What Keeps Leaders Up at Night?

By Kirsty Morris 

The conversation around ADHD often centres on diagnosis rates, waiting lists, and unmet need.

But behind every statistic is a clinic leader trying to make a service sustainable.

One thing that seems to be apparent is that:

• Growth isn’t the hard part – scaling safely, sustainably, and compliantly is.

So, what actually keeps ADHD clinic leaders up at night?

1️⃣ Patient Demand vs Clinical Capacity

Referrals are rising and awareness is increasing.

In many regions, demand significantly outpaces available assessment slots and leaders are therefore balancing:

• Reducing waiting times
• Protecting clinician wellbeing
• Maintaining diagnostic quality
• Avoiding rushed or inconsistent assessments

The tension is real: move too slowly and waiting lists grow; move too fast and quality risks slipping.

Scaling capacity isn’t just about hiring more clinicians. It’s about onboarding, supervision structures, consistent assessment frameworks, and clinical governance.

And that takes time.

2️⃣ Funding & Commissioning Uncertainty

Whether operating privately, under NHS contracts, or a hybrid model, funding structures can feel unpredictable.

I imagine the following questions will regularly come up:

• Will funding pathways remain stable?
• How do we forecast responsibly when demand fluctuates?
• How do we build something sustainable rather than reactive?

Scaling requires investment in people, systems, premises and technology.

But uncertainty makes long-term planning harder.

For many leaders, the challenge isn’t “How do we grow?”

It’s “How do we grow without overexposing the service financially?”

3️⃣ Compliance & Clinical Governance

As ADHD services expand, scrutiny increases. Regulatory compliance, documentation standards, safeguarding processes, prescribing protocols – all must evolve as the clinic grows.

A small team can communicate informally whilst a larger team requires structure.

What this means is:

• Clear SOPs
• Consistent assessment models
• Robust audit trails
• Defined prescribing governance
• Ongoing CPD and supervision frameworks

Compliance is of course a non-negotiable – but it can become overwhelming as complexity increases.

4️⃣ Patient Flow & Experience

From referral to assessment to titration and follow-up – patient flow is one of the most common operational bottlenecks.

Where do the main delays occur?

• Initial triage
• Admin processing
• Clinician availability
• Prescription turnaround
• Communication gaps

Each friction point impacts both patient experience and team workload.

And when services scale quickly, processes that once worked smoothly can suddenly feel strained.

5️⃣ Recruitment & Retention

Perhaps the most sensitive bottleneck of all.

ADHD services require:

• Clinicians confident in neurodevelopmental assessment
• Prescribers comfortable with ADHD medication management
• Admin teams who understand regulatory nuance
• Finding the right people is one challenge.
• Retaining them in a high-demand environment is another.

Burnout is a real risk – particularly when clinicians feel pressure from long waiting lists and emotionally complex cases.

Scaling without a recruitment strategy is of course, not sustainable.

So, What’s the Real Bottleneck?

Every clinic is different.

For some, it’s funding stability.

For others, it’s workforce capacity.

For others still, it’s operational infrastructure.

But one thing is consistent:

Scaling an ADHD clinic isn’t just about seeing more patients. It’s about protecting quality while demand accelerates. And that requires deliberate operational design.

If you’re leading or growing an ADHD service, I’d genuinely be interested to hear:

If you could remove one bottleneck tomorrow – which would it be?

• Funding?
• Workforce?
• Compliance burden?
• Patient flow systems?

The conversations happening quietly behind the scenes are just as important as the headlines about demand.

And the more openly we talk about operational realities, the better services we can build.

Let me know your thoughts – get in touch at [email protected] or call us on 0113 350 1308