ADHD, Right to Choose and Shared Care

We are receiving a high number of requests for a right to choose referral for ADHD diagnosis and subsequent treatment.

We need to update you on the practice position for medication prescribing in these circumstances.

ADHD is a lifelong condition, and managing it effectively requires a comprehensive and trusted assessment and treatment plan. The medications prescribed for ADHD are specialist medications and are controlled drugs, which necessitates specialist reviews. They can be used for many years, and it is crucial to ensure that you receive the right medication, at the right dose, with regular reviews to assess its effectiveness and any potential side effects.

Private providers, including Right to Choose, have much higher positive diagnosis rate for referrals, than when assessed by the NHS. For this reason, the local NHS ADHD service provided by the Cornwall Partnership NHS Trust will not accept a diagnosis from a private or RTC provider; they will instead re-assess themselves.

We feel that if our local service cannot accept a diagnosis from these providers, and would not prescribe without making a further assessment, then in turn we cannot take shared care responsibility for prescribing on their behalf either.

Shared Care is the special circumstance where a specialist medication is required for a patient, that requires the knowledge of a consultant but is issued by the GP. The GP remains responsible for this prescription as the prescriber. In these circumstances this level of care is beyond the scope of primary care, and it is preferred that you receive the appropriate follow-up and specialist support over the years through the local NHS service. General practice is also extreme pressures in terms of capacity and the additional workload that this creates is currently unmanageable.

In summary, this means that while we will refer you via the right to choose framework, if medication is recommended, this would need to be issued via the RTC provider and would not be possible via the NHS from the practice on a shared care basis.

We would therefore recommend and encourage that you use the existing ADHD Cornwall Partnership NHS Foundation Trust referral pathway if your expectation is that you would receive NHS treatment/medication once diagnosed. If you prefer to use an RTC provider, we strongly advice that you choose the provider carefully to ensure they are able to continue to prescribe for you.

This decision will also apply to any new patients joining the practice who may have been engaging with a RTC provider sharing care with their previous practice.

Unfortunately, the provision of ADHD services within the southwest is woefully inadequate. This leaves a significant commissioning gap that us as a surgery and the whole of Cornwall with the numbers of requests for assessments being far greater than the service provided. We feel that this is inadequate and are encouraging patients to contact the complaints department of the integrated care board for Cornwall and the Isles of Scilly (the CIOS ICB). This organisation is responsible for choosing and paying for NHS services within Cornwall.