ADHD Shared Care UK : Why Fragmented Pathways Are Failing Us

In my previous blog for BASW, I explored the social work implications of late-diagnosed ADHD in women. I wrote from both professional and personal perspectives, highlighting how gendered expectations and systemic blind spots delay recognition and support. This follow-up continues that thread — because diagnosis is only the beginning. What happens next, particularly in the UK’s fragmented shared care landscape, is a story of delay, distress, and disempowerment.

My Journey: Diagnosed but Disconnected

I was diagnosed with ADHD as an adult. Like many, I turned to private assessment after facing long NHS wait times. The process was thorough, compassionate, and resulted in a stabilising medication plan. But when I approached my GP to transfer prescribing under a shared care agreement, I hit a wall.

Despite being under the care of a GMC-registered psychiatrist, my GP declined to take on the prescription. I was told I’d need to be reassessed through the NHS. And so, I’m back on the waiting list — again. No continuity. No bridging care. Just a reset button.

What ADHD Shared Care UK Means — and Why It’s Failing Patients

Shared care is meant to be a collaborative arrangement between specialists and GPs, allowing patients to receive ongoing treatment in primary care once stabilised. But in practice, it’s optional. GPs are not obliged to accept shared care from private providers, even when the specialist is fully qualified and the patient is stable.

This discretionary model creates postcode lotteries and leaves thousands in limbo. According to NHS Digital’s ADHD Management Information report (May 2025), over 549,000 people in England are currently waiting for ADHD assessments. That figure includes many who, like me, are stuck between systems — diagnosed privately but unable to access NHS prescribing.

The Right to Choose: A Partial Solution?

Some patients navigate this by using NHS-commissioned Right to Choose ADHD providers, such as Psychiatry UK or Clinical Partners. These providers are more likely to have shared care agreements with GPs. But awareness is low, and eligibility criteria can be confusing. Many patients book private assessments without knowing their GP’s stance, only to find themselves back at square one.

Regional Inequities and Systemic Gaps

In areas like Cumbria, Chesterfield, and Essex, GPs have explicitly refused shared care with private ADHD providers. Meanwhile, some Integrated Care Boards (ICBs) are commissioning new ADHD services to reduce wait times — but implementation is patchy and slow.

An NHS England advisory note from October 2025 urges systems to “consider demand management and equitable access when redesigning ADHD pathways.” But without national standardisation, these efforts remain inconsistent.

The Human Cost

The impact of these delays is not just clinical — it’s emotional, economic, and social. Being forced to “start again” with NHS reassessment is demoralising. It undermines stability and trust. For those with executive dysfunction, navigating these systems is especially challenging.

The Centre for Mental Health estimates that untreated ADHD costs the UK economy over £17 billion annually. That figure reflects lost productivity, increased mental health crises, and the strain on families and services.

What Needs to Change

• National standardisation of shared care agreements for ADHD.
• Mandatory GP participation in shared care for stabilised patients under GMC-registered specialists.
• Clear guidance for patients on Right to Choose pathways.
• Trauma-informed systems that recognise the emotional toll of fragmented care.

A Social Work Perspective: Beyond Diagnosis, Towards Justice

ADHD is not just a clinical label; it’s a social justice issue. As social workers, we are trained to see the person in their environment, to understand how systems shape experience, and to advocate for equity. Yet when it comes to neurodivergence, our systems are failing, especially for those diagnosed later in life, those navigating private pathways, and those caught in the shared care gap.

The current model of ADHD care in the UK is fragmented, inequitable, and traumatising. It disproportionately affects women, working-class communities, and those with co-occurring conditions. It punishes people for seeking help privately and forces them to repeat assessments, retell their stories, and re-prove their needs — all while managing executive dysfunction, emotional dysregulation, and the daily realities of life with ADHD.

Social workers are uniquely positioned to challenge this. We understand the impact of delayed care on mental health, relationships, employment, and self-worth. We see how neurodivergent people are misunderstood, misdiagnosed, and marginalised. And we know that continuity of care is not a luxury — it’s a right.

Call to Action: What Can We Do?

Advocate for Standardised ADHD Shared Care UK

Push for national guidance that obligates GPs to accept shared care from GMC-registered specialists, including those in the private sector. Stabilised patients should not be penalised for how they accessed diagnosis.

Educate and Empower

Help people understand their rights under the NHS Right to Choose scheme. Support them in navigating referral pathways, requesting reasonable adjustments, and challenging gatekeeping.

Embed Neurodiversity in Practice

Ensure ADHD and other neurodivergent conditions are recognised in assessments, care plans, and safeguarding frameworks. Use trauma-informed approaches and avoid deficit-based language.

Challenge Systemic Barriers

Raise concerns about regional disparities, long wait times, and the emotional toll of fragmented care. Use supervision, team meetings, and professional forums to amplify these issues.

Speak from Lived Experience

If you are neurodivergent yourself, consider sharing your story. Representation matters. It helps dismantle stigma and builds trust with clients who feel unseen.

Closing Reflection

We cannot continue to treat ADHD care as optional, discretionary, or secondary. The consequences are too great. As social workers, we must be part of the solution — bridging gaps, challenging injustice, and building systems that honour neurodivergent lives.

My journey is one of many. Let’s make sure it leads somewhere better.