ADHD - right to choose referrals and prescriptions
Haresfield and Kempsey Surgeries can now only take over the prescribing of your ADHD medication if this request comes from an accredited Right to Choose Provider (see below) or from the local NHS ADHD service (community paediatrics) for children.
Right To Choose (RTC)
If you need a referral for a physical or mental health condition, in most cases you have the legal right to choose which hospital or service you go to. The service may also be a private organisation (provider), but it must have a contract with the NHS to supply services to it within England.
In recent years RTC referrals have become a common route to access diagnostic and treatment services for Attention Deficit and Hyperactivity Disorder (ADHD), due to long waiting times and an absence of NHS service provision in some geographical regions. Private providers have offered alternatives for people who would otherwise be waiting many months and sometimes years for NHS services. However, the nature and extent of the service that each provider offers is variable and often not clear to either the patient or the GP completing the referral. Below are some important points to explore if you are considering a RTC referral;
What level of qualification will the clinician you see have?
Does the organisation have robust policies and procedures in place?
Having made a diagnosis, can the service start medication and monitor it regularly?
Will you regularly need to travel long distances to be seen or have tests done?
Is there a separate waiting list to commence treatment once you have been seen for diagnosis?
Is the organisation well established and likely to be viable for the many years over which your treatment may continue?
Locally in Worcestershire there is an NHS ADHD service for children (community paediatrics) but not currently one for adults, who will instead need to choose a RTC provider. The Integrated Care Board (ICB - the organisation that plans and oversees health services in the area) have established an accreditation process for RTC providers, to assist the patient and their GP in this choice. At present there is only one provider on the list for adults and none for children, but the ICB are in the process of approving more. Accredited providers are guaranteed to be CQC registered, to be able to start and stabilise medication and to have robust procedures in place for the ongoing monitoring and follow-up of patients, including a clear shared care agreement.
Shared Care Agreements (SCA)
A SCA is a contract between a specialist and a patient’s GP that transfers responsibility for the day to day prescribing of a medication to the GP whilst the specialist retains overall responsibility for the patient’s care and their treatment plan. The GP must feel sufficiently familiar with the medication to prescribe it safely but is not expected to have a specialist level of knowledge about it or the condition it is prescribed for. These agreements rely on both services fulfilling their obligations under the contract and clear lines of communication between both parties. Ultimately, the GP carries the professional responsibility for any prescriptions issued in their name, even if under the guidance of a specialist.
GPs are not obliged to accept a SCA if they do not feel sufficiently experienced, or if workload pressures mean that to do so would impact upon their core services. If the GP cannot accept, then the responsibility for prescribing always rests with the specialist who has recommended the medication.
Unfortunately, due to the huge variation in the level of service offered, the nature of the medications involved, the lack of any robust SCA policies, difficulties in getting hold of the relevant specialists when issues arise and the significant workload that the administration of these arrangements has involved, Haresfield and Kempsey Surgeries have taken the difficult decision that we can no longer enter into SCAs for ADHD medication with providers other than those accredited by the ICB or the local NHS service for children.
This does NOT affect your right to choose. You can still be referred to any provider with an NHS contract for diagnosis and treatment, but any medication would need to be provided directly by the specialist rather than via your GP.
Currently the only accredited providers are;
For adults is Quay Healthcare https://quayhealthcare.org/adhd/adult-adhd-service/
For children is The Family Psychologist
We will update this notice as more providers are approved.