Practice news · October 2026

Talking adult ADHD with GPs on Pulse in Focus

Published 21 October 2026 · by Caledonian Psychiatry

Earlier this month Dr David Crocker, Founder and Clinical Director of Caledonian Psychiatry, joined Pulse editor Sofia Lind on Pulse in Focus, Pulse’s podcast for GPs, to talk about adult ADHD care. The episode was released on 13 October 2026. It picks up from his talk on managing adult ADHD at Pulse LIVE Glasgow in September, a session Pulse described as very busy, with a huge amount of interest from the GPs in the room.

The conversation came at a contentious moment for general practice. A Pulse survey of 829 GPs had found that 7 in 10 believe adult ADHD is overdiagnosed, and a government-commissioned independent review in England had just recommended that GPs take on long-term ADHD management, supported by funded shared care arrangements and consistent national standards. The interview set out to give the debate more nuance: whether ADHD really is overdiagnosed, whether every assessment can be trusted, when shared care makes sense, and what GPs can do to help.

Overdiagnosis, or catching up?

Dr Crocker said he understood why GPs feel the way they do, given a fourteen-fold rise in ADHD diagnoses over the last 20 years. But he questioned whether that rise is overdiagnosis at all, or a catching up on people who were missed, many of them women and older adults.

“A lot of those individuals were missed years and years ago. A lot of them got through school, got through university, got through jobs without being caught. Now they’re being caught and the diagnosis rate is up.”

GPs responding to the same Pulse survey estimated that, on average, 81% of the patients they refer go on to be diagnosed. Dr Crocker suggested that a high figure may partly reflect good referring: a GP who refers a clearly depressed patient to a psychiatrist would expect most such referrals to be confirmed. By the time adults reach an ADHD assessment, many have faced very long waits or significant private costs, and have done their homework. He also acknowledged that there is little published evidence on how diagnosis rates vary between clinics, which makes it hard for GPs, regulators and specialists alike to judge.

Judging an assessment

Asked whether every assessment service can be trusted, Dr Crocker said there are now a great many of them, and that some lean so heavily on proformas, questionnaires and rating scales that the result reads as generic rather than as a full psychiatric evaluation.

At Pulse LIVE, a GP had asked whether it is really a GP’s job to weed out poor assessments. Dr Crocker accepted that this is a hard ask of a busy GP, but argued that a blanket “yes” to every report fails, and so does a blanket “no”. GPs, he said, can make a reasonable judgement:

“I think I can look at a reasonable cardiology report. And whilst not being an expert in cardiology at all, I could probably give an opinion as to whether I think it’s something that I would look into more detail or if it’s something I think is totally false.”

He suggested a few simple questions to ask of any report:

• Is it detailed enough, and does it consider other explanations for the symptoms?
• Is it consistent with your own knowledge of the patient, and with the referral you made?
• Is there a medically trained prescriber behind it, or is the GP being asked to carry all the risk?
• Are the tests it asks for actually indicated? Requests for an ECG and blood tests that are not clinically needed can be a sign of a weaker report.

The standards we hold our own assessments to are set out in quality standards in ADHD and autism assessment.

When shared care makes sense

On shared care prescribing, Dr Crocker said the “when” is fairly clear: when the GP believes it is in the patient’s interest, when the patient is stable and has had a meaningful improvement in their quality of life, when the specialist recommends it, and when there is trust between the GP and the specialist clinic.

The “why” is harder. If the NHS could see people quickly, he said, he would fully support the NHS route. But many patients in Scotland face waits of several years.

“Is it reasonable to ask a patient that’s struggling not to have treatment for 177 weeks? There is obviously an argument of people pushing in and going privately to skip the queue. But really, the bigger picture is, well, can we help the queue? And if we can’t, how do we as doctors help people in the interim?”

Another GP at Pulse LIVE had described her practice’s decision not to share care with any private provider, for the sake of fairness. Dr Crocker acknowledged that practices are under enormous pressure, but questioned whether a blanket refusal is really fairer. Inequity in healthcare already exists, he said, and a blanket rule risks “poor outcomes for everyone instead of good outcomes for some”.

How we work with GPs is set out on our shared care page.

What helps in a referral

Dr Crocker’s first point was that any comment from a GP helps. Screening questionnaires are easy to repeat in clinic; what specialists rarely receive is a long-term view of the patient and a GP’s common-sense judgement on whether an assessment is reasonable. Beyond that, the most useful information includes:

• examples of ADHD symptoms in both childhood and adulthood, since the diagnosis needs both and this is where many assessments fall short
• evidence of impairment across different settings: home, work, money and relationships
• alcohol and substance use, and other medicines
• cardiovascular and physical health screening, where the GP’s knowledge is invaluable
• any information at all about risk

“Those are all really lofty expectations, but anything is better than nothing.”

Clear roles and open lines

Dr Crocker encouraged GPs to contact the specialist at any time. During the recent medicine shortages, he said, few GPs had got in touch about alternatives, and he would have welcomed working through options together. He also stressed being explicit in shared care requests about who does what: how often the GP prescribes, how often the specialist sees the patient, what happens if the patient does not attend, and how either side raises a concern. The patient receives the same information.

“I think transparency and open communication stops people from falling through the cracks.”

A personal note

Dr Crocker, who was diagnosed with ADHD as an adult, closed with his own story. As a junior doctor he drank so much caffeine that he developed a heart rhythm problem and needed cardioversion at work (a procedure to reset the heart’s rhythm), and psychiatrists diagnosed his ADHD soon afterwards. By then he already had three degrees, one of them in medicine. His point was that qualifications, appearance and outward success can hide how hard things are on the inside.

“I’ve got many friends who are GPs… So I implore them to be kind in these scenarios.”

He added one last figure before the interview ended. Of every 100 adults in Scotland estimated to have ADHD, he said, only around 13 to 18 are receiving treatment: “So when we worry about the overdiagnosis, just keep that in mind.”

Listen and read more

You can listen to the conversation using the player above, or on Apple Podcasts or Spotify. The full episode, which also features BMA council chair Dr Tom Dolphin on physician associates, is on Pulse’s website, which is intended for health professionals. A transcript of Dr Crocker’s interview is on his profile page; the quotations above are taken from it, lightly edited for readability.

GPs and other professionals can find referral and shared care information on our page for referring professionals.