A challenge in the adult ADHD pathway today isn’t demand, waiting lists, or even funding — it’s fragmentation at the NHS Right to Choose (RtC) entry point.
GPs and the adults they refer often face limited information, inconsistent acceptance thresholds, and different providers across neighbouring ICBs due to national RtC commissioning arrangements and a lack of accessible data. Inequity is built in from the very start — long before anyone reaches a waiting list or clinician.
For adults, the cost is cognitive and emotional. People already managing executive‑function difficulties are asked to navigate a complex system, repeat their story, and chase updates. Those with the least capacity to manage complexity are the ones most disadvantaged.
Through the London Adult ADHD Transformation Programme, TPHC convened more than 75 pan‑London commissioners, clinicians, and operational leads across an expert Clinical Reference Group and two sub‑groups, and hosted a Q&A with the national NHSE RtC team. Together, colleagues shared challenges, surfaced good practice, reviewed progress, and agreed next steps.
A clear picture emerged: no ICB is facing this alone. The challenges are shared — and so are the solutions. The group identified priority areas where collaboration can drive system‑wide improvement: accredited providers at entry point, defined clinical thresholds, agreed assessment and treatment principles, and consistent quality expectations across London. These now underpin the next phase of TPHC’s work, including development of a London‑wide RtC Adult ADHD specification.
This also marked an important mindset shift.
ADHD is not a standalone service — it is a cross‑cutting population health issue. That reframing opens the door to better collaboration, digital innovation, and consistent quality standards across the system.
One action every ICB can take today
Once an RtC‑accredited adult ADHD provider list is agreed, publishing it — with clear referral information, expected timelines, and details on support while waiting — would immediately improve equity and reduce unnecessary re‑referrals. It gives GPs clarity and gives patients a more predictable, less stressful journey.
The London Adult ADHD Transformation Programme now moves into its next phase, accelerating system‑wide improvement through coordinated design and implementation.
If you’re committed to reducing variation and improving ADHD pathways — and want to explore how this work can strengthen your local system and improve outcomes, contact Alison Williams at alison.williams68@nhs.net.
About the author
Alison is an Assistant Director at TPHC, leading the London ADHD transformation programme alongside a highly skilled team. She has a proven track record in delivering complex, multi-system transformation programmes that drive sustainable improvements in health and care outcomes for the last 18 years.
Committed to inclusive leadership and partnership-building, Alison helps stakeholders achieve their ambitions while fostering long-standing, trusted relationships across London and beyond.
As a counsellor with a special interest in supporting neurodiversity in the workplace, she champions the unique strengths, perspectives, and talents that neurodivergent young people bring—helping them thrive, grow, and confidently contribute their full selves at work.
About TPHC
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