Introduction
At Daybrook Medical Practice we are committed to providing comprehensive and equitable healthcare to all our patients. This includes a commitment to supporting patients with neurodevelopmental diagnoses.
We are mindful that pressures on NHS services have increased in recent years, and that patients may seek private diagnosis and treatment as a result. Patients may also be referred by a GP to a private provider offering NHS services, under patient choice (Right to Choose).
We have therefore reviewed our policy regarding the management of ADHD and the prescribing of ADHD medication, which can only be prescribed by GPs under a ‘Shared Care Agreement’.
Guidelines for Diagnosis and Management of ADHD
This Practice Policy is based on national and local guidance, specifically NICE guidance, and the Nottinghamshire Area Prescribing Committee (APC) Shared Care Information for Patients. The individual prescribing information forms for children and adults can be downloaded from the Nottinghamshire APC website.
Initiation of medication for ADHD must be by a specialist, after they have assessed the patient and provided a diagnosis. This will include:
- a shared decision-making approach with the patient regarding the risks and benefits of medication
- a review of mental health and social circumstances
- a review of physical health, including some baseline investigations. In some circumstances an electrocardiogram (ECG) or a cardiac assessment may be required.
- initiation and optimisation of the medication, including initial monitoring. After dose stabilisation, the specialist may request that prescribing and monitoring of ADHD medication is carried out under a ‘Shared Care Agreement’ with the GP.
The practice does not organise any of the above physical checks, as these are explicitly for the specialist initiating medication to undertake. This is specified both in NICE and Nottinghamshire APC guidance, and as a Practice we apply the same rules to private providers as are applicable NHS providers.
What is a ‘Shared Care Agreement’?
A Shared Care Agreement is a formal agreement between you (the patient), your GP and your specialist. It enables a GP to accept responsibility for the safe prescribing and monitoring of specialist medicines, where appropriate, whilst the specialist retains overall oversight, including the responsibility for regular reviews.
A GP is not legally bound to agree to a Shared Care Agreement. It is a ‘professional courtesy’ that GPs can agree to, to support the partial transfer of care from a specialist to the GP, where this is appropriate and, in the patient’s best interests.
If a GP is unable to agree to shared care, then ‘appropriate arrangements for the continuing care’ of a patient are warranted, which is likely to mean that the specialist who made the assessment and diagnosis will be requested to prescribe the medication.
The General Medical Council have published ethical guidance on Shared Care Agreements here.
Whilst this practice remains dedicated to delivering high quality care to our patients, we are not able to accept Shared Care Agreements with private providers, including with those offering NHS services under patient choice (Right to Choose). This decision is based on several important factors:
- Capacity and Workload: Our Practice is experiencing unprecedented workload pressures. Engaging in shared care with private providers would divert our resources and impact our ability to provide care to patients within our NHS Contract.
- Safety Concerns: Shared Care requires close collaboration and communication between healthcare providers. Unfortunately, we often encounter challenges in obtaining timely and comprehensive information from private providers, which can compromise patient safety.
- Expert Support: Managing ADHD medication requires specialist knowledge and support. In many cases private providers do not offer the necessary guidance for ongoing management, leaving GPs without the expert support that is required to ensure safe prescribing.
We therefore kindly request that patients who have received a diagnosis of ADHD from a private provider, including from those offering NHS services under patient choice (Right to Choose), continue to request prescriptions from their chosen provider. This ensures that patients receive care tailored to their specific needs, under the clinical expertise of a specialist who is able to provide ongoing support and monitoring.
Options when Shared Care is declined
You can request a referral from your GP to the Neurodevelopmental Specialist Service (NeSS), which is the Nottinghamshire NHS Provider for adult autism and adult ADHD assessment, treatment and support. Further information regarding this service can be found at:
https://www.nottinghamshirehealthcare.nhs.uk/neurodevelopmental-specialist-service/
You will be referred to the medicine pathway of the service which has a shorter waiting time than the assessment pathway.
Information about your assessment and diagnosis from your private provider will need to be provided, in order that NeSS can review the referral. NeSS may reject the referral if insufficient information is provided.
We can only accept ADHD Shared Care requests from NeSS.
Reviewed March 2025 Sarah Brown and Dr Lisa Bouch
Next review due March 2027