An independent provider in the Wiltshire area

Mrs X complains about the treatment her son, Mr X, received from the Practice following an initial ADHD assessment in December 2024. Specifically, Mrs X complains the Practice:

• unnecessarily completed a second assessment • reached an incorrect diagnosis; and • did not explain how it reached its decision.

4. Mrs X says the second assessment concluded Mr X did not have ADHD. Subsequently, Mrs X sought a private assessment which found Mr X has combined type ADHD (ADHD-C). This led to a seven-month delay in starting medication which she says impacted his academic future as he was preparing to sit his 11+ exam. Mrs X says she also had to pay for the cost of the private assessment and for Mr X’s ongoing medication and treatment.

5. As an outcome Mrs X would like and acknowledgement of failings including an explanation of how the Practice reached two different diagnoses. Mrs X would also like a financial remedy to cover the cost of Mr X’s treatment.

6. Mr X was initially assessed by the Practice for ADHD in December 2024. ADHD is a group of behavioural symptoms that include difficulty concentrating and paying attention, hyperactivity and impulsiveness. Following this assessment, the assessor informed Mrs X verbally that the medical conclusion of the assessment was that Mr X had ADHD.

7. The clinician that conducted the initial assessment in December 2024 ceased working for the Practice prior to completing the necessary documentation for the assessment. As a result, the Practice reassessed Mr X for ADHD.

8. Mr X was reassessed by the Practice for ADHD in February 2025. This assessment did not lead to a diagnosis for ADHD.

9. Mrs X complained to the Practice and asked for an explanation about the change in diagnosis. Mrs X sought a privately funded assessment which diagnosed Mr X with ADHD.

13. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

Reassessment

Mrs X complains about the Practice’s decision to undertake a second assessment. In its response the Practice explained the clinician who undertook the first assessment no longer works with the Practice. When they left, they had not fully concluded work on some cases. It acknowledged and appreciated the clinician may have given feedback to Mrs x before completing the written report.

14.

15. Under those circumstances the Practice explained it knew it had provided a service which was incomplete. Therefore it decided to undertake a full reassessment of all the affected cases, with a selected group of experienced clinicians. It explained a specialist nurse practitioner completed Mr X’s reassessment.

16. We consider the Practice took this decision in line with relevant guidelines.

17. We refer to the following local policy set out by the Practice: Contingency Plan for Clinicians unexpected absence – Outstanding Feedback and Reports’. The policy states:

‘for the reallocation of work on a permanent basis when the initial clinician cannot return to work within 4-6 weeks, draft reports may be completed by a clinical lead or delegated clinician. If no draft exists, a replacement clinician may redo the assessment.’

18. In this instance, we can see the initial clinician left the organisation without notice and without completing the draft reports. As such, the Practice followed its own policy and reallocated Mr X’s assessment to a new clinician.

We can see from this, the Practice acted appropriately in conducting a reassessment of Mr X in these circumstances. Mr X required reassessment in order to achieve a sound clinical conclusion. We consider the Practice to have acted appropriately.

19. We understand the process of reassessment must have been frustrating for both Mrs X and her son. For the reasons set out above, we do not consider there are any indications of a service failure in relation to this aspect of Mrs X’s complaint.

Diagnosis

20. Mrs X says the Practice failed to provide clarity around the diagnosis it has reached. Mrs X says the clinician who completed the initial assessment indicated Mr X had ADHD-C. The second clinician reached a decision indicating Mr X did not have ADHD. Mrs X seeks clarity in regarding the change in assessment.

21. In its response, the Practice explained all its clinicians must follow NICE guidelines, ensuring that the approach to ADHD diagnosis is consistent, and based on the best available clinical evidence.

22. We refer to NICE guidelines on the diagnosis and management of ADHD:

‘For an ADHD diagnosis, symptoms of hyperactivity, impulsivity or inattention should:

• meet the diagnostic criteria for hyperkinetic disorder in DSM-5 or ICD-11 (but exclusion based on a pervasive developmental disorder or an uncertain time of onset is not recommended) and • symptoms present before 12 years age • cause at least moderate psychological, social, or educational or occupational impairment based on interview or direct observation in multiple settings and • be happening often, occurring in 2 or more important settings including social, familial, educational or occupational settings.’

23. We can see a detailed clinical and psychological assessment was conducted by the Practice in February 2025 in accordance with NICE guidelines and was compared appropriately to the diagnostic criteria. Our clinician has reviewed Mr X’s assessment and confirms our view.

24. We can see the Practice conducted a detailed assessment of Mr X’s mental state and included observational reports of behaviour from parents and teachers of Mr X. Mr X also completed a self-assessment questionnaire which the Practice was able to use to reach a clinical conclusion.

25. Questionnaires are used as additional tools to support the diagnosis, and the information is compared to the diagnostic criteria. The ADHD diagnostic criteria is a standardised criteria for clinicians to use during an ADHD assessment to allow for consistent clinical conclusions for the diagnosis of ADHD.

26. We can see there is also evidence of information from a variety of sources including Mr X’s school and private tutor.

27. We understand this must be frustrating to receive differing diagnosis. Considering the evidence and advice, we can see the Practice conducted a thorough assessment in February 2025 in line with the relevant guidelines. For reasons set out above, we conclude there are no indications of a service failure in relation to this aspect of Mrs X’s complaint.

Explanation

28. Mrs X complains the Practice did not provide her with a satisfactory explanation as to how the clinician reached differing diagnosis in the first and second assessment conducted.

29. GMC, domain 2: Patients, partnership and communication, guidelines state:

‘You should check patients’ understanding of the information they’ve been given, and do your best to make sure they have the time and support they need to make informed decisions if they are able to.’

30. We can see the Practice explained the circumstances surrounding the clinician who conducted the first assessment having left the Practice. Further, it explained that the necessary paperwork to confirm the assessment diagnosis had not been completed and therefore a re-assessment was required. We can also see it explained how it reached a different decision. This is in line with Good Medical Practice. For this reason, we saw no indications of a failing

31. We understand the process of re-assessment would have been frustrating, particularly when provided with a diagnosis that contradicts the initial diagnosis provided verbally.

1. We were sorry to hear of how Mrs X and her son, Mr X, were affected by the assessment process for attention deficit hyperactivity disorder (ADHD).

2. We have carefully considered Mrs X’s complaint about the Practice. Having done so, we do not consider there to be any indications of service failings in Mr X’s care and treatment.

3. We acknowledge our decision will be disappointing for Mrs X. We are sorry for any further distress our decision may cause, and we hope our explanation set out below shows clearly how we have considered her complaint.