ADHD services for adults

ADHD (attention deficit hyperactivity disorder) is a condition that affects how someone pays attention, controls their actions, and manages their energy levels. People with ADHD might find it hard to focus, stay organised, keep still, or control impulses – but everyone’s experience is different.

In our services, an adult means anyone who is 18 years old or older.

More people are learning about ADHD, and more adults are asking for assessments and support. To keep up with this, local services need to change so they are easier to use and can help everyone who needs them.

Current challenges

Right now, the service focuses mostly on giving a diagnosis rather than meeting needs. This means many people who are struggling are not getting early help. If this keeps happening, waiting lists will continue to grow, and those with the greatest need will wait longer for support.

More and more people are being sent for ADHD assessments.

Being referred for an ADHD assessment does not always mean someone will receive an ADHD diagnosis. The assessment is done to understand what is causing the difficulties, and sometimes the outcome may be something different.

The rising demand costs a lot of money and is putting pressure on the NHS.

There are many NHS and private organisations offering ADHD assessments. This means people are not always getting the same type of care.

Because of all these challenges, our Adult ADHD services in Cheshire and Merseyside need to change so we can understand and support people better.

Our vision

Our plan for better Adult ADHD services in Cheshire and Merseyside aims to:

understand people’s needs in a clear and fair way
help more people get support without needing a diagnosis
increase the number of ADHD assessments through a new primary care service
make sure specialist services are available for people with the most complex needs

New model

A new care model is now being introduced across Cheshire and Merseyside. It aims to support anyone who needs help with possible ADHD symptoms, not just those who get a diagnosis.

This new model focuses on people’s needs, not just diagnosis. It helps people get support early, so they can better manage their symptoms. Diagnostic assessments are still available for adults whose symptoms meet certain clinical criteria.

Primary care services are a key part of this new model. They will help people understand their needs and find useful information, education, and support. Some GPs will also have extra ADHD training so they can carry out assessments when needed.

Commissioning policy

From 23 December 2025, NHS Cheshire and Merseyside have an Adult ADHD commissioning policy This makes sure all new patients referred from this date get a fair and consistent level of service. The aim is to create a clearer, joined-up pathway for referral, assessment, diagnosis, and treatment.

As detailed in the Policy, it follows strong evidence and national guidance, including NICE and the Royal College of Psychiatrists.

A diagnostic assessment will only be offered if an adult (18+) still has symptoms that cause significant difficulties in carrying out everyday tasks in at least two areas of daily life, and if changes to their environment have already been tried and reviewed.

Example areas of daily life include :

relationships
learning and education
work
safety and risk (for example driving or managing money)
self-care

The Policy also requires the first diagnostic appointment to be held face-to-face. Before starting any ADHD medication, there must also be a face-to-face physical health check. This helps make sure treatment is safe. Clinical decisions must be based on reliable information, and recent safety reports support this approach.

The full policy can be found on our website.

Changes to ADHD assessments in Cheshire and Merseyside for 2025/26

What’s changing?

NHS Cheshire and Merseyside Integrated Care Board (ICB) will be buying fewer adult ADHD assessments and titrations for the rest of 2025/26. Titration means slowly changing someone’s medicine to find the lowest dose that works well.

There will be fewer assessments and titrations than earlier in the year, but the total number for 2025/26 is still higher than in 2024/25.

Plans for ADHD assessments and titrations for 2026/27 are being developed.

Why are things changing?

More people across England need ADHD help than the NHS has money for.

In Cheshire and Merseyside, the cost of ADHD services has gone up a lot. It was £11 million in 2023/24 and is £35 million this year.

If we do not reduce the number of assessments and titrations, the ICB will overspend by about £23 million. This is not affordable and could affect access to other NHS services.

Why can’t the ICB spend more on ADHD assessments?

Integrated Care Boards (ICBs) plan and buy local NHS services. They must stay within their budgets.

Titration means slowly changing the amount of medicine a person takes to find the dose that works best for them.

Doctors start with a small dose and then adjust it up or down until it is safe, helpful, and causes the fewest side effects.

It is done carefully and over time.

Spending on ADHD services in Cheshire and Merseyside has grown from £11 million in 2023/24 to £35 million this year. This is too much for the current budget and puts access to other NHS services at risk.

What this means for you

If you already have a referral for an assessment, you will stay on the waiting list. But you may have to wait longer than before.

If you think you may have ADHD and have not been referred, you can use the support listed under “What if I am worried about my wellbeing whilst waiting?” and “What support is available without a diagnosis?”

The number of titrations is being reduced in the same way as assessments. If you are waiting for titration, you will stay on the list, but the wait may be longer.

However, the reduction in the number of assessments will mean fewer people waiting for titration overall.

If you are worried about your wellbeing while waiting, please use the support listed under “What support is available whilst I wait for titration?”

If you need more help, please make an appointment with your GP.

What if I am worried about my wellbeing whilst waiting?

We understand waiting can be hard. You can:

Visit the NHS website
Look for local support groups or charities that support individuals/families with ADHD symptoms/challenges
Talk to your GP about ways to manage your symptoms

If you are feeling anxious, stressed or overwhelmed, there is support available.

If you need urgent help, there are services you can use without calling your GP first.

You can also browse resources that can support you under “What support is available without a diagnosis?”

What support is available without a diagnosis?

ADHD has three main symptoms:

finding it hard to focus (inattention)
feeling very active (hyperactivity)
acting quickly without thinking (impulsivity)

Not everyone has all three. Some people manage their ADHD well, but it can still be challenging.

You can learn more in this video.

Resources

The information pack below contains practical advice and resources to support you:

Adult ADHD Information Pack

You may also find these helpful:

Workplaces and community services may offer support or adjustments even without a diagnosis. Please speak to your GP practice or your employer to see what is possible.

Is there support available whilst I wait for titration?

After your diagnosis, your clinician should have already talked with you about first-line, non‑medication support based on NICE guidance (NG87). This includes:

A treatment plan that looks at your whole life, including school, work and mental health
Advice about healthy lifestyle and food
Support if you also have other mental health or neurodiverse needs
A structured psychological (talking therapy) programme for ADHD
Regular follow‑ups in person or by phone

If you are struggling while waiting for titration, please contact the service that provided your diagnosis. They can review your first-line plan with you and suggest what might help.

More advice is available under “What if I am worried about my wellbeing whilst waiting?”

What happens...

If a person has had a private diagnosis and would like ongoing treatment funded by the NHS. Is the person required to undertake another assessment on the NHS pathway?

If someone has paid for a private ADHD assessment and then wants to use NHS services, they will still need an NHS assessment.

To do this, they must be referred by their GP.

Please note: people in this situation will be added to the NHS waiting list.

If a person has had a private diagnosis and the practice refuses to enter into shared care

GP practices in Cheshire and Merseyside are allowed to give shared care.

But each GP practice decides for each person whether they can safely do shared care.

They think about things like:

how well they know the provider
the information they have available and their confidence in the quality of the assessment

However, the British Medical Association (BMA) Principles for Shared Care Prescribing has guidance that says GP practices should not enter shared care with a private provider. This is because the NHS tries to keep private care and NHS care separate.

This means it is very unlikely that a GP practice will agree to shared care following a private diagnosis.

If a person has had a private diagnosis and the person is wanting the ICB to fund private titration of medication

The ICB will not pay for private titration.

What is titration?