ADHD services for adults

Awareness of ADHD is rising, and demand for diagnosis and support services continues to grow. To meet this demand, it's essential that local services adapt to ensure they are accessible and meet the needs of the community.

Current challenges

The current service model is diagnosis rather than needs-led. This means people who may be struggling are not getting the early support they need.

The focus on diagnosis is also driving significant growth in demand for ADHD assessments. Not all people referred to assessment services need a formal diagnosis. If this is not addressed, the demand for diagnosis will keep growing. As the number of people now being referred for an assessment is far more than the services were originally designed to cope with, waiting times are growing

The increasing costs of this rising demand are not affordable and are putting a huge strain on NHS budgets.

There are many NHS and Independent Sector organisations providing ADHD assessments for our local population, which is leading to inconsistencies in the way care is accessed and provided.

For these reasons, the way we deliver our Adult ADHD services in Cheshire and Merseyside has to urgently change so they can better understand and meet people’s needs.

Our vision

Our vision for transformed Adult ADHD services in Cheshire and Merseyside is one that seeks to:

consistently understand need
increase the ability for more people to access support to meet their needs without a requirement for a formal diagnosis
increase diagnostic capacity through a new primary care service and
ensure sufficient secondary care provision for those with the most complex needs.

New model

A new care model is currently being rolled out across Cheshire and Merseyside. It seeks to ensure everyone who needs help with suspected ADHD symptoms is supported, rather than just those people who are diagnosed with ADHD.

It does this by being needs-led, not diagnosis-led, focusing on helping people access early support to manage their symptoms. Referrals to diagnostic assessment services remain available for those with symptoms that meet specific clinical criteria.

New primary care services are at the heart of this model, working with people to better understand their needs and to help them to access relevant information, education and support. GPs with additional ADHD training will also have the ability to undertake assessments for those who need it.

More information will be provided as this new innovative approach is rolled out, commencing in Cheshire West, Liverpool and Wirral.

Commissioning policy

NHS Cheshire and Merseyside has introduced a commissioning policy from 23 December 2025 to ensure that, for new patients referred from this date, there is provision of a consistent level of service for adult patients with suspected ADHD, as well as ensuring delivery of a more integrated referral assessment, diagnosis and treatment pathway, thereby preventing patients from experiencing a differential level of care/pathway depending on which provider they are referred to for support.

The commissioning policy follows a robust evidence base, in line with NICE guidance and the Royal College of Psychiatrists recommendations.

NHS Cheshire and Merseyside is implementing a clear referral threshold, whereby a diagnostic assessment is only offered if an adult’s (18 years and above) ADHD symptoms continue to cause significant functional impairment in at least two life domains and environmental modifications have been implemented and reviewed.

Domains refer to key areas of daily functioning that are commonly affected by ADHD, including interpersonal relationships, educational progress and learning, occupational performance and employment, risk awareness and safety (e.g. driving, financial management), and self-care.

In addition, the initial diagnostic appointment in the ADHD assessment pathway should be conducted face-to-face, and a mandatory face-to-face appointment for a physical health review is required before initiating pharmacological treatment. This allows for a comprehensive assessment and baseline physical investigations, which will inform the safety and appropriateness of initiating pharmacological treatment for ADHD. Clinical decisions must be based on reliable observations, and a recent prevention of future deaths report supports this approach.

The full policy can be accessed here.

Changes to ADHD assessments in Cheshire and Merseyside for 2025/26

What’s changing?

NHS Cheshire and Merseyside Integrated Care Board (ICB) is reducing the number of assessments it is purchasing for the remainder of 2025/26.

Whilst this will mean fewer assessments than available in the first half of the year, the overall level of assessments in 2025/26 will still be above that provided in 2024/25.

Why are things changing?

Demand for ADHD services across England is higher than the NHS financial resources available.

NHS Cheshire and Merseyside’s spending on ADHD services has risen sharply – from £11 million in 2023/24 to £35 million this year.

Unless we reduce the number of assessments, NHS Cheshire and Merseyside faces an overspend of around £23m which is neither sustainable nor affordable within existing budgets and places other services at risk.

Why can’t the ICB spend more on ADHD assessments?

Integrated care boards – such as NHS Cheshire and Merseyside – are responsible for planning and purchasing NHS services and making sure they stay within their local budgets.

NHS Cheshire and Merseyside’s spending on ADHD services has risen sharply – from £11 million in 2023/24 to £35 million this year.

This level of spend is not affordable within existing budgets and places other services at risk.

What this means for you

If you have already been referred for an assessment, you will remain on the waiting list but are likely to wait longer for an assessment than you would have otherwise.

If you believe you may have ADHD and have not already been referred for an assessment, you should use the resources detailed below under What if I am worried about my wellbeing whilst waiting? and What support is available without a diagnosis?

Should you require further support make an appointment to see your GP.

What if I am worried about my wellbeing whilst waiting?

We know waiting can be tough. In the meantime, you can:

Visit the NHS web pages
Explore local support groups or charities
Talk to your GP about self-management strategies

Thank you for your patience and understanding.

If you are feeling anxious, stressed or overwhelmed there’s a range of support available.

If you feel you need more urgent help, options are available without needing to contact your GP practice first.

What support is available without a diagnosis?

ADHD has three core symptoms – being inattentive, being hyperactive, and being impulsive – although not everyone has all three. Many people manage their ADHD successfully, but ADHD can be challenging to live with.

You can find out more about ADHD and how it can affect you in this video.

You may also find the following resources helpful:

Workplaces and community services can often provide support and adjustments without a formal diagnosis. Please speak with your GP practice or employer about what may be available.

What happens if...

There is a private diagnosis – is the person required to undertake another assessment on the NHS pathway?

Where a person has received a diagnosis following a private, self-funded assessment and wants to transfer to an NHS-funded service, they will need to have an assessment via an NHS-funded service. To do this, they need to be referred by their GP. In doing so they will apply NHS Cheshire and Merseyside’s Commissioning Policy.

Please note that these individuals would be added to existing waiting lists.

There is a private diagnosis and the practice refuses to enter into shared care

Whilst practices across Cheshire and Merseyside are commissioned to provide shared care, it is for the practice to determine whether they enter into shared care on a person-by-person basis. In reaching this decision the practice will consider a number of issues, including the practice’s knowledge of and relationship with the provider they are being asked to share care with.

However, in the case of private diagnoses, in its document ‘General practices responsibility responding to private healthcare’, the British Medical Association (BMA) states that entering into shared care with a provider ‘is not recommended due to the general NHS constitution principle of keeping as clear a separation as possible between private and NHS care’.

Therefore, it is highly unlikely that a practice will enter into shared care with a provider who has given a private diagnosis.

There is a private diagnosis and the person is wanting the ICB to fund private titration of medication

The ICB would not fund private titration. Where a person has a positive diagnosis following a private, self-funded assessment and wishes to receive NHS treatment, including titration, they need to be referred by their GP for an NHS assessment. When referring the person, the practice will apply NHS Cheshire and Merseyside’s Commissioning Policy.