There’s a lot happening in ADHD and neurodivergence policy right now, and it’s easy to see the headlines without understanding what they mean for you day to day. Here’s where things actually stand, and — more usefully — what your options are if you’ve had a private ADHD diagnosis and your GP won’t take on shared care.
What’s happening: the short version
The Fonagy Review is the independent government review into mental health, ADHD and autism services, chaired by Professor Peter Fonagy. Its interim findings rejected the idea that most ADHD and autism are simply being “overdiagnosed”: underlying prevalence looks broadly stable, but diagnosis has become the gatekeeper for getting any support at all — in schools, at work, through benefits — and the review argues that’s a design flaw in the system. Fonagy has also publicly rejected the idea of the “snowflake generation” framing, pointing to real rises in youth distress, self-harm and eating conditions.
At the same time, the Parliamentary and Health Service Ombudsman has been publishing its own findings, based on around 3,000 complaints, showing roughly 562,000 open NHS ADHD/autism referrals, over 60% of them waiting more than a year, and cases where Integrated Care Boards (ICBs) wrongly told patients they couldn’t use their NHS Right to Choose entitlement at all. Separately, some ICBs have been capping or rationing Right to Choose referrals through “indicative activity plans” — effectively limiting how many people can exercise a right that, on paper, they still have.
So: one review says that the system’s design is the problem, one watchdog documenting that people’s existing rights are being mishandled, and a quieter administrative squeeze on the route many private patients rely on to get back into NHS-funded care. It’s a messy picture, and it explains why so many patients feel confused about what all this means for them.
Why GPs are saying no to shared care — and it’s usually not about your diagnosis
If your GP has declined a shared care agreement after a private assessment, it’s worth knowing this is very rarely a judgement on whether your diagnosis is real. Since late 2024, several Local Medical Committees have been actively advising GP practices to withdraw from ADHD shared care arrangements altogether, calling them unfunded secondary-care work being pushed onto general practice — in one case, GPs were offered £50 per patient per year and called it “derisory.” This is a funding and workload dispute between general practice and commissioners, playing out over the heads of patients who just want continuity of care.
Will the Fonagy Review get you shared care?
Probably not directly, and it’s worth being honest about that with anyone reading this. The review’s focus is the diagnostic and support system as a whole — who gets assessed, how prevalence is understood, how support is gated by diagnosis — rather than the specific mechanics of GP funding for shared care. It may shift the wider conversation, but it isn’t a lever you can point to right now to unstick an individual refusal.
What is more immediately useful: NHS England’s 2026/27 payment guidance for ADHD and autism services now sets out that assessment providers must send a formal, documented shared care request to the GP, and if the GP refuses or simply doesn’t respond within 21 days, the provider may be able to bill for ongoing medication management themselves rather than leaving the patient stranded. That’s a concrete, current mechanism — separate from the Fonagy Review — that’s worth asking your assessing provider about directly.
If you’re stuck right now, here’s a sensible order of steps:
- Make sure a formal, written shared care request has actually been sent by your diagnosing clinician or provider — not just discussed informally with your surgery. This starts the clock on the 21-day window.
- If your GP refuses or goes quiet, ask your assessment provider whether they can manage prescribing and monitoring directly under the new national payment framework, rather than waiting indefinitely on the GP.
- If a refusal seems to misstate your rights (for example, being told you can’t use Right to Choose at all), you can escalate to the ICB, and from there to the Ombudsman — whose recent report shows this is now a recognised, documented complaint category, not a fringe issue.
- Don’t treat medication access as the only route to support. The review’s own argument is that help shouldn’t be entirely gated behind diagnosis or prescribing status — which matters if you’re mid-process, waiting on shared care, or have decided medication isn’t for you. There is also the government gateway to support currently open to get funded ADHD coaching if you are in work.
Government Gateway Access to Work support
If you are employed (or about to start a job), Access to Work — the government grant scheme, applied for via Government Gateway, funds support for people with a health condition or disability to get or stay in work. It’s still running and still doesn’t need to be paid back or affect other benefits, and it covers things directly relevant here: one-to-one sessions with a mental health professional, support workers, job coaches, and assistive technology, alongside more familiar adjustments like travel costs.
However, it’s currently under real strain. As of early 2026 there were around 60,000-66,000 applications awaiting a decision, with some people waiting up to 37 weeks for an outcome. The government has announced a recruitment drive — nearly 500 extra caseworkers — aiming to clear the backlog entirely by September 2027, and payment turnaround for already-approved claims has improved to a standard 10-day window. Whilst it’s genuinely worth applying, especially since urgent start-date cases are being prioritised (96% decided within 28 days), but apply as early as possible and don’t expect a fast general decision in the meantime.
Where coaching fits in
This last point is where our coaching offer is genuinely different from a lot of what’s out there. Because it’s delivered by qualified clinicians rather than generalist ADHD coaches, it can run alongside mental health support, adapting to a co-occurring difficulty. Importantly it doesn’t need a resolved shared care agreement or a settled prescription before it’s useful. If you’re stuck in the gap between a private diagnosis and NHS follow-through, that’s exactly the point at which support shouldn’t have to wait.
This is general information about the current policy landscape, not a guarantee of outcome — ICB policies and individual GP practice decisions vary, and anyone in a live dispute with their GP or ICB should check the specifics with them directly.
