In an independent review into mental health conditions, ADHD and autism, published on 9 October 2026, the government expressed that it wants to change who looks after people with ADHD. Specialists should concentrate on complex cases and starting medication, while long-term care should move into primary care, the review added.
According to the review, medication has a stronger evidence base than psychosocial treatments for ADHD, such as parent training and cognitive behavioural therapy. It also noted that stimulant effect sizes are “among the largest reported for any psychiatric intervention”. A review of the harms of ADHD medicines, which was commissioned for the report, found little evidence that they were causing widespread harm in England, despite a large rise in prescribing.
The real difficulty is in getting people from diagnosis to treatment. New ADHD diagnoses have risen sharply since 2020, but the review found that the proportion of people going on to receive medication has fallen. Giving evidence to MPs on 14 October 2026, the review’s vice-chair, Gillian Baird, said that the rate of moving from an ADHD diagnosis to treatment had halved since the COVID-19 pandemic, with “no follow-through at the moment”.
Those who do start treatment can then struggle to stay on it. Many are started on medication by independent providers, then rely on their GP to take over prescribing under ‘shared care’. However, the average GP acceptance of these arrangements has fallen to around 62%, the review said. It noted that to compensate for this, some patients pay for private prescriptions, while others have their treatment disrupted or stopped, adding that diagnosis can become “the beginning of another wait”.
To make ADHD care work, the review recommended that funded shared-care arrangements should be held to a national standard (recommendation 5), while medication reviews and safe deprescribing should be strengthened and standardised (recommendation 4), and neighbourhood teams built across professions (recommendation 6).
Much of this is medicines work: titrating doses, checking blood pressure, pulse, weight and growth, as well as reviewing — at least once a year — whether treatment should continue.
However, pharmacists — the NHS’s medicines experts — are only mentioned once in the review’s 599 pages, in a table in the annex.
This is surprising given the ADHD taskforce, whose work the review builds on, said in November 2025 that pharmacists should be able to train in specialist ADHD care, including prescribing. It suggested prescribing pharmacists take on post-diagnostic management, follow-up and physical health checks, in a stepped model like the one used for diabetes. The Fonagy review, however, does not take this up.
Pharmacists are already doing some of this work in specialist services. At NHS Lanarkshire in Scotland, prescribing pharmacists in child and adolescent mental health services took over medication reviews for patients on psychiatrists’ caseloads. Between February 2025 and April 2025, the team had 394 patients and offered 482 appointments, around 70% of which for titrating ADHD medicines. Attendance was 93% — up from 74% in the same period in 2024 — while the average wait for a first review is now just under 7 weeks, which was against a 12-week target.
At East and North Hertfordshire NHS Trust, a pharmacist with an ADHD scope of practice, working five hours per week alongside two consultants during a six-month pilot, saved an estimated 20–26 hours of consultant time per month on repeat prescribing for stable patients. She also completed shared-care agreements so children could move to GP prescribing. Elsewhere in the county, the results of an evaluation at Hertfordshire Partnership University NHS Foundation Trust, published in 2021, revealed that two pharmacist prescribers could manage a caseload of 50 children and young people with ADHD, adjusting doses with consultant approval.
Some pharmacists go further. In Shropshire, Telford and Wrekin, a specialist pharmacist in child and adolescent mental health services carries out ADHD assessments for young people and supports them and their families after diagnosis.
These are local examples that would need evaluation before wider roll out and all sit in specialist services rather than general practice or community pharmacy. But the routine medication work pharmacists took on — freeing up specialists’ time — is the work the review wants moved into primary care.
Pharmacists also need to be written into the workforce plans set out in recommendation 6 on the development of neighbourhood teams
This does not mean primary care can simply absorb long-term ADHD care. According to the review, GPs are turning down shared care because of concerns about the quality of independent providers’ assessments and about whether specialist support will still be there after handover. Pharmacists would face the same problem. They would need confidence in the diagnosis and a specialist team to turn to, as well as the training and supervision the review recommends for the wider workforce.
The review asked the government to publish a cross-government mental health strategy in 2026. That gives the Department of Health and Social Care and NHS England a short window to name independent prescribing pharmacists as able to take on titration, monitoring and review as part of the national shared-care standard. Newly qualified pharmacists now join the register as independent prescribers, so the number able to do this work will only grow.
As the medicines experts in the multidisciplinary team, pharmacists must be included in those teams from the start
Pharmacists also need to be written into the workforce plans set out in recommendation 6 on the development of neighbourhood teams. The review’s example of a neighbourhood team for children and young people lists ten professions and services, from speech and language therapy to specialist teachers and the voluntary sector. Pharmacists are not named, even though many of the children with ADHD these teams support will be taking medicines that need careful titration and monitoring. As the medicines experts in the multidisciplinary team, pharmacists must be included in those teams from the start and in the national competency framework the review proposes.
Integrated care boards meanwhile do not need to wait. They should commission pharmacist-led ADHD clinics now in general practice or community pharmacy, rather than starting another round of pilots. The taskforce has already suggested how to pay for them: ring-fenced funding for locally commissioned services or the new neighbourhood provider contracts that NHS England is still developing.
The Fonagy review is right that ADHD care needs to move closer to home. But it has all but ignored the profession best placed to make that happen. The government must not make the same mistake. PJ
