Setting up a private ADHD service as a GP

You can set up a private ADHD service as a GP, but not as a GP diagnosing ADHD alone. NICE NG87 says ADHD should only be diagnosed by a specialist psychiatrist, paediatrician or other appropriately qualified healthcare professional with training and expertise in diagnosing ADHD. So a GP-led private ADHD clinic either employs specialist assessors, works inside a specialist-led team, or takes on titration and prescribing under shared care. This playbook covers private ADHD assessment, titration, controlled drugs, CQC, shared care, Right to Choose and pricing.

The short answer

To launch a private ADHD clinic you need specialist assessors who meet a written competency framework, and an assessment process built on NICE NG87: a full clinical and psychosocial assessment, a structured interview such as DIVA-5, rating scales and observer reports. You need a titration protocol with blood pressure, pulse and weight monitoring, and a private controlled drug prescriber number and private CD pads (FP10PCD in England) for stimulants. In England, you need CQC registration for treatment of disease, disorder or injury once you treat. In Wales, Scotland and Northern Ireland, check with HIW, HIS or RQIA.

Above all, you need an honest plan for long-term prescribing. NHS GPs can decline shared care with private providers, and many do, so assume you will prescribe and monitor for as long as the patient stays on treatment. Most GP-led services start with adults. Children need paediatric expertise, safeguarding arrangements and a working link with local CAMHS or community paediatrics.

Demand for private ADHD assessment, and the service models that work

Demand is high and NHS capacity is stretched. The independent ADHD Taskforce, set up by NHS England, published its interim report in June 2025 and its final report on 6 November 2025. NHS England’s plain English summary of the report says that only 25% of children and 15% of adults with ADHD get medication. The Taskforce recommended that ADHD be treated more like other common long-term conditions, with GP practices supported to take on some parts of ADHD care. Since May 2025, NHS England has published quarterly management information on ADHD referrals and waits.

Those are NHS recommendations, not a change to who may diagnose. NICE NG87 is still the standard a private service is judged against.

Three realistic models for a GP

Model	Who diagnoses and starts medication	Your role as a GP
A. Multidisciplinary clinic you own	Employed or contracted specialist assessors: consultant psychiatrists for adults, and paediatricians or child and adolescent psychiatrists for children. Specialist nurses or other clinicians can assess if they meet your competency framework.	Medical director: governance, the physical health and cardiovascular baseline, titration to protocol, monitoring and prescribing.
B. GP with a special interest	You, once you have completed recognised ADHD training and supervised assessments, working within a specialist-led team that reviews your cases.	Assessor and prescriber, with a specialist available for complex cases, second opinions and peer review.
C. Titration and ongoing prescribing under shared care	A specialist service (NHS or private) diagnoses, and starts medication or agrees your titration protocol.	Titration, monitoring and repeat prescribing under a written shared care agreement, with a route back to the specialist.

What is not a model is a GP making the diagnosis alone from a questionnaire. NICE says a diagnosis should not be made solely on rating scales or observational data, and that medication should only be started by a healthcare professional with training and expertise in diagnosing and managing ADHD.

Packages and formats

• Assessment only, with a written report.
• Assessment plus titration: diagnosis, baseline physical checks, then titration to a stable dose.
• Titration for an existing diagnosis. Patients diagnosed elsewhere who need a prescriber. Have your specialist review the original report before you accept it, because report quality varies.
• Ongoing medication management: monthly prescriptions, six-monthly checks and an annual review, often as a subscription.

Assessments can be in person, by video or hybrid. The physical baseline still needs measured height, weight, pulse and blood pressure.

Regulation: CQC, HIW, HIS and RQIA

England (CQC)

CQC’s scope guidance makes an unusual distinction. It does not consider the diagnosis of ADHD (or autism) to be treatment, so a service that only diagnoses does not need to register for treatment of disease, disorder or injury. Diagnosis of ADHD is also outside diagnostic and screening procedures, because it does not use equipment to measure physiological data.

Once you prescribe, titrate or monitor medication, you are treating, and you need treatment of disease, disorder or injury. A private GP service is usually registered for this already, so the work is updating your statement of purpose and checking with CQC whether anything else needs a variation, for example a new location or starting to see children. If you add ambulatory blood pressure monitoring, note that CQC excludes non-ambulatory blood pressure readings and 12-lead ECGs from diagnostic and screening procedures, but not ambulatory monitoring. See which CQC regulated activities you need.

