1. Introduction: A Requirement With No Public Route to Fulfil It
If you are taking ADHD medication in Northern Ireland, NICE guidelines require a specialist annual review, but there are no commissioned adult ADHD services in Northern Ireland to provide one. Unlike England, where NHS teams are expected to deliver annual reviews, adults on ADHD medication in Northern Ireland are largely left to arrange their own follow-up care. For most people that means either no review at all or a private appointment.
This is not a story about a slow health service. In Northern Ireland the problem is categorically different from England or the Republic of Ireland: the Health and Social Care system has no commissioned pathway for adult ADHD at all, including follow-up care. The Department of Health confirmed this in the final Needs Assessment report published on 12 February 2026, which formally acknowledged the total absence of a public commissioning pathway for adults. With more than 9,500 adults waiting for an initial assessment and waits exceeding eight years in some trust areas, the annual review gap is a structural absence rather than a capacity bottleneck. This guide explains what the annual review involves, why it is clinically important in Northern Ireland specifically, and how to access one.
2. What Is an ADHD Annual Review?
An ADHD annual review is a structured specialist appointment to assess whether current ADHD medication is still appropriate, working effectively, and being monitored safely. It is conducted by a specialist, a Consultant Psychiatrist or an appropriately qualified clinical nurse specialist, and it sits separately from the initial diagnostic assessment and from the frequent appointments of the early titration phase.
- It is a mandated safety check. NICE Quality Statement 7 requires that every adult with ADHD taking medication has a specialist review at least once a year.
- It applies in Northern Ireland. The Department of Health follows NICE guidance, so the annual review requirement applies here as it does in England, even though the HSC has no commissioned pathway to deliver it for adults.
- It is a standalone annual checkpoint. The review is not a first assessment and not a titration visit; it is a dedicated yearly evaluation for people already established on medication.
- It protects continuity. Without an annual review there is increased risk of suboptimal dosing, unmonitored side effects, and Shared Care Agreements lapsing.
3. What an ADHD Annual Review Covers in Northern Ireland
Stimulant medications such as methylphenidate and lisdexamfetamine, and non-stimulants such as atomoxetine, act powerfully on the cardiovascular and central nervous systems, so the annual review is a comprehensive physical, psychological, and regulatory checkpoint. In Northern Ireland it carries an additional dimension: methylphenidate is a controlled drug, and prescriptions are monitored and audited both by the prescribing clinic in Belfast and centrally by the Northern Ireland pharmacy directorate. The review therefore functions as part of responsible controlled-drug prescribing as well as clinical best practice.
4. Why NI Adults on ADHD Medication Aren’t Getting Their Annual Reviews
Northern Ireland’s annual review gap is structural, not incidental. Despite the endorsement of NICE guideline NG87 during 2018 and 2019, there is no commissioned adult ADHD service anywhere within the Health and Social Care system, and no service model has been put in place to deliver one. The Department of Health’s February 2026 Needs Assessment report confirmed this position, publishing the finding without a commissioning timeline attached.
Without a commissioned pathway, the HSC has no mechanism to systematically provide annual reviews for the tens of thousands of adults in Northern Ireland now on ADHD medication. Many of these adults were assessed privately or transitioned out of Child and Adolescent Mental Health Services at school-leaving age, and are maintained on medication through a Shared Care Agreement with their GP. The specialist annual review component of that agreement has no HSC provider to fulfil it. Some GP practices are willing to carry out basic annual physical monitoring, recording blood pressure and weight, but this is not the same as a specialist annual review by a Consultant Psychiatrist. The result is a growing population of adults on controlled ADHD medication without the specialist oversight NICE guidelines require. To put the scale in context, adult ADHD assessment waits in the Belfast Trust reached 432 weeks at one point, with 1,710 adults on the list at the end of 2022–2023.
5. Annual Reviews and Shared Care Agreements in Northern Ireland
The Shared Care Agreement dynamic in Northern Ireland is different from England and the Republic of Ireland, and it is the practical reason the annual review matters so much here. A Shared Care Agreement is a formal arrangement in which a Consultant Psychiatrist provides the clinical expertise and annual specialist reviews, while the patient’s local GP takes over responsibility for issuing monthly prescriptions. This is what allows patients to obtain their medication through standard Health and Social Care channels rather than paying full retail prices; under HSC, prescriptions are dispensed free of charge to all residents once shared care is in place.
