ADHD is becoming more and more prevalent and the lack of capacity in core NHS services causes some difficulties for GP’s.
ADHD care can be provided by core NHS providers (NSFT in N&W), Right to Choose providers and Private providers.
For the GP there should be little difference in how the general practice element of the care is provided. As long as the provider is a safe provider, the correspondence/requests are coming from a named individual and contain the required information
ADHD drugs are Amber Shared care drugs and as such require a shared care agreement to be in place. You can have a shared care agreement with NSFT, a Right to Choose provider or a private provider.
ADHD patients who are receiving ADHD medications need to remain under the care of a specialist and review annual reviews from the specialist as per the shared care agreement.
If the patient is not receiving annual reviews then the terms of the shared care agreement are not being upheld and the GP should not be prescribing.
The responsibility for annual reviews depends on who is providing the care.
- NSFT
- Patients who are assessed and treatment initiated by NSFT will be offerred annual reviews by NSFT
- Right to Choose (RTC)
- Where patients have been referred by General Practice to a RTC provider that does not offer ongoing reviews those patients will not be offered ongoing reviews by NSFT automatically, but they should be referred into NSFT so that thy can be added to their list of patients for NSFT.
- Where patients have been referred to a RTC provider by NSFT as part of their waiting list initiative (ProblemShared), those patients will be offered annual reviews by NSFT without requiring GP involvement.
- Patients who in the future are referred to a N&W approved RTC provider under the new framework will receive annual reviews from their RTC provider (details of framework to be circulated by ICB soon)
- Private
- Where patients have received a diagnosis and treatment initiation privately they will not be offered ongoing care by NSFT but directed back to their private provider.
- Patients wishing to transfer to NHS care need to be referred into NSFT with details of the diagnosis and treatment attached. Once NSFT starts to see them they can be discharged by their private provider but not before then.
Practices should not take on workload which is outside of best practice and should not be prescribing outside of a shared care agreement or where the patient isn't under a specialist provider and does not have planned annual reviews with the specialist.
To do so risks practicing outside of recognised competencies
Patients who have been receiving services from private providers can transition to either core NHS services (NSFT) or Right to Choose providers.
With NSFT depending on what assessment they received from their private provider they may either need to wait to be assessed again or may be able to transition straight onto the annual review process.
With RTC providers they are likely to need to join the waiting list but the wait is shorter.
There are a number of considerations
- Eligibility for Right to Choose – The patient must be eligible for NHS-funded care and be referred by an NHS GP for their first outpatient appointment with an NHS-commissioned provider.
- Provider Must Be NHS-Commissioned – The new provider must be listed as an NHS-funded option under Right to Choose (not all private providers are included).
- No Automatic Continuation of Care – If a patient has already started treatment privately, they may need to restart the referral process with their GP, who will assess clinical need before making a new referral under RTC.
- Mixed Funding Considerations – If a patient self-funds part of their treatment, transitioning to NHS care for the same treatment is not always guaranteed, as per NHS England guidelines on private and NHS care separation.