Overview
In 2021, a young person in Brighton took their own life after waiting more than two years for an ADHD assessment. They were not a patient at our practice, but the tragedy deeply affected the team at WELLBN, a GP practice in Brighton. This event, and the unacceptable delays it highlighted in access to neurodivergent care, became the catalyst for a local solution: a primary care-led ADHD diagnostic and treatment service for adults aged 18 and over.
Over four years later, the WELLBN Adult ADHD Service has become a pioneering example of what community-based care can achieve—delivering safe, timely, and holistic ADHD care to patients who might otherwise fall through the cracks.
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The Challenge
Nationally, adult ADHD services are overstretched. Patients commonly wait two to five years for assessment and treatment via secondary care pathways. For many—especially those from deprived areas or with coexisting mental health needs—these delays can lead to crisis, school or job loss, relationship breakdown, or worsening mental health.
In Sussex, the Integrated Care Board (ICB) spends approximately £15 million per month on outsourced Right to Choose (RTC) providers, some charging up to £3,000 per diagnosis. Despite the scale of this spending, many patients still experience fragmented or incomplete care, often without any psychosocial support.
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The Solution
WELLBN designed and implemented an NHS-based, in-practice ADHD service—entirely within a primary care setting. Over the course of four years, we:
• Trained a multidisciplinary team of GPs and pharmacists through the UKAAN programme
• Built a complete pathway from referral to diagnosis, treatment, and follow-up
• Developed robust clinical governance and quality assurance systems
• Costed the service at £1,000 per patient—a third of some commercial providers
• Introduced a unique holistic consultation stage to integrate psychosocial support
Our model not only improves access, but also addresses health inequalities by proactively supporting patients who would otherwise struggle to navigate the system.
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Service Pathway
1. Referral & Screening: Patients are referred or self-refer and complete structured ADHD screening tools. Patients need to join the practice.
2. Comprehensive Diagnostic Assessment: A full assessment by trained clinicians using validated tools (e.g. DIVA-5), collateral history, and risk review.
3. Holistic Consultation: A dedicated session between diagnosis and treatment to explore lifestyle, mental health, education, employment, and support needs.
4. Initiation of Treatment: Where appropriate, medication is offered with shared decision-making and ongoing titration support.
5. Handover or Continued Care: Stabilised patients are discharged to GP care or supported within the practice as needed.
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Impact
• Reduced waiting times from years to weeks/months
• Increased access for deprived and underserved populations
• Higher patient satisfaction through continuity and holistic care
• Cost-effective delivery at 66% lower cost than some RTC providers
• Clinically robust model in line with NICE and UKAAN standards
“Before this service, I had nowhere to turn. I didn’t even realise ADHD could affect adults like me. Being diagnosed changed everything—now I have support, medication, and hope.”
— Patient Testimonial (anonymised)