Box 2.

Summary of themes, with illustrative quotes

Theme and sub-themes	Summary	Illustrative quotes
A system under stress: Lack of provision Deferring responsibility of care Variation in ADHD management	Demand for ADHD services is increasing, stretching already limited resources even further. A lack of capacity in primary care, coupled with gaps in secondary care, negatively impacts care pathways. Patients and healthcare professionals reported difficulties linked with variations in ADHD management, within and between practices.	‘The health service in general practice particularly is not paid to support everything. We have limited resources; we have to manage within those limited resources.’ (GP-5) ‘The particular one is the complete absence, or the paucity of actual services for people with ADHD. So, it’s great when I can see somebody with angina. I know I’ve got a system where I can assess that patient, I can arrange investigations. I can pull together an initial primary care treatment programme and I can refer on … and I know that system’s going to work. I don’t have that for ADHD. The systems are very poor.’ (GP-2)
Incompatibility between ADHD and the healthcare system: Barriers to accessing care — a complex system Consequences for the individual	The systems/processes involved in accessing care are counterintuitive to characteristics of ADHD, such as difficulties with organisational skills and attention. These barriers have consequences for individuals.	‘But I think just things like inflexible appointment keeping and being thrown off waiting lists because you are not keeping your appointments or making it very difficult for you to enter systems because you have got to fill in very big questionnaires and submit them on time, that kind of thing, that can be hard for people.’ (GP-1)
Strategies for change in ADHD primary care provision: Clarifying responsibility for care Need for training/information Improving provision	Three main areas of focus for change are identified to best equip healthcare professionals to provide care to young people with ADHD: clarifying responsibility, providing training and information, and improving provisions	Example of good practice: ‘I think what we provide is having quite a knowledgeable practice workforce, who see a lot of patients with ADHD. They have got understanding and knowledge. We provide longer appointments … that would be helpful.’ (PracticeManager-4)

ADHD = attention deficit hyperactivity disorder.