Attention Deficit Hyperactivity Disorder (ADHD) Referrals and Medication

As a practice we are committed to supporting patients with neurodevelopmental diagnoses, both children and adults.

We are mindful that pressures on NHS services have increased in recent years, and that often patients seek diagnosis and treatment from a right to choode or private provider as a result. This policy sets out the practice’s position on acknowledging diagnosis and taking over treatment where requested.

This document is based on national and local guidance, specifically NICE guidance, and the Surrey Prescribing Advisory Database.

Attention Deficit Hyperactivity Disorder (ADHD) can affect many aspects of a person’s life. However, diagnosis is complex and requires a specialist, usually a consultant psychiatrist to do this. 

GPs are not able to make a diagnosis of ADHD and a referral is needed to an ADHD specialist. If an ADHD diagnosis is subsequently made by the specialist, they may choose to offer medications to help manage the symptoms. These medications are potentially dangerous and therefore require careful monitoring.

NHS ADHD Service

The Adult NHS ADHD service in Surrey is provided by Surrey and Borders Partnership and for children this is provided by Mindworks.    Once a diagnosis is made, the specialist is responsible for starting medications, making any adjustments until the dose has been stabilised.  The specialist will also remain responsible for arranging an annual review which includes a review of your ADHD symptoms, your medication and a physical assessment.

Once an established dose of the appropriate medication has been stabilised by the local NHS ADHD service, your GP may take on responsibility for on-going prescribing and monitoring under a ‘shared care agreement’ with the NHS service specialist, however responsibility for prescribing and monitoring remains with the specialist.  It can take 3-6 months for the correct dose to be stabilised, but can take longer depending on side effects etc.  Share care is not a standard NHS GP service, so the Mental Health Commissioners fund GPs to do this as an optional extra service. Please note that GPs are not required to take on Shared Care - this is entirely at their discretion.

Right to Choose

Alternatively patients can exercise their ‘Right to Choose’ and ask to be referred to a private provider who has an existing contract to provide NHS services.  This may be because the wait times are shorter.  

Details of right of choose providers can be found at https://adhduk.co.uk/right-to-choose .  If you wish to exercise your right to choose, you should research the options and let us have the details of your chosen provider.

Referral

There are a large number of right to choose providers and each has its own referral process.  It is not practical for your GP to complete a different referral process for every patient who chooses a different provider.  Most providers require a core set of information, so we will only make referrals in a standard format.  You should consider whether a provider will accept a referral in this way when choosing a provider.  If the provider needs additional information they can request this from you directly. 

Prescriptions

If you are diagnosed with ADHD, the right to choose provider may suggest medications for you.  The medications used for ADHD are restricted so that GPs cannot routinely prescribe them; the specialist service is responsible for prescribing ADHD medication.    

The specialist service may request that your GP prescribes them under a shared care agreement.  We are not commissioned to provide shared care with any provider other than Surrey and Borders Partnership.  Doctors at Ashley Centre Surgery will not enter into shared care agreements with right to choose private providers. 

Getting ADHD medication must therefore all be done through the right to choose provider.  Not all right to choose providers will provide a prescribing service (a problem that is created by other ICBs not commissioning a complete pathway) so you should consider this when choosing a provider. 

Diagnosis and Follow-up

If a patient who has been diagnosed by a private or right to choose service wishes to receive their ADHD treatment on the NHS from their GP, they will need to be referred to an NHS mental health specialist for an assessment.  This referral will still need to go through the NHS waiting list. 

Most right to choose providers perform remote and /or online assessments, and the local NHS ADHD services may or may not have sufficient confidence in these diagnostic processes to accept their diagnosis.  They may not take over your care until they have completed their own assessment and diagnostic process.  Therefore your right to choose diagnosis may not be universally accepted, and you may find you cannot seek treatment and follow-up directly with local services, effectively putting you to the back of the original queue

If the NHS mental health specialist feels the patient meets NHS criteria to start ADHD medication, a shared care agreement may then be agreed between the NHS specialist and GP. This is still likely to be subject to a waiting time for response from Surrey and Borders Partnership, which the surgery does not have control over.

 

For further information on ADHD please visit the NHS website - https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/

For further information on right to choose please visit the https://www.nhs.uk/using-the-nhs/about-the-nhs/your-choices-in-the-nhs/