Bold claim: poorly regulated private clinics are putting children with ADHD at real risk. And this is the part most people miss: the problem isn’t just about rules on paper—it’s about how care is actually delivered to kids.
Children with ADHD are being exposed to powerful stimulant medications after minimal or no in-person examinations, according to doctors. A surge in remote-only assessments has led to what clinicians describe as widespread and unsafe practice, with diagnoses and prescriptions being issued via video links. In response, health authorities in Greater Manchester have overhauled prescribing rules to require face-to-face checks to safeguard young patients.
Rashad Nawaz, a consultant pediatrician based in Manchester and Liverpool, has written to national regulators and health bodies. He warns that some young patients with potential heart issues have been prescribed stimulants by national online providers without any in-person evaluation.
Prescribing stimulants such as methylphenidate (the active ingredient in brands like Ritalin) is allowed, and there are non-stimulant options as well. While a University of Southampton study suggests the benefits of ADHD medications generally outweigh certain cardiovascular side effects like higher blood pressure and heart rate, guidelines from the National Institute for Health and Care Excellence (NICE) insist on a full physical assessment, including cardiovascular history and a hands-on heart exam, before treatment starts.
Nawaz reports finding three children in the last year with previously unknown heart murmurs. One child was already taking ADHD medication prescribed by a large national provider. After referral to pediatric cardiology, two were found to have harmless “innocent” murmurs, but one had a ventricular septal defect (VSD), a hole in the heart. None showed symptoms yet, but the VSD could carry implications down the line. Nawaz emphasizes that these cases illustrate the risk of skipping thorough physical assessments prior to medication and characterizes the situation as a serious clinical risk and potential negligence.
The NHS is grappling with record demand for ADHD services. Many families use the “Right to Choose” pathway to access private care funded by the NHS. Yet senior clinicians warn that some private providers—some with lucrative NHS contracts—may lack the infrastructure to keep patients safe.
Professor Marios Adamou, an NHS psychiatrist, describes a clinical vacuum created by heavy reliance on online-only providers. Local GPs are increasingly asked to conduct checks for private services or even initiate treatment, which places doctors in a difficult position because the prescribing clinician bears full legal and clinical responsibility for safe prescribing.
Nawaz also raises concerns about a shrinking workforce, pointing to health professionals trained mainly in adult care who end up treating children without adequate pediatric expertise. In one example, a child was prescribed medication via video link despite a family history of congenital heart disease—an important detail missing from the private provider’s report.
Nawaz notes that many large private providers do not typically see children face to face. Reports suggest they prescribe medications with only basic measurements (often supplied by parents) and a health-check checklist, without a proper physical examination.
In light of these concerns, NHS Greater Manchester has launched a new “safety first” pathway. Chief Medical Officer Professor Manisha Kumar explains the goal: children’s safety must come first. The region’s approach introduces face-to-face assessments and physical health checks before ADHD medications can be prescribed.
Under the new system, families retain the right to choose, but the practical effect is that providers cannot initiate ADHD treatment in Greater Manchester without demonstrating a robust, in-person clinical assessment.
