ADHD services should move to primary care, NHS taskforce recommends

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.