Fig. 2

Different ADHD clinical care provision models in England. Dashed lines indicate key areas of communication between general and specialist healthcare providers. Case A Primary care model in North Bristol, delivering mental healthcare in GP surgery by specialist mental health nurse alongside other common mental health problems (depression, anxiety disorders). Dealing with < 100 referrals at date of consensus meeting. Issues arising: transfer of care over to other primary care services where ADHD diagnoses are not recognised. Case B Hybrid service in the Wirral, taking referrals both from primary and secondary care. Some transfer of specialism into primary care with the development of GP hubs who complete annual reviews and freeing up specialist time for new assessments and more complex cases. This service currently manages approximately 500 referrals per year. Issues arising: sudden restriction of medication prescribing in primary care through prescribing formularies, financial limitations, and concerns about funding diversion from secondary into primary care. Case C Tertiary ‘light’ service model in Leicester, working closely with secondary service and providing training with long-term aim to transfer care of ADHD into secondary healthcare. Well supported by healthcare commissioners and currently dealing with over 1000 referrals per year. Issues arising: high caseload in secondary care restricts capacity to take on ADHD cases, even for secondary care clinicians with adequate training. The number of required annual reviews has built up over time to the point where tertiary care is struggling to manage caseload