As a practice we are committed to supporting patients with neurodevelopmental diagnoses, both children and adults.
We are writing this to explain the situation with regards to ADHD and Oxfordshire NHS services, whilst being mindful of the distress that the current situation is causing many of our patients. This is a complex area which is often misunderstood. This policy sets out the practice’s policy on acknowledging diagnosis and taking over treatment where requested.
This document is based on national and local guidance, specifically NICE guidance. Attention Deficit Hyperactivity Disorder (ADHD) can affect many aspects of a person’s life. However, diagnosis is complex and requires a specialist, usually a consultant psychiatrist to do this.
GPs (General Practitioners) are not able to make a diagnosis of ADHD and a referral is needed to an ADHD specialist. If an ADHD diagnosis is subsequently made by the specialist, they may choose to offer medications to help manage the symptoms. These medications are potentially dangerous and therefore require careful monitoring.
Adults
The Adult NHS ADHD service in Oxfordshire is provided by Oxford Health NHS Foundation Trust (OHFT), unfortunately they have paused taking new referrals from 5th February 2024, as their current waiting list exceeds three years. As of May 2024, the adult service is assessing patients referred in May 2021 (except for referrals from SEND (Special Education Needs & Disability) services, or patients who have now entered adulthood and are very newly diagnosed by CAMHS (Child and Adolescent Mental Health Service.))
Children
The paediatric NHS ADHD service is also provided by Oxford Health NHS Foundation Trust (OHFT) but referrals are made through the child’s school – teachers / SENCOs (Special Education Needs Co-ordinator).
As of May 2024, the waiting time for assessment was around 6 years.
What should happen
A patient’s GP (or school in the case of a child) should refer the patient to the NHS ADHD service where the patient is assessed.
The NHS ADHD service is commissioned to assess, diagnose, start medication, titrate the medication to the appropriate dose and provide post-diagnostic reviews.
The specialist will also remain responsible for arranging an annual review which includes a review of your ADHD symptoms, your medication, and a physical assessment.
Once an established dose of the appropriate medication has been established, we may take on responsibility for on-going prescribing and monitoring under a “shared care agreement” with the NHS service specialist, however responsibility for prescribing and monitoring remains with the specialist. This SCA is a carefully crafted, well-established and pre-arranged agreement with defined responsibilities for both the NHS specialist and NHS GP. This is essential as it provides the NHS GP with prompt access to a specialist in the event of any concerns or problems.
What is happening now.
We understand that, often in desperation and because of a lack of local NHS provision, patients are seeking assessment from either private providers or “Right to Choose” providers.
Private providers
You need to be aware that should you choose to be referred to a private provider, and a diagnosis is made, we will not be able to prescribe ADHD medication or arrange monitoring. This is because the private providers may not be able to offer the same follow-up or monitoring as NHS specialists. As a practice, we will not enter into a shared care agreement with a private provider. Getting the ADHD medication must all be done through the private provider, and you should check on the costs of ongoing treatment including prescribing and yearly reviews.
Private providers each have their own referral process and you should refer to their websites for more information. We may need information from you in order to complete a referral to a private provider on your behalf. Failure to respond to a request for information about your referral in a timely manner, will result in your referral request being cancelled.
“Right to choose”
Under NHS England’s Right to Choose legislation patients can exercise their right to see any appropriate health service provider.
This provider can be anywhere in England, as long as the provider holds any NHS commissioning contract in England – it does not have to be in Oxfordshire.
In our experience, the Right to Choose provider only offers an assessment/diagnosis (often done remotely) and then discharges the patient back to their NHS GP or tries to enter into a SCA with the GP. This SCA has not been pre-agreed with the GP.
What about a “post-diagnostic review” (PDR) on the NHS?
Oxford Health NHS Foundation Trust is also commissioned to provide PDRs.
A PDR is where patients already diagnosed with ADHD (either privately or abroad) can be referred to the NHS ADHD service for them to take over the prescribing of ADHD medication.
As of May 2024, the waiting list for this is around 3 years for adults and 2 years for children.
This is also a difficult area as there can be complications in these cases which normally arise from the quality of the diagnostic report. It is common for diagnostic reports from other countries to fail to meet the minimum NHS requirements, thus requiring the patient to be re-assessed before consideration of medication.
Where does that leave us?
Whilst some private or Right to Choose specialists try to unilaterally impose a shared care agreement (SCA) on the NHS GP, none have been pre-arranged with Long Furlong Medical Centre.
We believe that without a SCA, patients and GPs alike are left vulnerable. GPs cannot be expected to take on additional medico-legal risk because of a lack of NHS specialist provision, and patients should not be left without the care they need due to a lack of comprehensive NHS funding.
Everyone at Long Furlong Medical Centre is sympathetic to the plight of our patients who have been forced down a private or ‘right-to-choose’ route because of the situation in Oxfordshire.
However, we have all carefully discussed the situation, weighed up the needs of all our patients and concluded that, with regret, we cannot absorb more unfunded work because of the failings of other parts of the NHS service.
To that end, we will not be entering into SCAs, nor taking over the prescribing of ADHD medications, from any private or Right to Choose provider.
We understand that this will be upsetting for those concerned but with the current state of primary care it is an inevitability for which we apologise.
This is our final decision, and further complaints should be made to your Member of Parliament or the BOB (Buckinghamshire, Oxfordshire and Berkshire) ICB ‘planned care team’: bobicb.plannedcare@nhs.net
Everyone at Long Furlong Medical Centre sincerely hope that the local services commissioned to provide ADHD care are improved as soon as possible.