In England, doctors are sounding the alarm over poorly regulated clinics that are putting children with ADHD at risk. These clinics are prescribing powerful stimulants without conducting essential physical examinations, which is a serious concern. A surge in remote-only assessments has led to what one clinician calls "widespread and unsafe practice." Children are being diagnosed and medicated via video link, raising questions about the safety and effectiveness of this approach.
Rashad Nawaz, a consultant paediatrician, has written to national regulators and health bodies, highlighting cases of young patients with potential underlying heart conditions who were prescribed stimulants without a single in-person check. This is despite guidelines from the National Institute for Health and Care Excellence (NICE) that mandate a full physical assessment, including a cardiovascular history and a physical examination of the heart, before treatment begins.
Nawaz has identified three children in the past year with previously unknown heart murmurs, one of whom was already taking ADHD medication prescribed by a large national provider. This is a critical issue, as stimulants can have significant side effects, including increased blood pressure and heart rate. A study from the University of Southampton found that the benefits of taking drugs for attention deficit hyperactivity disorder outweigh the impact of these increases, but the risks cannot be ignored.
The NHS is struggling to cope with record demand for ADHD services, and many families use the "Right to Choose" scheme to access private care funded by the NHS. However, senior clinicians argue that some private companies, many of whom hold lucrative NHS contracts, lack the infrastructure to ensure patient safety. Prof Marios Adamou, an NHS psychiatrist, said the reliance on online-only providers had created a dangerous clinical vacuum.
Nawaz also warned of a "deskilling" of the workforce, claiming that health professionals trained primarily in adult care were "medically treating" children without adequate paediatric experience. In one instance, a child was prescribed medication via video link despite a family history of congenital heart disease, a critical detail that was entirely absent from the private provider’s report.
In response to the warnings, NHS Greater Manchester has implemented a new "safety first" pathway. Prof Manisha Kumar, the region’s chief medical officer, said the move was necessary because "children’s safety has to come first." While the new system maintains the right to choose, it in effect bars providers from initiating treatment in the region unless they can prove a robust, in-person clinical assessment has taken place.