The Taskforce recommended that CQC should have oversight of all ADHD service providers, NHS and private. That is a recommendation, not a change in the law, but build an assessment-only service as if it will be inspected.

Wales, Scotland and Northern Ireland

• Wales: HIW says independent clinics and independent medical agencies (remote or online services) where private medical services are provided regularly by doctors must register under the Care Standards Act 2000.
• Scotland: Healthcare Improvement Scotland registers independent clinics (premises where doctors, nurses and other listed professionals provide services), and it started regulating independent medical agencies, which have no clinic premises, in 2025.
• Northern Ireland: RQIA registers independent clinics and independent medical agencies.

CQC’s carve-out for diagnosis-only services is English guidance. Don’t assume it applies elsewhere: ask HIW, HIS or RQIA in writing before you offer assessments in their nation.

Clinical governance: assessment, titration and monitoring to NICE NG87

The private ADHD assessment

NICE NG87 says a diagnosis rests on a full clinical and psychosocial assessment, a full developmental and psychiatric history, observer reports and an assessment of mental state. Symptoms must meet DSM-5 or ICD-11 criteria, cause at least moderate impairment and occur in two or more important settings. The assessment should also cover coexisting conditions, social, educational or occupational circumstances and physical health. For children, it includes the parents’ or carers’ mental health.

A practical assessment pathway looks like this:

1. Pre-assessment screening. Self-report and informant rating scales, a health questionnaire and any school or previous reports. NICE names the Conners’ rating scales and the Strengths and Difficulties Questionnaire as helpful added tools, not a basis for diagnosis on their own.
2. Structured diagnostic interview. DIVA-5, from the DIVA Foundation, covers the DSM-5 ADHD criteria in childhood and adulthood and the impairment they cause. Young DIVA-5 covers ages 5 to 17, and DIVA-5 ID covers people with an intellectual disability.
3. Collateral history. The UK Adult ADHD Network’s assessment quality standard (AQAS) says information should be gathered from one or more informants whenever possible, ideally including someone who knew the person as a child.
4. Differential diagnosis. AQAS expects the report to say the symptoms are not better explained by another condition, with real-life examples of each symptom. It also says total assessment time should be at least two hours in most cases.
5. Objective testing, if you use it. NICE lists QbTest as an option to help diagnose ADHD in people aged 6 to 17.

Eligibility and exclusions

Write down who you will and won’t see. Typical reasons to refer on, or to delay treatment, include active psychosis or mania (NICE says to stop ADHD medication during an episode), active substance misuse or a high risk of diversion, a current eating disorder, significant self-harm risk, and the cardiac features NICE lists for a cardiology opinion before treatment. NICE says to obtain a second opinion or refer to a tertiary service if symptoms do not respond to one or more stimulants and one non-stimulant.

Baseline before medication

NICE lists what the pre-treatment assessment should include:

• a review confirming the person still meets the criteria and needs treatment
• mental health and social circumstances, including coexisting conditions and a risk assessment for substance misuse and drug diversion
• a medical history, current medicines, and height and weight measured against the normal range
• baseline pulse and blood pressure, measured with an appropriately sized cuff
• a cardiovascular assessment

An ECG is not needed before stimulants, atomoxetine or guanfacine unless there are specific cardiac features or the person takes a medicine that may increase cardiac risk.

ADHD titration

During titration, NICE says to record symptoms, impairment and adverse effects on standard scales at baseline and at each dose change, and to review progress regularly with a specialist, for example by weekly telephone contact. Titrate in line with the BNF or BNF for Children until symptoms, behaviour and functioning improve with tolerable adverse effects. Titrate more slowly, and monitor more often, in people with autism, tic disorders, learning disability, mental health conditions or physical conditions such as cardiac disease or epilepsy. NICE uses 6-week trials at an adequate dose before switching between first-line medicines.

Monitoring and annual review

What	NICE NG87 frequency
Heart rate and blood pressure	Before and after each dose change, and every 6 months
Weight (adults)	Every 6 months. Consider BMI and changing medication if weight change persists.
Height (children and young people)	Every 6 months, plotted on a growth chart
Weight (children 10 and under)	Every 3 months
Weight (over 10 and young people)	At 3 and 6 months after starting, then every 6 months
Medication review	At least once a year, by a healthcare professional with training and expertise in managing ADHD

NICE advises against routine blood tests or ECGs unless clinically indicated. If someone has sustained resting tachycardia over 120 beats per minute, an arrhythmia, or a systolic blood pressure above the 95th centile (or a clinically significant rise) on two occasions, reduce the dose and refer them on.

