Shirehampton Group Practice is committed to ensuring safe, evidence-based, and consistent prescribing. To safeguard patients and maintain clinical governance, we will not assume prescribing responsibility for ADHD medications initiated privately, even where a shared care agreement is provided.

Patients will be directed to appropriate NHS pathways for assessment, diagnosis, titration, and prescribing. Shared care prescribing will only be considered once patients have been stabilised by an NHS service and meet the required monitoring standards.

General principles

• We do not accept shared care prescribing requests from private providers for ADHD medications.
• This applies even where a shared care agreement is provided by the private provider.
• All patients are recommended to access ADHD diagnosis and prescribing via NHS pathways.
• If shared care is declined by the GP, prescribing responsibility remains with the initiating specialist.
• The GP will not initiate ADHD medication, adjust doses or switch medication without specialist advice, undertake re-titration following a pause in medication.
• Failure to attend specialist reviews and/or monitoring requests under shared care agreements will result in a suspension in prescribing until specialist review and/or monitoring has taken place.

Why have we restricted ADHD shared care prescribing to NHS / Right to Choose providers only?

• GP practices are under a lot of pressure. As a practice we have decided it is the best interest of our patient population to focus on providing the services that we must offer under the terms of our NHS contract.
• Some specialist medications are only safe for GPs to prescribe under a ‘Shared Care Agreement’ – which includes ADHD treatments.
• GPs do not have to prescribe shared care medications if they feel unable to do so or if they are not able to do this in a safe manner – it is not part of their contract and has always been a core part of the specialist role as per local Avon LMC guidance

New patient registration

• All new patients will be informed at registration that the practice does not take over ADHD prescribing from private providers.
• Where appropriate, patients will be referred as per current guidance either to AWP (Avon and Wiltshire Mental Health Partnership) and/or NHS Right to Choose pathways.

Existing patients/Ongoing ADHD requests

• If clinically appropriate, patients requesting ADHD assessment or treatment are directed to the NHS Right to Choose pathway or local NHS ADHD services.
• If a patient is diagnosed and titrated via an NHS provider, the practice will consider shared care prescribing once the patient is stable.
• Shared care will only continue if patients attend:
  • Annual reviews with the diagnosing psychiatrist, and
  • Six-monthly physical health checks at the practice (blood pressure, weight, pulse).
• Failure to attend these checks will result in cessation of shared care prescribing.

Why do I need to be under the care of an ADHD specialist to continue to access my ADHD medicines?

ADHD medicines must be started and overseen by an ADHD specialist. A GP may be able to take over prescribing ADHD medicines, but only if there is a “shared care agreement” in place between the GP and the ADHD specialist.

A GP is not obliged to agree to share care and/or prescribe shared care medicines for their patient and where the GP declines to enter into a shared care agreement, full responsibility for all elements of the patient’s care remains with their specialist service.

Private ADHD assessments

When patients choose to seek privately funded healthcare, several fundamental principles apply. Please read the following guidance before paying for an ADHD assessment outside the NHS. If you have any questions or concerns, please speak with your GP.

It is important that patients are fully aware of the longer-term implications of privately funding elements of their healthcare, including what to expect once they have paid for and received an assessment and/or diagnosis. This includes an understanding of the limitations of cover provided by any private medical insurance and how ongoing supplies of medication should be obtained.

Important factors to be aware of

• If you wish to receive NHS funded care and treatment for ADHD, you should be assessed and diagnosed in line with NICE guidelines. All NHS funded services will do this automatically. However, if a diagnosis is made through another route, that diagnosis will need to be reassessed and confirmed as NICE compliant before NHS funded care and treatment can begin.
• You have the right to privately fund an ADHD assessment and diagnosis, but this should be on the expectation that everything after that diagnosis – including medication costs – will also be self-funded. Your GP has the right to refuse to prescribe ADHD medication on the NHS if you paid for a private assessment and diagnosis outside of the NHS pathway.
• If you wish to receive NHS funded treatment following a privately funded diagnosis, the diagnosis will still need to be reassessed and confirmed as NICE compliant by the NHS funded service at the point at which you are seen by them. A privately funded diagnosis cannot be used to advance your position on this waiting list, nor can it be used to bypass the assessment stage and progress straight to treatment.
• Please be aware that an NHS clinician cannot be compelled to accept a diagnosis made following a privately funded assessment and may disagree with the diagnosis you have been given.
• Please be aware that a recommendation from a privately funded specialist does not entitle you to NHS prescriptions for that medicine. The NHS clinician will determine the most clinically appropriate treatment for you, taking into account local and national guidelines, as they take personal clinical responsibility for your treatment. The clinician who signs the prescription is legally liable for the prescribing and the consequent effects of that drug