How do you respond when you receive a letter from a private ADHD clinic asking you to prescribe Concerta? With a sigh and roll of the eyes? With a slight sense of discomfort, maybe even panic? Or with a murmur of delight that your patient has finally got the diagnosis that you suspected for some years?
The fall out from ADHD can be life-changing; it is associated with poorer outcomes such as RTAs, criminality, substance misuse, teenage pregnancy and underachievement – even high functioning adults can still be held back by it. ADHD doubles the risk of dying prematurely (BMJ 2015). Medication is extremely effective, vastly improves functionality and can significantly mitigate the adverse consequences (BJGP 2020).
Waiting times for assessment, often 5 years on the NHS, coupled with a growing exposure of the condition, has led to a boom in private clinics offering ADHD assessment. A very recent BBC Panorama report has brought this sharply into focus.
In a sting operation, an undercover journalist posed as a patient at 3 different private clinics, all of whom gave him a diagnosis of ADHD. He started the process with a 3.5 hour (yes, three and half HOURS!) consultation with an NHS consultant (skipping the waiting list, BBC cameras in full view), who told him he did NOT have ADHD. Glossing over the bias, inconsistency with blinding and unblinding, uncontrolled conditions and conflicts that this programme comes with, it is a thought-provoking piece for those of us on the sharp end of general practice to think about.
There have been howls of outrage from ADHD support networks about the sensational focus of the documentary, and the way it questions the legitimacy of diagnoses made in the private sector, as it states the vast majority of patients come away with a positive diagnosis. My experience locally is that it is a similar level of those who are assessed in the NHS (not that any of my patients have ever had 3.5 hours of a consultant’s time!) as it is naturally a highly selected population.
Exposing poor practice in private clinics is welcomed of course (although one wonders if this is not the role of CQC…). The real difficulty is that this highlights concerns that a lot of GP’s will already have had about private assessments, without providing any solutions. People are turning to private clinics as the NHS is not keeping up with demand, and not through any fault of their own. When the waiting time is 5 years, it is not surprising.
The Panorama exposé feeds into the narrative that ADHD is somehow not a real condition, with real adverse effects; that people are being over medicated and ‘something needs to be done’ without any suggestions as to what this should be. This level of noise is unhelpful, strays into culture-wars territory, and detracts from the patient in need and what we can do to help them.
So what do we do? The RCPsych has helpfully stepped in with a response, and a link to their very useful self-help guide to ADHD, including plenty of non-pharma options to enable your patients to life safely with ADHD, and even to harness the benefits and thrive with it.