The following information below is taken from the Gloucestershire Integrated Care Board (ICB) information and has been adapted into our own policy here at Painswick Surgery.
Background
The NHS ADHD service is overwhelmed with referrals and has a long wait. There are many private providers that have set up in recent years, offering diagnosis and treatment for ADHD. They often promise a quick diagnosis and may commence medication and can sometimes mislead patients that they will automatically be able to have a “shared care agreement” where their GP can prescribe medication. Unfortunately, this is not always the case, and some parents have then been left in a difficult position of not being able to afford medication that had been started for their child when they thought that the NHS would automatically take over prescribing responsibilities.
We as GPs need to be sure that these private providers are performing assessments in line with NICE (National Institute of Clinical Excellence) and NHS guidelines and unfortunately some of them are not. We practically cannot check out every provider, so the NHS have commissioned (i.e. have a contract with) a handful of approved private providers where they have been satisfied that they are registered and carrying out assessments and considering medication in line with NHS practice.
You may have heard of something called “Right to Choose” (If you are based in England under the NHS, you now have a legal right to choose your mental healthcare provider and your choice of mental healthcare team.) For CHILDREN, at the date of issue of this guidance, there are only currently Choice providers contracted to the NHS to provide assessment but NOT ongoing management under the NHS. Unfortunately, there is no readily accessible, up to date NHS produced list of which providers are currently contracted to provide NHS Patient Choice ADHD services, either assessment and/or ongoing care. To promote access by patients, ADHD UK do however publish such a list on their website, the content and updating of which is the responsibility of ADHD UK. Right to Choose – ADHD UK
Factsheet
- Please do carefully consider your options for your child before you make any decisions about an ADHD assessment. Whilst private providers may have a shorter wait then the NHS, and you may be wanting to be seen as soon as possible (which we do entirely understand), we will only be able to enter a “shared care agreement” (i.e. prescribe on the NHS) for those under 18 years who have been assessed and started on medication by an NHS Team and once the consultant contacts us.
- Any ADHD care and treatment recommended by a private provider that you wish to take will need to be paid for privately by you whilst waiting for an NHS assessment. (NB this also includes the private providers on the “Right to Choose” list): Right to Choose – ADHD UK
- Some parents merely wish to explore the diagnosis to access support and funding in school and are not looking to consider medication. If this is the case, then one of the NHS ADHD providers offering diagnosis only, or one of the approved private providers via “right to choose” may be your best option: Right to Choose – ADHD UK
- The key thing is that children with possible ADHD need to be showing problems in ALL areas – i.e., home, with wider family members, school, sports clubs etc. For referral on the NHS pathway, children must be on the “Graduated pathway” – i.e. a MyPlan or MyPlan+ If your child is not, then they will not meet the criteria to be seen as there needs to be documented concerns from the SENCO/teaching staff/Educational Psychology teams. This is to ensure that we are correctly identifying children with ADHD and not labelling children who do not and may need an entirely different level and type of support.
- We have no influence over the NHS waiting times for ADHD assessment. We at Painswick do understand that you may feel frustrated about the wait on the NHS for Mental Health and Neurodiversity problems, and we can assure you that we do too. We have seen an overwhelming increase in requests for referrals. We have written this factsheet to ensure that you have all the information available to you so that you can make an informed decision.
- Children who have had a private ADHD assessment where the provider has diagnosed ADHD will not be able to “queue jump” and will need to be referred to the NHS as a new patient. The NHS team may or may not accept the private assessment, depending on a variety of factors (e.g. whether they have done the assessments in line with NICE guidelines, their own opinions of the evidence presented to them, how they have responded to medication).
- Some NHS ADHD providers outside Gloucestershire offer a “diagnosis only” service whereby they would not prescribe any medication. If this is the case and you wish your child to be considered for medication, you would need to be referred on the NHS waiting list to be seen and considered (again, no “queue jump” option so would be a wait to be seen).
- If you do see a private provider on the right to choose pathway and they recommend medication and you wish to consider an NHS shared care agreement, you would need to then be referred on the NHS waiting list where they would consider this request (again, there is no “queue jump” option). In the meantime, you would need to pay for the prescriptions privately and please do be aware that the wait is often long (can vary between 1-2 years). If you are choosing this, please do plan for the fact that you may need to pay for private prescriptions for a couple of years before you are seen.