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 patients have then been left in a difficult position of not being able to afford medication that had been started 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 the “Right to choose” to access a private provider on the NHS. 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. 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 for patients, ADHD UK (a registered charity independent to the NHS) do however publish such a list on their website, the content and updating of which is the responsibility of ADHD UK. If you wish to be seen via the right to choose, ADHD UK provides details of the information that you need to complete for each individual provider before you approach us for a referral. Find more information here: ADHD UK – Right to Choose
Factsheet
- Please do carefully consider your options before you make any decisions about an ADHD assessment as the processes are complicated. We have digested the ICB advice and summarised it in this information sheet, so you are fully informed of your options before you decide what to do next.
- We will only be able to enter a “shared care agreement” (i.e. prescribe on the NHS) if you have either:
~ Been seen by the Gloucestershire NHS Adult ADHD Service
~ Been assessed by an NHS contracted service/Choice provider as part of their NHS contracted activity
- To clarify the above point, the ICB states that:
~“Confusion can occur if a patient has been referred to an NHS contracted private provider for an NHS assessment, but the patient has then accepted care privately from that provider to speed up their assessment process. This can be clarified by being able to answer the Question – has the patient paid for any part of the diagnosis either directly or indirectly (i.e. via medical insurance)?
~ If any part has been paid for, then this represents a request to bring private sector healthcare activity under the NHS. If a GP considers that the request warrants NHS consideration, then the patient should be referred to an NHS service provider for assessment and review within normal NHS processes and their associated timescales.”
- The practicality of this means that if you have paid to see someone privately even if they are on the ADHD UK list of providers that offer NHS contracted services, then we cannot accept Shared Care on the NHS, and you would need to continue to pay for your prescriptions privately. If this is the case, we could refer you to the NHS Gloucestershire ADHD assessment team but there is a long wait to be seen, and you would need to pay for your prescriptions until you are seen by them.
- Patients are sometimes given the impression by private providers that a Shared Care Agreement is something that will happen automatically and GPs have to agree to it. This is not the case and all requests for Shared Care need to be considered carefully as the medications for ADHD are controlled drugs and ones that must only be initiated if safe to do so.
- As GPs we then need to carefully consider the NHS request to accept clinical responsibility for shared care according to the general principles that apply i.e.:
1. Does the GP have confidence in the diagnosis based on the information available?
2. Are the details of exactly what shared care responsibilities are being requested clear?
3. Does the GP consider that the shared care request details are reasonable?
4. Does the GP feel confident in accepting the clinical responsibility involved in the shared care?
5. Is the shared care in the patient’s best interests for ongoing provision of safe and quality care?
6. Are all other parties involved in the shared care in agreement with their part within it?
- You will need to obtain your medication from the provider who started it whilst waiting for a decision regarding your shared care agreement with us at Painswick Surgery. We aim to make this decision within 4 weeks from receiving the letter from your Psychiatrist or Specialist clinician. The process takes some time and involves both our practice pharmacist and a GP Partner. We all need to be sure that the conditions have been met before we can take on the SCA (Shared Care Agreement).
- Some patients merely wish to explore an assessment to understand why they struggle with certain tasks and are not interested in starting 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: ADHD UK – Right to Choose
- Patients with possible ADHD need to have demonstrated problems in ALL areas/environments (e.g. home, work, education) and have been since childhood. There may be other explanations for your symptoms and there is often a crossover with other conditions such as anxiety and low mood or depression. Sometimes simple strategies to help with overwhelm and time management can be more beneficial and there are plenty of coaching and counselling options available for patient to explore that can be effective and remove the need for medication.
- 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 Services, 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 about the options available to you.
- According to the right to choose rules, if you have previously had an assessment for ADHD privately, you would not be eligible to access the NHS right to choose pathway. E.g., if you approach us to say you have seen someone privately who has diagnosed you with ADHD and you now wish to have the prescriptions on the NHS, you will need to be referred to the Gloucestershire Adult ADHD NHS service. The wait is over a year. There is unfortunately no “queue jump” option and often the NHS team do not accept previous private assessments.