Primary Care ADHD Pathway: Eliminating Delays and Delivering Safe, Equitable Prescribing

WellBN

Project summary

We identified significant delays in ADHD assessment, with patients waiting up to 15 months locally and historically 3–4 years. These delays created clinical risk, including deterioration in mental health and crisis presentations, and contributed to health inequalities, with some patients accessing private diagnosis while others remained untreated.

In response, we developed a primary care–led ADHD pathway to deliver timely, safe, and equitable care.

The model includes GP-led assessment, pharmacist-led medication initiation, titration and monitoring, and structured clinical governance. We partnered with Quays Healthcare to support scalable delivery. The pathway provides end-to-end care including diagnosis, pharmacological treatment where appropriate, and transition to shared care.

To reduce reliance on medication alone, we introduced multidisciplinary group consultations led by a GP, psychiatrist and health coach, focusing on coping strategies, lifestyle interventions and peer support.

This approach enabled a balanced model of care, supporting appropriate prescribing while improving patient outcomes.

The impact has been significant. Waiting times reduced from 15 months to approximately 4 weeks. Over 500 patients have been assessed and managed within primary care. 49% of patients were initiated on medication, with the remainder supported through structured non-pharmacological interventions.

The pathway eliminated referrals to secondary care for ADHD assessment, representing a 100% reduction in demand. This reduced system pressure and improved continuity of care.

The model also delivers strong value. Previous secondary care costs were approximately £2,500–£3,000 per patient. Our in-house pathway costs around £600 per patient, delivering substantial cost efficiency alongside improved access and outcomes.

This project demonstrates how primary care can deliver a scalable, safe and equitable ADHD service, improving access, reducing risk, and supporting appropriate prescribing.