Children, consent and safeguarding

Seeing children changes the service. You need paediatric or child psychiatry assessors, teacher and parent rating scales, growth monitoring and safeguarding arrangements for the whole team. Young people aged 16 or 17 are presumed able to consent. Under 16, a child can consent if they are Gillick competent, and otherwise someone with parental responsibility consents. NICE also expects young people to be reassessed at school-leaving age, with a planned transition to adult services.

Agree how you will work with local CAMHS or community paediatrics first. If a child is already under an NHS service, coordinate with it rather than prescribe in parallel. This is why many GP-led services start with adults only.

Audit and outcome measures

• change in symptom and impairment scores from baseline
• the proportion of patients reaching a stable dose, and how long titration takes
• monitoring checks and annual reviews done on time
• quarterly peer review of a sample of reports against AQAS
• the diagnosis rate per assessor, since an unusually high or low rate is a signal worth reviewing
• lost prescriptions, early requests and any suspected diversion

Use the same approach as any clinical audit in your practice.

Prescribing ADHD medicines privately: controlled drugs and pharmacy partners

Medicine	Controlled drug status	Place in NICE NG87
Methylphenidate	Schedule 2	First line for children 5 and over, and first line (with lisdexamfetamine) for adults
Lisdexamfetamine	Schedule 2	First line for adults. In children, after a 6-week methylphenidate trial.
Dexamfetamine	Schedule 2	When someone responds to lisdexamfetamine but can’t tolerate its longer effect
Atomoxetine	Not a controlled drug	When stimulants are not tolerated or have not worked
Guanfacine	Not a controlled drug	Children and young people, when stimulants are not tolerated or have not worked. In adults, only with tertiary service advice.

Schedule 2 stimulants on private prescription

• The form. Private Schedule 2 and 3 prescriptions go on your nation’s private CD form: FP10PCD in England, with the equivalents for Wales, Scotland and Northern Ireland set out in our private prescribing guide.
• Your private CD prescriber code. The form must carry your six-digit private prescriber identification number. NHSBSA says private prescribers without one should contact their local NHS England team, which arranges the number and the pads. It is separate from any NHS prescriber number you hold. Apply weeks before launch.
• The 30-day rule. NHSBSA strongly recommends no more than 30 days’ supply of Schedule 2, 3 and 4 drugs on one prescription. In practice, that means a new prescription every month.
• Validity. The prescription is valid for 28 days. It must include the dose, form, strength and total quantity in words and figures.
• Paper, not electronic. Private Schedule 2 and 3 prescriptions cannot be sent electronically. The pharmacy needs the wet-signed original before it dispenses, so build posting or collection into your monthly workflow.

Safe custody and records

Most private ADHD services hold no stock: the patient or a pharmacy partner receives the FP10PCD and a community pharmacy dispenses it. If you ever hold Schedule 2 stimulants, keep them in a locked controlled drugs cabinet and keep a CD register, as regulation 19 of the Misuse of Drugs Regulations 2001 requires. In any case, store blank FP10PCD pads securely, log serial numbers, and keep a clear prescription history in the record so early or duplicate requests stand out.

Remote prescribing

GMC prescribing guidance says that if you don’t have access to relevant information from the patient’s records, you must not prescribe controlled drugs or medicines liable to misuse, except in narrow circumstances. Before you start a stimulant, get a summary of the NHS record with the patient’s consent, and make consent to share information with their NHS GP a condition of treatment.

Choosing a prescribing and pharmacy partner

Decide who signs the prescriptions: your own prescribers, or a contracted specialist under your protocol. For medicines that are not Schedule 2 or 3, such as atomoxetine and guanfacine, private e-prescribing to a pharmacy partner that dispenses and delivers is lawful with an advanced electronic signature. It saves the patient a trip and saves you the post.

