ADHD Policy
ADHD has become an increasingly common diagnosis, leading to a growing number of patent requiring stimulant medications. NHS secondary care services have been overwhelmed for many years, resulting in waiting lists of 2-5 years. To address this issue, the Government introduced the "Right to Choose" legislation, allowing private providers (such as Psychiatry UK) to support the NHS services through contracted work.
Due to the surge in ADHD diagnoses and the strain on NHS services, GPs have had to support patients through Shared Care Agreements (SCAs). These medications are classified as “Amber” on the local BSW formulary, meaning they can only be prescribed under an appropriate shared care arrangement. The current BSW Shared Care Agreement is attached for reference.
Practice Policy for ADHD Diagnosis and Medication Initiation
· Self-Rating Questionnaire: Patients must complete a self-rating questionnaire to assess for ADHD symptoms.
· Specialist Referral: A referral to a specialist for ADHD assessment and diagnosis is required, either through the NHS or privately.
· Private Care Options: Due to long NHS waiting lists, patients may choose private care and self-funded prescriptions initially for ADHD medication.
Shared Care Agreement for ADHD Medication
ADHD medications, including Methylphenidate and other stimulant medications, require a shared care agreement between the patient, specialist, and GP to ensure continuity of care once the medication has been stabilized by the specialist.
Patient Responsibilities:
· Medication Compliance: The patient must take the medication as prescribed by the specialist and GP.
· Reporting Side Effects: The patient must inform either the specialist or GP of any side effects, changes in symptoms, or concerns about treatment.
Specialist Responsibilities:
· Oversight of Initial Prescription: The specialist retains responsibility for initiating and stabilizing ADHD medication.
· Annual Review: The specialist must conduct an annual review of the patient's condition, reassessing effectiveness and addressing side effects or changes.
GP Responsibilities:
· Prescribing Medication: Once the medication has been initiated and stabilized by the specialist, the GP will take over prescribing under the shared care agreement.
· Referral Back to Specialist: If issues arise, including non-compliance, adverse reactions, or changes in diagnosis, the GP must refer the patient back to the specialist.
· Validity of Shared Care Agreement: The GP will not prescribe ADHD medication without a valid shared care agreement.
Private Prescribing Requirements
· CQC Registration: Specialists prescribing ADHD medication privately must be CQC-registered.
· Valid Shared Care Agreement: A valid agreement must be provided to the GP before prescribing.
· Notification to Patients: A letter will be sent informing patients that prescriptions may be discontinued if specialist care ceases.
· Practice Discretion: The practice reserves the right to decline private prescribing if a valid agreement is not provided.
NHS Prescribing Requirements
· Stabilization of Treatment: The GP will only take over prescribing once the patient is stable on their medication, as determined by the specialist.
· Shared Care Agreement Compliance: NHS prescribing will align with shared care agreements, ensuring defined roles.
· CQC Registered Providers: All NHS providers involved in ADHD care must be CQC registered to ensure quality of care.
General Terms
· Review of Shared Care Agreement: The agreement should be reviewed periodically to ensure it remains relevant.
· Communication: All parties (patient, specialist, and GP) must maintain clear communication to ensure continuity of care.
By following this shared care agreement, Minerva PCN ensures that patients receive safe, effective, and continuous ADHD care, whether their treatment is initiated through the NHS or privately.
Acknowledgement
Both the GP and specialist are responsible for ensuring the shared care agreement is followed and will review and modify the agreement as necessary.