The Handover Problem: What to Ask Before Booking a Private ADHD Assessment
For adults in England who suspect they have attention deficit hyperactivity disorder, the wait for an NHS assessment can stretch to several years in parts of the country. Against that backdrop, a private assessment — commonly £500 to £1,500 for the diagnostic appointment alone — can look like a clean solution. For many people it genuinely is.
The complication usually arrives later, in a GP consultation room, when a clinician's letter asks the practice to take over prescribing. That arrangement is a shared care agreement: a specialist diagnoses, initiates and stabilises treatment, and the GP continues prescribing and monitoring under an agreed protocol. It is voluntary, it is not a patient entitlement, and practices are entitled to say no. A growing number do.
Why the handover matters more than the appointment
A diagnosis on paper changes little on its own. What changes things is access to medication — usually a stimulant such as methylphenidate or lisdexamfetamine, or a non-stimulant such as atomoxetine or guanfacine — and that access depends on a chain of clinical responsibility holding together. Most ADHD medicines are controlled drugs, which means ongoing review, physical monitoring and a clear line of accountability. If that chain breaks, the prescription stops.
None of this is an argument against going privately. It is an argument for asking better questions at the point of booking, while you still have leverage.
1. How is the diagnosis reached, and who signs it off?
Ask which diagnostic framework the clinic works to — DSM-5-TR or ICD-11 — and who actually conducts the assessment. Request the clinician's name and professional registration in advance, and verify it on the relevant register. Ask whether the process includes a developmental history and corroborating evidence from someone who knew you as a child, since adult presentation without that context is thinner ground. Structured tools such as the DIVA-5 or a validated symptom checklist are a reasonable minimum, not a guarantee. Thirty minutes on video with a self-report questionnaire is not the same product as a multi-session assessment, and it should not be priced as though it were.
2. Who looks after titration, and who checks my physical health?
Titration — finding the right drug and dose — typically runs over weeks to months and requires blood pressure, pulse and sometimes weight monitoring. Ask how many review appointments the package includes, what happens beyond that, and who reviews cardiovascular risk if you have pre-existing hypertension or a family history of cardiac problems. Ask, too, whether the clinic prescribes during titration and how those private prescription costs are incurred. A clinic that cannot describe its monitoring schedule in plain terms is unlikely to satisfy a cautious GP later.
3. What exactly will my GP receive?
Ask to see a specimen shared care letter before you pay. A practice needs a confirmed diagnosis with the evidence behind it, the named drug and dose, a monitoring schedule with defined responsibilities, who to contact in an emergency, and a named specialist. Letters that arrive without these elements are routinely declined, and the patient is left holding an unfinished process. It is reasonable to ask what proportion of the clinic's shared care requests are accepted, though treat any figure with polite scepticism.
4. What will this cost me twelve months from now?
The headline assessment fee is rarely the whole outlay. Add titration reviews, the cost of private prescriptions while the clinic prescribes (this varies considerably between pharmacies and between drugs), and any annual review fee. Compare that with the NHS position: the standard prescription charge in England is around £10 per item, with a prepayment certificate available if you need several; prescriptions are free in Scotland, Wales and Northern Ireland. If shared care is agreed, your costs fall to NHS levels — but the specialist review may still be charged for. Ask the clinic directly how annual reviews are handled once a GP is prescribing.
5. What is the plan if shared care is refused?
This is the question most often skipped and most often regretted. Will the clinic keep prescribing privately on an ongoing basis, at what monthly cost, and will it continue annual reviews and monitoring? Or does it discharge patients once the diagnostic report is issued? Get the answer in writing. A clinic that will not support you beyond the assessment should say so clearly, and you should factor that into your decision.
Two pieces of context worth knowing
First, Right to Choose. In England the NHS Choice Framework allows a GP to refer you to an alternative NHS-commissioned provider, which can shorten waits considerably. A purely private clinic does not qualify. Paying for an assessment in the belief that it converts into NHS-funded care is a common and expensive misunderstanding.
Second, supply. Since 2023 there have been periodic shortages of several ADHD medicines, and a GP who has agreed to prescribe may still be unable to dispense. Ask how the clinic handles shortages and whether it will support switching.
How to hold the conversation
Speak to your GP practice before booking, and ask what its shared care policy is in general terms; many practices will explain this without discussing your case. Get the clinic's answers by email. Check whether your private medical insurance covers any of it, and read the complaints and refund policy. If a clinic is evasive about diagnosis standards, monitoring or exit arrangements, treat that as information rather than an obstacle.
The private ADHD sector contains careful clinicians doing thorough work and, inevitably, businesses optimised for throughput. The difference is rarely visible in an advertisement. It tends to show up in a letter to a GP six months later.
