A practice in the Stratford-on-Avon area

6. Mrs A claims that, during the period 2018 to April 2025, GPs at the Practice: • failed to consider and refer her for diagnosis of ADHD • failed to appropriately manage her ongoing symptoms of anxiety, emotional distress, lack of focus and low self-worth • provided ineffective referrals to support services and failed to review these.

7. Mrs A says that because of this, she suffered a delayed diagnosis of ADHD and worse symptoms over a prolonged period which she now feels were avoidable. In addition, she says she suffered the expense of paying for private treatment, due to the ineffectiveness of the treatments offered.

8. As an outcome, Mrs A would like a formal acknowledgement of any failings, a full written apology, service improvements and a financial payment.

9. Mrs A was first seen at the Practice in June 2018, with ongoing symptoms of anxiety and depression. She was treated with propranolol and diazepam and referred to MIND for counselling. She reported back in October and November 2018 with depression and was referred to CRUSE.

10. From 2018 to 2021, Mrs A reports that she started to see a private therapist, paying for weekly sessions.

11. From 2022 to 2024, the Practice offered referrals to the Perinatal MH Team, IAPT Counselling and a Health and Wellbeing coach. The Practice also completed medication reviews and signposted Mrs A to the New Hope and Parent Project.

12. In March 2025, during a consultation with a GP at the Practice, Mrs A challenged her treatment, asking why the Practice had prescribed her medication for many years without seeking specialist input. During this consultation, the GP offered a private referral to a psychiatrist.

13. As a result of this referral, Mrs A reports that she received a diagnosis of ADHD from the psychiatrist.

ADHD referral/treatment for anxiety and depression

17. Before we decide if we should investigate a complaint in more detail, we look at a few different factors. We consider whether there are signs the organisation concerned has got something wrong. We do this by comparing what should have happened with what did happen. If what happened fell far short of what should have happened, we call this a failing. We also look at whether what happened had a negative impact on the person in question. If we think it did, we will go on to consider what, if anything, the organisation has done to try to put things right.

18. If we think there was a failing, and that this had an impact that has not been put right, we will usually investigate in more detail.

19. Mrs A told us that the Practice failed to consider and refer her for ADHD diagnosis from June 2018 to April 2025. She also felt that her symptoms had not been appropriately managed because GPs deemed them to be related to her mental health, rather than ADHD.

20. The Practice explained that it treated her for depression and anxiety, based on the symptoms presented during that period and also her existing diagnosis of anxiety with depression, which had been made by Mrs A’s previous GP surgery.

21. Both versions of the Guidance says that doctors must adequately assess a patient’s condition, taking account of their history, including symptoms and that they must propose, provide or prescribe drugs or treatment based on the best available evidence. This means that any treatment provided or suggested must be evidence-based, with particular focus on patient history and symptoms which are reported in consultations.

22. The Practice continued with treatment for depression and anxiety from 2018 to 2025, based on Mrs A’s medical history and also the GPs’ own observations of her symptoms based on consultations during that period.

23. We considered whether, as Mrs A believes, any of the GPs should have thought about the possibility her symptoms were down to ADHD.

24. Our adviser explained that ADHD symptoms presented by adults differ from those in children. For example, adults with ADHD may struggle to hold down a job, or struggle to concentrate on tasks. There is no evidence in the records of such issues with Mrs A.

25. Our adviser explained that many of those diagnosed with ADHD have a higher incidence of mental health problems, and noted that there is evidence in Mrs A’s medical records of typical depression and anxiety symptoms, which were ongoing, but for different reasons. At times, they were due to work pressure or bereavement, or other life events. Our adviser did not identify any evidence of symptoms which suggest that an ADHD referral should have been made.

26. Given this, we saw no indications that the Practice missed an opportunity for referral for ADHD and that it was appropriate for GPs to treat her for the anxiety and depression she presented with.

Referrals

27. The law says a person needs to make their complaint to us within a year of becoming aware of the problem. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason to do so.

28. Mrs A was aware of the diagnoses and treatment she was receiving as the events took place. The first referral from the Practice was June 2018, and during the period up to September 2023, there were other referrals made to different mental health support services. Mrs A complained to us on 15 May 2025, meaning her complaints relating to referrals are between one and six years beyond our one-year time limit.

29. We have discussed this with Mrs A to understand the reasons why she did not complain about her treatment sooner than she did. Mrs A explained to us that from June 2018 up to April 2025, she had ‘trusted the professionals’ so hadn’t felt the need to complain about her care and treatment.

30. It is not clear why she came to believe the referrals made were not appropriate until much later. The trigger appears to have been her ADHD diagnosis. We have already set out that we think the GPs were right to deem her ongoing symptoms as being anxiety and depression related, and that there was no reason to make an earlier referral for ADHD.

31. We recognise why her diagnosis caused Mrs A to question the care and treatment that she had received before. We think it was fair to question, much later, whether ADHD had been the cause all along. But we do not think there was a good reason to question the adequacy of the referrals made and whether they ought to have been reviewed. We think that Mrs A would have known – or ought reasonably to have known – if she did not find the referrals useful at the time. It was open to her to question them and submit a complaint at the relevant time, but she did not. We have not, therefore seen a good reason to put the time limit to one side.

32. Our decision is not made without recognition of the difficulties Mrs A has experienced over a prolonged period. We hope we have explained the thorough consideration we have given to our decision and clearly outlined the reasons for it.

1. We have carefully considered Mrs A’s complaint about the Practice.

2. We are sorry to learn of Mrs A’s difficulties with her mental health over the past decade. She has clearly suffered, and we understand that the problems she experienced continue to cause her distress.

3. We think that the Practice acted appropriately in its management and treatment of her ongoing symptoms of anxiety and depression and in not considering an ADHD referral sooner. Her complaint about referrals is out of time and we saw no good reason to put the time limit aside.

4. We have, therefore, decided not to investigate in more detail or take any further action.

5. We understand that this was, and continues to be, an upsetting time for Mrs A. Our decision is not made without recognition of the difficulties Mrs A has experienced over a prolonged period. We have explained the reasons for our decision below.