ADHD and your GP

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’.

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:

  • Ask to meet your GP and explain the impact of not being able to access medicine will have on your life.
  • NHS Guidance says that the “NHS should not withdraw NHS Care because a patient chooses to buy private care, nor should patients who access private care be placed at an advantage or disadvantage in relation to the NHS care they receive” and that “The NHS should continue to provide free of charge all care that the patient would have been entitled to had they not chosen to have additional private care“, and “Where the same diagnostic, monitoring or other procedure is needed for both the NHS and private elements of care, the NHS should provide this free of charge and share the results with the private provider” (source here). Based on this you can ask your GP practice manager and/or GP to explain how their refusal to provide shared care does not break the NHS Guidance on private care.
  • 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.

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