Adult ADHD

ADHD stimulant medication can greatly benefit some patients. National guidance*, however, expects long-term involvement of specialists in reviewing these patients and their medical treatment (i.e. at least yearly review by a psychiatrist), but this does not currently happen in Oxfordshire. GPs are not adequately trained or qualified to review these medicines and ensure their safety.

We have lobbied the local health service on this issue over a number of years, but regrettably no NHS service has been put in place. In addition, the local NHS adult ADHD service is currently closed to new referrals due to lack of capacity.

The practice has taken the difficult decision that we cannot safely prescribe stimulant medication for ADHD without yearly review by a psychiatrist, in order to ensure the safety and appropriateness of the prescription.

The summary below takes this situation into account.

Please navigate to the relevant section of the page:

  1. You think you may have ADHD but have not yet been referred for assessment
  2. You have been referred already and not seen yet
  3. You have been seen and started on ADHD medication by your specialist
  4. We are already prescribing your ADHD medication
  5. We have to reduce & stop your ADHD medication

1. You think you may have ADHD but have not yet been referred for assessment

The local NHS ADHD service is closed to new referrals, but you may be able to be seen by a different provider under the NHS ‘Right to Choose’ scheme.

Please be aware that, if you are seen and started on ADHD medication by the specialist, we will only be able to take over the prescription if all the following are true:

  1. The specialist clinic is NHS quality assured (see list below), AND
  2. The treatment started is available on the NHS in Oxfordshire, AND
  3. The specialist agrees not to discharge you and to continue seeing you yearly for medication review, AND
  4. You are stable on treatment and meet the criteria for shared care (we will check this if the above are all true), AND
  5. You complete and sign the patient agreement form

There is currently just one NHS quality-assured ‘Right to Choose’ provider which has confirmed it is taking on new adult ADHD referrals including medication reviews:

ProviderWebsite
Psychiatry-UKhttps://psychiatry-uk.com/  

Modality LLP (https://www.modalitycommunityservices.com/) are also listed as quality-assured, but have not responded to our requests regarding whether they will see adults for ADHD assessment and/or medication review under NHS Right to Choose.

If you would like to pursue NHS Right to Choose ADHD referral, we would recommend following the instructions on Psychiatry-UK’s website https://psychiatry-uk.com/right-to-choose/. Once completed, email the letter & ASRS form to mrhc.generaladmin@nhs.net including your name, address, and date of birth, and stating that you would like to be referred for ADHD assessment. Please note: if you score less than 4 in section A, you are highly unlikely to have significant ADHD and we will not be able to refer you.

If you are diagnosed with ADHD and started on medication, the specialist may write to us to request we take over prescribing under shared care. We will review the request as per the criteria above and make a decision.

Until we have made a decision, please continue to get prescriptions from your specialist.

Please allow 4 weeks for us to receive the request and make a decision.

Private assessment

You may choose to be seen privately for ADHD assessment. Please be advised that we cannot usually ‘share care’ or take over prescribing from a private specialist, so prescriptions are likely to need to continue to come from the specialist until/unless you are seen in the NHS.

2. You have been referred already and not seen yet

If you are on the waiting list for the Oxfordshire NHS ADHD service, you will still be seen. Please note that due to the lack of annual reviews, we will not be able to prescribe for you, and as a result the specialists will most likely not start medication.

They will still assess you, diagnose you if appropriate, and provide advice and support.

If you would like to be referred instead to a ‘Right to Choose’ provider so that you are more likely to have access to medication, please cancel your current referral and see section 1 above.

3.You have been seen and started on ADHD medication by your specialist

Your specialist may write to us once you are stable to ask us to take over prescribing. Please note that we will only be able to do this if you meet all the listed criteria in section 1 – criteria a) through to e).

If any of these are not true, prescriptions will need to continue to come from your specialist. Otherwise, once you have signed and returned the patient agreement form, we will be able to take over prescribing of your ADHD medication.

Private assessment

Please be advised that we cannot usually ‘share care’ or take over prescribing from a private specialist, so prescriptions are likely to need to continue to come from the specialist until/unless you are seen in the NHS.

4.We are already prescribing your ADHD medication

If you have normal physical monitoring tests within the last 6 months (weight, blood pressure and pulse) and have seen a psychiatrist to review your ADHD medication in the last year, we will be able to continue your prescription unless there is an exceptional reason not to.

We expect you to arrange to see a psychiatrist every year, and continue to have physical monitoring every 6 months. If you do not already have a psychiatry review arranged for when it is next due, please arrange this. See above (section 1) for referral via ‘Right to Choose’, ensuring you pick an approved provider that can provide annual medication review. Alternately, for patients for whom we have already been prescribing ADHD medication only, we will accept a private psychiatry review. 

In terms of finding a private psychiatrist, we would recommend checking their details, including their area of specialty, on the medical register at gmc-uk.org, and ensuring that they have the letters MRCPsych (Member of the Royal College of Psychiatrists) or FRCPsych (Fellow of the Royal College of Psychiatrists) after their name, indicating that they are a current member of the Royal College of Psychiatrists (RCPsych).

Non-urgent advice: Please Note

If you go 18 months without psychiatry review of your ADHD medication, or fail to attend for or submit physical monitoring (9 months since the last check), we will contact you to arrange to reduce and stop your prescription for safety reasons.

We may also stop your prescription if it is deemed unsafe due to abnormal physical monitoring or other relevant health conditions.

5.We have to reduce & stop your ADHD medication

We may have to reduce & stop your ADHD medication if we cannot ensure that it is safe to continue. We will arrange this if you go 18 months without psychiatry review of your ADHD medication, or fail to attend for or submit physical monitoring (9 months since the last check).

We may also have to stop your medication if there are safety concerns, for example due to an abnormal blood pressure, pulse, or weight result.

Depending on the concerns, this will usually be done by a gradual reduction, but occasionally we may recommend stopping the medication without a reduction. We will ask you to make an appointment by calling the practice between 1pm and 4pm and asking for the practice manager. You will then be booked a telephone consultation with our prescribing lead GP.

If this has not happened within 1 month of our request, we will start to gradually reduce the dose on your prescription each month until the medication has been stopped. Please consult us during this time if you experience unexpected or intrusive symptoms – book an appointment with any GP. A gradual reduction may not be possible if you are already on the lowest prescribable dose, or if we have significant safety concerns indicating that you should come off medication immediately.

We would like to again express our regret that this is necessary due to lack of access to NHS specialist medication review. Patients should not be left without the care they need due to a lack of comprehensive NHS funding. Our local representatives continue to raise this issue with local funding and decision-making groups. If you feel able to, please voice your concerns to those in a position to change things. You can contact the “planned care team” at the local health board (BOB ICB, email address: bobicb-ox.plannedcare@nhs.net), and/or your MP.

*NICE guideline NG87: https://www.nice.org.uk/guidance/ng87/