Concerns over the safety of children diagnosed with attention deficit hyperactivity disorder (ADHD) have escalated due to the practices of poorly regulated private clinics. Doctors have raised alarms about these clinics prescribing powerful stimulants without conducting essential physical examinations. The increased use of remote assessments has led to what some clinicians describe as “widespread and unsafe practice,” where diagnoses and prescriptions occur solely through video consultations.
In response to these clinical warnings, health authorities in Greater Manchester are revising their prescribing guidelines. The new regulations will mandate face-to-face assessments before any ADHD medication is prescribed, aiming to safeguard the health of children affected by this condition.
Rashad Nawaz, a consultant paediatrician with clinics in Manchester and Liverpool, has taken the initiative to alert national regulators and health bodies about the risks involved. He reported treating young patients with undetected heart conditions who had been prescribed stimulants by national online providers without any in-person evaluations. “None of them had symptoms,” Nawaz noted, “but the one with a ventricular septal defect (VSD) may do in the future.”
The National Institute for Health and Care Excellence (NICE) stipulates that a comprehensive physical assessment, including a cardiovascular history and a heart examination, must occur prior to the commencement of treatment. Despite this, Nawaz has identified three children over the past year with previously unknown heart murmurs, raising serious concerns about the adequacy of remote assessments.
In one case, a child had been prescribed ADHD medication without a face-to-face consultation, despite a family history of congenital heart disease. Nawaz indicated that many children are undergoing insufficient physical assessments before receiving potentially harmful medication. “This worries me greatly. It is serious clinical risk and negligent,” he said.
The NHS is grappling with unprecedented demand for ADHD services. Many families are utilizing the “Right to Choose” scheme, which allows access to private care funded by the NHS. Yet, senior clinicians argue that numerous private companies, some of which hold lucrative NHS contracts, lack the infrastructure necessary to ensure patient safety.
Prof Marios Adamou, an NHS psychiatrist, articulated the dangers posed by an over-reliance on online-only providers. “Local GPs are frequently asked to perform these checks on behalf of private services or even start treatment,” he explained. “This places clinicians in a difficult position, given that the prescribing clinician carries full legal and clinical responsibility for safe prescribing.”
The situation has also raised concerns about the professional competence of those prescribing medication. Nawaz warned of a “deskilling” trend where health professionals, primarily trained in adult care, are treating children without adequate paediatric experience.
In light of the serious implications of these findings, NHS Greater Manchester is implementing a new “safety first” pathway. Prof Manisha Kumar, the region’s chief medical officer, emphasized the necessity of these changes, stating, “children’s safety has to come first.” The new protocols will require face-to-face assessments and physical health checks prior to the prescription of ADHD medication.
While the new system acknowledges the right to choose, it effectively prohibits providers from initiating treatment in the region unless they can demonstrate that a thorough in-person clinical assessment has occurred. This shift aims to address the growing concerns regarding the safety of children receiving ADHD treatment and to ensure that proper medical practices are upheld.