Choose a record system that keeps that choice open. A good example is Jump EHR, a newer system on the market, which integrates private e-prescribing with several pharmacy partners (SignatureRx, Roseway, Chemist4U, Healistic and CloudRx), so you and the patient aren’t tied to one pharmacy. Semble and Hero Health are established alternatives, so compare the prescribing integrations each offers. Whatever you choose, Schedule 2 stimulants still go on a paper FP10PCD or your nation’s equivalent.

Systems: records, questionnaires, monitoring and letters

• Clinical record. Coded diagnoses, templates for assessment and titration, and an audit trail.
• Questionnaires. Online rating scales for the patient and informants before the assessment and at each dose change, saved straight into the record.
• Monitoring. A flowsheet for blood pressure, pulse and weight, growth charts for children, and recalls for six-monthly checks and the annual review.
• Prescribing log. Every CD prescription with its date, quantity and serial number, plus a flag for early requests.
• Letters. Structured letters to the patient’s NHS GP at diagnosis, at the start of medication, at the end of titration and after each annual review. See how to send consultation notes to the NHS GP.

Staff, training and how to become an ADHD assessor

• Medical director (often the GP). Owns the protocols, prescribing governance, audit and the relationship with regulators.
• Specialist assessors. Consultant psychiatrists for adults, and paediatricians or child and adolescent psychiatrists for children. Specialist nurses or other clinicians can assess if they meet your written competency framework. Check each one’s GMC or NMC registration, and specialist register entry where relevant.
• Prescribers for titration. Doctors or independent prescribers with ADHD medication training, working to your protocol.
• Nurse, HCA and admin support. Observations, questionnaires, monthly prescription logistics and letters.

How to become an ADHD assessor

There is no single licence. The UK Adult ADHD Network (UKAAN) runs courses in diagnosis and assessment and in pharmacological treatment of adult ADHD, but it says attendance alone is not enough to assess independently. Its assessment standard expects assessors to have worked clinically in mental health for several years, to have completed specific training, and to have done a run of supervised assessments (it suggests 10 to 20 cases). For a GP, a realistic route is training, then supervised assessments within a specialist-led team, then a defined scope of practice that you discuss at appraisal.

Write the competency framework down: training, supervised cases, the age groups each assessor may see, and report peer review.

Indemnity

Tell your indemnity provider before launch. Check that your cover includes ADHD assessment, controlled drug prescribing, remote consultations, children if you see them, and patients in each nation you serve. Contracted assessors need their own cover too. See indemnity for private GP work.

Premises and equipment

• A validated blood pressure monitor with a range of cuff sizes, including paediatric cuffs if you see children
• Calibrated scales and a stadiometer, plus growth charts
• A 12-lead ECG if you want one on site (CQC does not treat it as a diagnostic and screening procedure)
• Secure, locked storage for blank FP10PCD pads

For remote patients, decide how you will get reliable baseline measurements, for example a clinic visit or a local partner clinic.

Pricing and unit economics for a private ADHD clinic

The figures below are illustrative only. They are worked examples to show the structure, not market rates. Use your own assessor fees and local prices.

Stage (illustrative)	Example price	Example direct cost	Example contribution
Adult assessment: about 3 hours of specialist time including the report	£950	£525 (specialist at an assumed £150 an hour, plus £75 of admin and systems)	£425
Titration package: baseline checks and about 5 contacts over 8 to 12 weeks	£500	£300 (3 hours of prescriber time at an assumed £100 an hour)	£200
Monthly medication management: a CD prescription each month and six-monthly checks	£50 a month	£25 a month (prescriber time, admin, tracked post)	£25 a month
Annual review by a specialist	£250	£150	£100

The patient also pays the pharmacy for the medicine. Tell them that before they book.

What drives margin: assessor cost, missed appointments, how many patients go on to titration, and how long they stay on monthly management. The monthly CD prescription is the hidden cost: each one is a wet-signed paper form that must reach the pharmacy.

Other cost lines: indemnity, regulator fees, the record system, rating scale licences where they apply, a QbTest licence if you use it, specialist supervision and peer review, training, and marketing. For a broader model, see private GP pricing and break-even.

Marketing an ADHD clinic: advertising rules

• Don’t advertise the medicines. Regulation 284 of the Human Medicines Regulations 2012 bans advertising likely to lead to the use of a prescription-only medicine, and CAP Code rule 12.12 says POMs must not be advertised to the public.
• Promote the consultation. ASA guidance says websites should primarily offer the consultation, not the POM. Don’t name medicines on the homepage, and keep price lists free of product claims. “Private ADHD assessment for adults” is fine, but anything implying a prescription is the result is not.
• Don’t promise a diagnosis. Say that the assessment may or may not confirm ADHD, and publish what happens next in each case.
• Be clear about the whole cost. Show the assessment, titration, monthly management and medicine costs, and explain that the NHS GP may decline shared care.

