
show us the money and maybe we will think about is.
Not doing it for free though.
Niche condition with high thresholds to diagnosis and severe disruption to patient and others > drug that helps the severe symptoms > discovery that drug helps performance in others > widening of diagnosis > too much cost for specialist services > med industrial commissioning influencers suggest it go to primary care > no one trusts GPs with more money > work dump go primary care > performance enhancement drugs become standard in society without an explicit decision that that is a good thing, and without the ability of generalist doctors to say ‘no’ without becoming an expert themselves.
There is no room for individual choice on controversial treatments in UK primary care. It is by no means clear cut that the current use pattern for ADHD medications is a homogenous defined population with severe difficulties. We are drifting into the medicalisation of under performance in a knowledge economy without ever having an explicit decision to do so. What is worse is that by making this a generalist issue the burden on a GP is to go along with the ‘expert’ consensus (hammer and nail specialties) for many different treatments. There is no framework for GPs saying ‘I’m not sure about this’ or ‘I’m just not comfortable’ without becoming an super expert as the burden in our commissioning / regulatory / referrals framework tilts towards ‘Gp to do’ if there is a guideline unless we can demonstrate to a high level the knowledge to say no.
It seems that our modern society incentivises people to medications, whether it is the Soma of ubiquitous SSRIs, GLP1 injections (albeit they really work for the stubborn and significant problem of obesity and I’m very happy to dole them out when allowed), ADHD meds for performance issues, antihistamines for sleep problems.
Something doesn’t sit right with me. Are we (Gps) part of the problem?
if we can charge 1 k for an assessment over 1 – 2 hours then I can see it could be viable ….
MF as long as we are honest and distinguish between ADH trait and ADH disorder. I wash my hands of ADHD and leave to the specialists and unfortunately the profit seeking private companies otherwise you will get into all sorts of trouble trying to reign back on overdiagnosis.
🙌🏻 Simon Gilbert is spot on
The irony that type 2 diabetes can be fixed with lifestyle measures, are they saying that adhd is a disease of modern living as well?
The answer to every care provision conundrum from every quango / reviewing body: “Yeah, tell the GPs to do it – they’ve got loads of free time.” Emphasis on the free.
The answer to every care provision conundrum from every quango / review body in the UK: “Yeah, tell the GPs to do it, cos they’ve got loads of free time.” Emphasis on the ‘free.’
And Simon is spot on 🙌
Where’s the training, staffing and funding? No. We are not specialists and refuse to be one.