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ADHD Shared Care Agreement Policy

NOTICE OF ADHD SCHARED CARE AGREEMENT POLICY

At Primrose Hill Surgery, we are committed to providing comprehensive and equitable healthcare to all our patients. With this guiding principle in mind, we have recently undertaken a review of our policies regarding the management of Attention Deficit Hyperactivity Disorder (ADHD) and the prescribing of ADHD medications. Our decision to update our ADHD SCA (Shared care Agreement) Policy and prescribing practices stems from a conscientious effort to align with the latest guidance from the Medicines Management Team (MMT).

Central to our updated policy is the understanding that equitable access to care is paramount. Therefore, in accordance with the MMT guidance, we have made the decision to discontinue the practice of prescribing ADHD medication that has been recommended by consultants seen privately. This adjustment ensures that all patients receive consistent and standardised care, regardless of their route to diagnosis or treatment.

It is crucial to recognise that the management of ADHD, particularly through medication, necessitates regular monitoring and specialist oversight. While we remain dedicated to delivering high-quality care to our patients, our resources and capabilities may not extend to providing the specialised monitoring required for patients diagnosed and treated privately.

As such, we kindly request that patients who have received a diagnosis of ADHD through private consultation continue to seek medication prescriptions from their private specialists. This approach ensures that individuals receive the comprehensive care they deserve, tailored to their specific needs and under the supervision of a specialist equipped to provide ongoing support and monitoring.

For patients who may wish to transition to NHS care for their ADHD management, we are here to assist. We encourage those seeking NHS support to initiate contact through our e-consultation platform. Upon receipt of your request, we will facilitate your referral to the appropriate NHS service, ensuring a seamless transition to continued care within the public healthcare system.

At Primrose Hill Surgery, we are committed to fostering an environment of inclusivity and fairness in healthcare delivery. Our decision to update our ADHD SCA Policy and prescribing practices reflects this commitment, prioritising the well-being and equitable treatment of all our patients.

Thank you for your understanding and cooperation as we strive to provide the best possible care to our community.

 

Primrose Hill Surgery Shared Care Agreement (SCA) Policy

NICE guidance issued in 2018 on the diagnosis and management of ADHD in adults states; ‘After titration and dose stabilisation, prescribing and monitoring of ADHD medication should be carried out under Shared Care Protocol arrangements with primary care’.

Please kindly note that the Primrose Hill Surgery does not accept any private ADHD shared care agreements.

What is ‘Shared Care’?

A ‘Shared Care Agreement’ or SCA is an agreement between you, your GP, and your psychiatrist. It enables the care and treatment you receive for ADHD to be shared between the psychiatrist and your GP. This will only occur with your agreement and when your ADHD medication is stable.

A shared care agreement is not something a GP is legally bound to sign, it is a ‘professional courtesy’ that GPs often sign to help patients continue to receive care. A GP is fully entitled to refuse a shared care agreement if they are not happy with the burden of responsibility it puts on them, and then the consultant must take full responsibility for prescribing and any necessary monitoring.

If a GP refuses shared care, then ‘appropriate arrangements for the continuing care’ of a patient are warranted, which could mean being passed back to the psychiatric team who made the assessment. What this means for adults with ADHD is that any diagnosis from a private clinic for which a GP refuses to sign a shared care agreement will likely result in the requirement for medications to be issued privately, rather than by the NHS. However, shared care agreements with private healthcare providers when this service is being provided for the patient on behalf of the NHS (such as through the Right to Choose scheme) are common.

The General Medical Council have published ethical guidance on SCAs here.

What to do if SCA is refused?

As GPs are not legally obliged to take on shared care, options are limited by there are steps that may help in some cases:

  • If your GP is unwilling to accept your diagnosis, you can ask them if they are willing to refer you through the NHS pathway, and to take on shared care while you are waiting.
  • It is possible to change GP if you are having difficulties with them, though it is important to make sure that a new GP will accept shared care before you do so.

What to do if your GP says “There is no ADHD service in your area”.

In England and Wales, the NICE guidelines for ADHD Assessment state that everyone should be able to get an ADHD Assessment. If your GP says there are no ADHD Assessment services in your area, you are still entitled to ask for one. In England, this could mean using the ‘Right to Choose’ scheme or asking your GP for an ‘Individual Funding Request’ or IFR. Patients in Wales and Northern Ireland do not have access to the Right to Choose scheme, and instead have their own IFR processes; see links for Wales and Northern Ireland.

As Scotland does not follow NICE guidelines, and therefore there is no guarantee of care. The Royal College of Psychiatrists in Scotland has released good practice guidelines on the subject (which can be found here). Scotland has an alternative to the IFR scheme, called the Peer Approved Clinical System, however, this largely focuses on medicine and not diagnosis.

Date published: 1 May 2024
Date last updated: 1 May 2024