See advertising rules for private GPs for the wider rules.

ADHD shared care, Right to Choose and the NHS GP

ADHD shared care with private providers

NICE NG87 expects shared care with primary care after dose stabilisation, but that was written for NHS pathways. The BMA’s position on private providers is different:

• Its guidance on private healthcare (updated 31 August 2023) says shared care with private providers is not recommended, because of the principle of keeping NHS and private care as separate as possible.
• All shared care is voluntary, and practices can decline on clinical and capacity grounds. Prescribing then stays with the private provider.
• It says shared care may be appropriate where a private provider is delivering commissioned NHS services and appropriate arrangements are in place.
• Its shared care principles (updated September 2026) say a practice can decline shared care for any reason.

NHS England’s guidance on prescribing responsibility says clinical responsibility sits with whoever signs the prescription, and that the specialist keeps prescribing until the GP has agreed to take over in each individual case. So plan to prescribe and monitor for the whole course of treatment, and price it that way.

If a patient asks their NHS GP anyway, an ADHD shared care agreement should include:

• the assessment report
• the medicine, dose and how long they have been stable (the BMA notes stabilisation is often 3 months)
• who does each monitoring check, and how often
• the annual review, which you keep
• how the GP can reach a specialist quickly
• when to refer back or stop

What Right to Choose means for a private ADHD service

Many patients ask about Right to Choose, so be clear about how it differs from your service. In England, the NHS Choice Framework gives patients a legal right to choose which provider they are referred to for a first outpatient appointment with a consultant-led or mental health professional-led service. The provider must have an NHS contract for that service, the referral must be clinically appropriate, and the right does not apply if the patient is already receiving care for that condition. The assessment is then NHS-funded and free to the patient.

• A self-funded private clinic is not a Right to Choose provider. To take Right to Choose referrals you need an NHS contract for the service, which means NHS commissioning, NHS data reporting and no charge to the patient. That is a different business from a private service.
• Volumes are managed. NHS England’s October 2025 advice to systems on ADHD service delivery says commissioners can agree or set an indicative activity plan with each provider and manage activity against it, so Right to Choose capacity varies by area. Check the current position with the ICB rather than relying on reports.
• It is England only. The Choice Framework applies to the NHS in England.
• Be straight with patients. Right to Choose may cost them nothing. Your offer is speed, continuity and choice.

Communicating with the registered GP

Ask for consent to share at booking. Write at diagnosis, at the start of medication, at the end of titration and after every annual review. Say who is prescribing and monitoring, so there is no risk of the NHS GP prescribing in parallel. See how independent GPs should communicate with NHS GPs.

Launch checklist for a private ADHD clinic

1. Choose your model (A, B or C) and your age range. Starting with adults only is simpler.
2. Recruit or contract specialist assessors, and write the competency framework.
3. Write the assessment protocol: screening scales, DIVA-5 or Young DIVA-5, collateral history, differential diagnosis and the report template.
4. Write the eligibility and exclusion criteria, and a titration and monitoring protocol to NICE NG87.
5. Apply for your private CD prescriber number and FP10PCD pads (or your nation’s equivalent).
6. Set up secure pad storage, a serial-number log and a monthly prescription workflow, including posting or collection.
7. Choose a pharmacy partner for non-CD medicines, and agree how CD prescriptions reach the pharmacy.
8. Confirm your regulator position: in England, treatment of disease, disorder or injury and an updated statement of purpose; elsewhere, written confirmation from HIW, HIS or RQIA.
9. Extend your indemnity, and check that contracted assessors have their own.
10. Configure the record: templates, rating scales, monitoring flowsheets, recalls, the CD prescription log and NHS GP letter templates.
11. Write the safeguarding policy and, if you see children, agree working links with CAMHS and community paediatrics.
12. Write consent and information-sharing forms, and patient information covering costs, outcomes, shared care and Right to Choose.
13. Check website copy against the ASA guidance on prescription-only medicines.
14. Set the audit plan, run a small pilot, and review it before you open fully.