This is part of a series of blogs on getting assessed for ADHD so check out the overview page for links to the other related posts.
TL;DR: The quickest way to get an ADHD assessment on the NHS is to get your GP to refer you to a provider under Right to Choose. psychiatry-uk and ADHD 360 have detailed guidance on how to do this and forms that your GP can use. If the assessment results in a diagnosis you can continue under right to choose for titration if medication is recommended. This means you only pay NHS prescription charges. An assessment will have about a 6 month wait. Titration a further 3 months. These lead times are continually changing.
The quickest way to get an assessment is to pay for a private assessment. This will cost in the region of £300-600 for the initial assessment. If medication is recommended you may have to pay for the clinical wrapper around this as well as private prescription charges. Budget at least £1000 for the assessment and titration. You will then need to convince your GP to continue to prescribe post titration if you don’t want to continue paying private prescription charges
As covered above various ADHD providers describe the steps to getting an assessment. I’m going to describe my journey through assessment, diagnosis, and into titration over a series of blogs. Titration is the process of working out what medication and what dose works for you. I’ll also share some of the info I have picked up along the way from others I know who have been through this. There is a lot to cover so I’ll break it down. This blog will give an overview of the whole process and then subsequent blogs will dive a little deeper into each step. I am going to assume you want to do this through the NHS and therefore will be following the right to choose (RTC) path.
What is right to choose?
In short, in the NHS, If a GP needs to refer you for a physical or mental health condition, in most cases you have the legal right to choose the hospital or service you’d like to go to. So if your local health authority has a 2 year ADHD assessment waiting list and another provider has a shorter wait you can be asked to be treated there. And with the use of video calls for assessments its possible to be assessed anywhere in the country from the comfort of your home.
Step 1: Why do you want an ADHD assessment?
I’ll share my story in more detail here. In summary: It might sound like a silly question but it is one you must ponder before step 2 which is contacting your GP. Part of this involves thinking about how the traits which you think are ADHD like negatively impact your life. For me, at the time of seeing my GP, it was an answer. I wanted to know if I had ADHD so I could see if that explained why some things just don’t work for me.
You will also need to consider if you are mentally resilient enough to go into the process. Many of us find this whole process stressful so you will need to think about how you can marshal the support to get through it.
Step 2: Meet with your GP
To use Right to Choose you will need a GP referral to get an assessment. You will want to know which provider you would like to be referred to as they all have slightly different referral processes and forms. This can be an anxiety-inducing time so I have provided a guide on what I did along with the advice I had from others in this blog.
Step 3: Follow up with the GP and RTC admin team
This step should not be necessary, but it was for me. And for everyone I’ve spoken to. In a most un ADHD fashion I checked in with my provider a few weeks after my GP referral to see if they had received the paperwork. They had not. So I chased the Doctors team. And I checked in again and P-UK now had some of the forms but not all of them. Around again. Eventually they got all the right forms. It took a couple of months to get this far. Frustrating but understandable given how much pressure the NHS is under.
Step 4: Complete the pre-assessment questionnaire
When you have been successfully referred you will be asked to fill in some forms. The specifics will vary by provider but the general format is self-report information (childhood and adult), medical history, reference report childhood, and reference report adult.
The medical history form serves 2 main purposes. The first is to highlight anything that might result in ADHD-like symptoms but isn’t ADHD. The second is to determine if there are any medical considerations that would impact on the recommended course of action if you are diagnosed. For example some medications cant be used if you have certain pre-existing conditions.
The self-report just asks a bunch of questions, linked to the diagnostic criteria, for you to answer with childhood and adult examples. The referee report is similar but you ask someone else to fill it in for you.
I go into more detail on the pre assessment paperwork in this blog including more on the referee aspects.
Step 5: The Assessment
I was more anxious than expected leading up to this so I’ll describe this step in more detail here. The format for my assessment was an hour long video call. I cover this in detail here. We went over some of the examples from my pre-assessment and added new examples. We went over some key medical history validating what was on that form. At the end of the call I was informed I had a positive diagnosis of combined type (impulsive, hyperactive) ADHD. Medication was the recommended treatment.
This was all confirmed in writing and led to me going on the titration waiting list.
Step 6: Titration
This is where I am currently at. The consultant psychiatrist has recommended a 6-week drug ramp up which will be monitored. I share my pre-titration thinking here.
Step 7: Transfer back to GP
If titration completes successfully and you have a stable dose of medication with positive effects and manageable side effects you can move out of titration and back to GP care. You will then transition back to your GP who will write your prescriptions. There may be an annual check-up or a journey back into titration if things change.
Titration does not work for everyone. If medication does not provide positive effects, or if the medication’s side effects outweigh the benefits then other treatments will need to be explored. This is likely to be counselling or coaching in some form or other.