The annual review is the mechanism that keeps the agreement clinically valid, because it demonstrates that specialist oversight is being actively maintained. Under general medical guidance, the clinical and legal liability for a prescribed medication falls on the practitioner who signs the prescription, and because stimulants are tightly regulated controlled drugs, GPs must remain confident in the ongoing safety of the treatment plan. If annual reviews stop happening, the clinical basis for the GP to continue prescribing under shared care is weakened. Increasingly, GPs in Northern Ireland have told patients they cannot keep prescribing without evidence of a current specialist review, a stance that is clinically appropriate and consistent with responsible controlled-drug prescribing. ADHD Now’s annual review provides exactly this documentation: a clinical letter confirming that the review took place, that current medication remains appropriate, and that monitoring was conducted.
6. The Standardised Instruments Behind a Rigorous Review
A high-quality review is built on validated, clinician-led psychometric measurement rather than automated or observational tools. At ADHD Now the adult pathway deliberately excludes the QbTest and the Conners Adult ADHD Rating Scales, because these do not provide the broad comorbidity screening and retrospective developmental tracking required for a comprehensive adult formulation. Instead, the clinical team relies on three internationally recognised instruments, ensuring that reports are accepted by GPs, employers, and public bodies across Northern Ireland.
7. How ADHD Now’s Annual Review Works in Northern Ireland
ADHD Now provides a structured, online annual review delivered by a Consultant Psychiatrist, accessible across Belfast, Derry, Antrim, Newry, Omagh, and all Northern Ireland trust areas. The service is delivered by the ADHD Now Northern Ireland clinical team Mary Horgan and Stacey McKeown, operating in clinical partnership with Duality Healthcare, a locally registered primary care provider. This local footprint gives GPs the clinical accountability that remote, Great Britain-based platforms cannot offer.
The pathway is designed to combine patient convenience with full regulatory compliance. Before the appointment, the patient completes a brief symptom rating update and medication history form. During the live online consultation, the Consultant Psychiatrist works through every NICE Quality Statement 7 requirement, including cardiovascular monitoring, medication effectiveness across the day, comorbidity changes, Shared Care Agreement status, and treatment goals. After the consultation, the clinic issues a clinical letter to the patient’s GP confirming the review outcome, the current medication, and the monitoring results, explicitly requesting continuation of the Shared Care Agreement for another year.
The cost is £125 per follow-up review. This is a meaningful clinical distinction: some Belfast providers offer only a GP-led annual physical (typically around £110), whereas ADHD Now’s review is led end to end by a Consultant Psychiatrist, which is what NICE Quality Statement 7 actually requires for a specialist review.
For readers who do not yet have a formal diagnosis, the first step is an adult ADHD assessment in Northern Ireland. Full pathway and pricing information is set out on the adult ADHD medication page, and the detailed guide to ADHD medication in Northern Ireland covers prescribing, dispensing, and GP shared care across the province.
Frequently Asked Questions
9. Conclusion: The Only Reliable Route to Specialist Oversight
In Northern Ireland the annual review gap is not a delay to be waited out; it is a structural absence with no public remedy in sight. For every adult on controlled ADHD medication through a private or shared care pathway, the specialist annual review is the safeguard that keeps treatment safe, keeps dosing appropriate, and keeps the Shared Care Agreement clinically valid. With no commissioned HSC service to provide it, a private Consultant Psychiatrist-led review is currently the only reliable way to meet that requirement.
By using validated instruments such as the WEISS Symptom Record, the Wender Utah Rating Scale, and the Adult ADHD Self-Report Scale, and by working through a locally registered clinical partnership, the ADHD Now Northern Ireland team delivers the documented specialist oversight that patients, GPs, and the wider prescribing framework depend on.
Works Cited
- National Institute for Health and Care Excellence. (2018, updated 2019). _Attention deficit hyperactivity disorder: diagnosis and management (NG87)_.[LINK]
- National Institute for Health and Care Excellence. _Attention deficit hyperactivity disorder (NG87): Recommendations_.[LINK]
- Department of Health (Northern Ireland). (2026). _ADHD Needs Assessment report published_. [LINK]
- The Brief NI. (2026). _Health Minister publishes ADHD Needs Assessment with no commissioning timeline_. [LINK]
- Northern Ireland Assembly Research and Information Service. (2024). _Briefing Paper: Adult ADHD services in Northern Ireland_.[LINK]
- Health Service Executive. (2021). _ADHD in Adults Model of Care_.[LINK]
- NovoPsych. _Weiss Symptom Record II (WSR-II)_. [LINK]
- NovoPsych. _Wender Utah Rating Scale – 25 item version (WURS-25)_. [LINK]
- NovoPsych. _Adult ADHD Self-Report Scale (ASRS)_.[LINK]
- Reimherr, F.W., et al. (2021). _Wender Utah Rating Scale: Psychometrics, clinical utility and implications regarding the elements of ADHD_. Journal of Psychiatric Research. [LINK]